Employment Injury
Employment Injury
EMPLOYMENT INJURY CONTENT
Injury Benefit
To qualify for an injury benefit, the person must be incapable of work as a result of an accident arising out of and in the course of insured employment, or must be incapable of work as a result of a prescribed disease.
How is an Injury Benefit Computed?
The daily rate of injury benefit is 90% of the person’s average insurable weekly earnings, divided by 6.
Average insurable weekly earnings means the earnings on which contributions were based over the relevant quarter. The relevant quarter may be the quarter but one immediately preceding the contribution quarter in which the accident occurred if the insured person had been in the service of the employer for 7 or more contribution weeks; but it may be a later quarter depending on the length of service with the employer in question.
Payment of Injury Benefit
Injury benefit is payable for a period or periods of incapacity for work during the 52 weeks immediately following the relevant accident or of the development of the prescribed disease as the case may be.
Payment is not normally made for the first three days of incapacity for work . These are treated as “waiting days”, as in the case of sickness benefit. However, payment may be made from the first day of incapacity for work if this falls within eight (8) weeks of the end of an earlier period of incapacity for which sickness or injury benefit was payable. Also, as for sickness benefit, payment is made for the waiting days if the incapacity for work lasts for two (2) or more weeks.
Disablement Benefit and Grant
To qualify for disablement benefit, a person must be suffering from a loss of physical or mental faculty as a result of an employment accident or a prescribed disease which arose out of or in the course of employment. This benefit is not available to an insured person until at least three (3) days have passed after the relevant accident.
If a person has been off work as a result of an employment injury or a prescribed disease, he may qualify for disablement benefit after 52 weeks from the date of the relevant accident or after he has ceased to receive injury benefit, whichever event occurs first.
Disablement Benefits payments maybe increased as a result of Employment Injury (E.I.) calculations.
How is Disablement Benefit Computed?
The disablement benefit payable is calculated by reference to the percentage loss of faculty suffered, the weekly amount of benefit payable or would have been payable as injury benefit, and the length of time disablement is assessed to last. For example, a total loss of sight, according to the schedule of prescribed degrees of disablement constitutes 100% disablement and the disablement benefit payable in such a case would be at the same rate as injury benefit, that is, 90% of average insurable weekly earnings. Benefit in respect of disablement of under 100% would be proportionately less.
How to Assess the Degrees of Disablement
Assessment of degree of disablement is made by a medical authority after examination of the claimant. The assessment may be provisional or final depending on whether or not the condition of the person has stabilized.
If the degree of disablement suffered is less than 1%, the claimant is deemed not to have suffered disablement.
Where the degree of disablement is assessed at 30% or more, disablement benefit is payable in the form ofa weekly disablement pension. Payment for assessment of less than 30% is made in the form of a lump sum disablement grant. If the disablement is permanent (e.g. loss of an arm) pension will be payable for life, but if the loss of faculty is temporary, it is payable for a limited period only.
When a person receiving disablement benefit for an assessment of less than 100% enters hospital for treatment of the injury or disease, or becomes incapable of work as a result of the injury or disease within five (5) years from the date of the accident or development of the disease, the disablement benefit is increased to an amount which would be payable if the assessment were 100%.
Constant Attendance Allowance
An additional allowance (known as “a constant attendance allowance”) may be paid to an injured person whose disablement is 100% and who requires the constant help of another person. This allowance is equal to one-half of the disablement pension.
Medical Expenses
A person qualifies for a refund of expenses incurred in the treatment of an employment injury or a prescribed disease.
Payments are made in respect of:
- Medical, surgical, dental and hospital treatment, skilled nursing services and the supply of medicines;
- The supply, fitting, maintenance, repair and renewal of artificial limbs, dentures, spectacles and otherapparatus and appliances;
- The cost of travelling for the purpose of obtaining any of the above.
The Payment of Medical Expenses
For medical expenses to be paid:
The expenses must be reasonable and reasonably incurred;
The expenses must relate to obtaining treatment which is so provided as to secure maximum effectiveness at minimum reasonable cost;
The fees or charges constituting the medical expenses must not be more than would be properly and reasonably charged to the insured person if he/she were paying them him/herself.
The amount of fees and charges which may be refunded as medical expenses is determined by the Director. Where it is considered desirable, the National Insurance Board may pay the medical expenses incurred to the medical practitioner or institution from whom or at which the person obtained treatment.
Important Note: If travelling overseas for medical treatment this information along with supporting evidence from the medical practitioner or institution must be sent to the National Insurance Office. Failure to do so may result in the claim being restricted to $1,000.
Funeral Grant
To qualify for a Funeral Grant, death must have resulted from personal injury caused by accident arising out of and in the course of employment, or from a prescribed disease.
Amount Payable as a Funeral Grant
The amount of a funeral grant is currently $2,185. The grant is payable to the person who has met or is liable to meet the cost of the funeral of the deceased.
The amount of fees and charges which may be refunded as medical expenses is determined by the Director. Where it is considered desirable, the National Insurance Board may pay the medical expenses incurred to the medical practitioner or institution from whom or at which the person obtained treatment.
Important Note: If travelling overseas for medical treatment this information along with supporting evidence from the medical practitioner or institution must be sent to the National Insurance Office. Failure to do so may result in the claim being restricted to $1,000.
Death Benefit
Death benefit is payable to the dependents of a person who dies as a result of an employment accident or a prescribed disease, in the following order of priority.
- Where the deceased is survived by a spouse who was wholly or mainly maintained by the deceased at the time of death;
- All unmarried children, including adopted children and step-children of the deceased who, at the time of death were living with or were wholly or mainly maintained by the deceased;
Any other person, including a spouse or children not qualifying under (i) or (ii) adjudged by the Directorto have been wholly or in part dependent upon the earnings of the deceased.
In the case of (i), benefit is payable for life; in the case of (ii), it is payable until the children concerned reach their sixteenth birthday. However, if the child is in full time education in an approved educational institution, the benefit is payable until that child attains the age of 25 years. In the case of invalid children, this benefit may continue beyond the sixteenth birthday and for so long as invalidity lasts; in the case of (iii) it is payable for a maximum of 52 weeks commencing from the date of death of the deceased.
When does Death Benefit Cease?
This benefit ceases if the beneficiary marries or remarries as the case may be or cohabits as the spouse of another person.
Where a death benefit payable to a spouse ceases because of remarriage or cohabitation, that person is entitled to a gratuity equal to a year’s pension.
In the case of invalid children, benefit may continue beyond the sixteenth birthday and for so long as invalidity lasts.
How is Death Benefit Computed?
The Death Benefit available for distribution to dependents is equivalent to the weekly amount of disablement pension which would have been payable to the deceased person had he been alive and 100% disabled.
A widow/widower receives one-half of the amount which would have been payable. A common-law spouse may be treated as a widow/widower where no legal spouse exists.
Children receive each one-sixth (1/6) of the amount which would have been payable; however, a child who is an orphan or an invalid may receive one-third (1/3).
Other dependents receive one-sixth (1/6), but the amount may be fixed at one-half (1 /2) of the available pension in certain circumstances.