LTIA is a benefit for people with long-term ill-health or an injury. Many people start claiming LTIA when their Short Term Incapacity Allowance (STIA) ends after the maximum period of 364 days or because they want to claim incapacity benefit and work.
LTIA and STIA are very different benefits. The main differences are:
- STIA is a short-term benefit which we can only pay up to 364 days
- in some cases, LTIA can be claimed for many years
- LTIA is based on the effects of your illness or injury, not whether or not you can work or your financial circumstances
- you’ll only get the same amount of LTIA as maximum STIA if you are given a LTIA 100% award
- you can claim LTIA and work, unlike STIA
- LTIA is based on a medical assessment by a doctor at Employment, Social Security and Housing, not medical certificates
- not all LTIA awards include Social Security contribution credits
If you don’t agree with our decision about LTIA or you don’t understand it
If you've applied for, or are claiming LTIA, and you think our decision is wrong, you can:
1. Ask us to explain our decision to you. You can call us, email, write a letter or come into the Customer Hub to discuss your claim.
2. If you’re unhappy with this explanation, (or if you prefer), you have 21 days from the date you receive the decision letter to ask us to reconsider your claim and check our calculations. This is called a redetermination.
3. If you're unhappy with the result of your redetermination, you can appeal to an independent tribunal. You have 14 days from the date you receive your redetermination award or decision letter to submit your appeal.
If you have an appeal or redetermination, your award could go up, stay the same, or go down.
Different types of decisions
If you receive a decision from us in writing about LTIA, it’s usually because:
- you’ve been awarded LTIA after submitting a claim (including a level of award and dates)
- your claim for LTIA has not been approved or you are awarded less than 5%
- you’ve had a change of circumstances which affects your benefit
- you’ve been told to pay money back
- you’re receiving another benefit which affects your LTIA
- your LTIA award changes after a medical assessment review, or doesn’t change
If our decision is based on your contribution record, you don’t have the right to a redetermination or to appeal to an independent tribunal.
If your circumstances have changed since our decision
You can’t appeal or ask for a redetermination if your circumstances have changed since your award. The doctors who carry out our medical assessments or the tribunal will not consider any changes to your circumstances that happened after we made our decision that you are appealing against.
Contact us straight away if your circumstances change, as you may need to claim again or to have a new medical assessment.
Asking us to reconsider our decision
Asking us to reconsider our decision is called a redetermination. You must ask us within 21 days of receiving the letter or email that contains the decision. When we receive your request for a redetermination we’ll write to you to confirm the next steps.
You should:
- let us know if there is a special circumstance which means you can’t contact us or supply evidence within 21 days
- give us additional evidence about your illness or injury that you didn’t give us for your first medical assessment
- explain why you think we have got it wrong
Once you have asked for a redetermination, we’ll get a second opinion from a doctor who was not involved with the original decision. You’ll need to attend a new medical assessment appointment. They’ll look at any evidence you have sent.
If we agree, we’ll send you a letter to confirm your new award. Any benefit you are awarded will be back-dated to the date of the original decision.
If we think our original decision was correct, we’ll send you a letter to confirm this.
If you don’t agree with this decision from your redetermination, you have 14 days to appeal against it to an independent tribunal.
Appealing to an independent tribunal
You have 14 days from the day you receive the redetermination decision letter to appeal to an independent tribunal. You cannot appeal to an independent tribunal if you have not first had a redetermination.
To appeal to an independent tribunal, complete and submit the appeal form to the Registrar of Appeals at the address on the form.
The independent tribunal will look at:
- the evidence
- the law
- your circumstances at the time the officer made the decision you are appealing against
The appeal process with the Registrar of Appeals
The Registrar of Appeals will tell us you have appealed our decision. They'll forward any documents you have submitted in support of your appeal.
We may contact you to explain the decision in more detail. If you accept the explanation, you can choose not to continue with your appeal.
If you want to continue with your appeal and you’ve submitted new information to the Registrar of Appeals, we might look at the decision again (even if we have already done so).
We’ll let you know if we make a new decision, and tell you how this may affect your appeal.
If your case goes to the Tribunal, you’ll have to present your case to a panel of tribunal members who are appointed by the States of Jersey. The tribunal members are completely independent from Employment, Social Security and Housing.
Tribunals for LTIA have a legally qualified chairman to help apply the law to your appeal and two doctors to consider the medical evidence.
Once the tribunal has made their decision, you’ll be sent a written explanation of the decision. A copy will also be sent to us at Employment, Social Security and Housing.
If your appeal is successful
If your appeal is successful, we’ll usually carry out the tribunal’s decision as soon as we receive a written copy of it.
Situations where your appeal won’t succeed
There are some situations where it’s not possible for your appeal to succeed, such as:
- if you think your award should be more than 100%
- if you are appealing because you disagree with the legislation or States policy
- if the decision you want can only be reached if the tribunal goes against legislation
- if you’re appealing because your circumstances have changed after the decision was made
If we think your appeal won’t succeed, we’ll ask the chairman of the tribunal for a decision. If they agree, the chairman will write to you to let you know. Your appeal will then be closed unless you write to the Registrar of Appeals within 14 days from the day you receive the chairman’s letter to renew your appeal.
If you renew your appeal, it will continue to the Tribunal even if it can’t succeed.
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