ESA and Income Protection Insurance

Its not so much that claiming Incap/ESA is a condition of the insurance, but rather that a failure to meet the criteria of either would be an in-road for the insurance company to question your claim. Its not explicit in the policy wording that claiming Incap is mandatory but it is the first question on the review form. Given that the policy wording predates ESA's introduction (and the split division of WRAG and Support groups) I imagine a lawyer could argue the point if a person chose to stop claiming ESA as it was too harrowing a process these days (given the income from insurance would remain). When you already have a health problem, dealing the demands of lawyers, tribunals and court cases is a tough call.

Hi,

I know exactly what you must be going through as my friend is in an identical position to yours.

I will tell you what i told her.

That is, if your insurers' criteria is different to DWP'S, then DWP reports and assessments should have no bearing whatsoever on your PHI claim if your personal circumstances have not changed.

This would/can be proved by your GP's/ Specialists reports,so personally, i cannot see under what grounds payments could stop just because of a WRAG assessment has been made.

Furthermore, you are only obliged to tell your insurers if you are recieving DWP payments as this will effect your own insurance payments, and nothing else. If your payments stop then you inform them, without going into any details and then wait for them to contact you.

Hope this helped.

Radhika.

Hi, I also receive phi and IB, my phi is paid for and provided by my employer, and i have been receiving both since 2005. After my assessment when I was declared fit to work I appealed and am still awaiting my tribunal, in the meantime i have done a lot of digging. I am finding one major problem, the IB rules specifically included entitlement for those of us who were employed, to receive IB, and indeed most PHI schemes seemed to take this into their income calculation ie a % salary less IB. Unfortunately having been through the legislation this very important sentence does not appear to be embodied in the new ESA rules. I had a very confusing letter from DWP after contacting my MP for clarification on this point, which seemed to say try to get it at tribunal, but ESA is not intended to help those of us who are employed, so he sentence appears to be deliberately missing and we are one of the many groups who stand to lose out. I do know of one person in my position who won on appeal, but it cannot be guaranteed that even if we win at tribunal we will be granted ESA. the double whammie then kicks in, legal advice i received seems to say that as IB existed when my PHI payments first started, then just because they have been replaced by ESA to which we are no longer eligible that is our problem and the insurers are under no obligation to cover my loss of IB/ESA. I have yet to follow up on whether because my contract is with my employer and not with the insurer whether I can insist my employer makes up any deficit as a result of the loss of IB/ESA. All i know is it seems to be a minefield, and we seem to be a nice little group to take benefit from. I have absolutely no fear that the insurance will stop as they use different criteria (I'm also own occupation) what is more alarming is the potential total loss of IB/ESA income under the new rules which seems to have been overlooked.

Well i have my Work focused interview next week so god only knows what they will come up with, it makes no sense at all to attend a WFI when you have been forced to give up a well paid bloody good job you enjoyed due to illness,what's the point in even discussing it, if your too ill to work your too ill.
Now that IB has gone it appears that when it comes to ESA the reports previously submitted by the medical professionals stating that you are unfit for any work now mean nothing, regardless if they were accepted over the past years. Just because of the change to ESA do they honestly believe your cured?
sorry for the rant i know it's not helping anyone but seriously don't know how much more of this stress i can handle, were has all the common sense gone in this country .

Hi
Can i just ask, if you are getting PHI under your employers scheme, does it mean that you are still technically employed by them and are on "sick leave" that their insurers are paying you for???

If that is the case,and for whatever reason you stopped getting ESA,can you not insist that your employers make up the difference as it is not your fault that there is a change in legislation and if IB no longer exists and you are no longer getting it then your insurers cannot deduct it!!!!You might have a case of mis-selling you a PHI policy???

So,technically, your insurers should stop taking out the IB deductions, unless they are taking them out rgardless of you getting IB or not as years ago one would have been entitled to IB during sickness.

As for ESA if it is not mentioned in your policy, then it should have no bearing as say for example you did get it(ESA CR)and fell under the 12 month rule and thereafter could not claim ESA (IR)due to you having savings etc and still was unfit for work, surely your insurers cannot penalise you for having savings!!!!

Alot of these PHI policies were written at the time of the IB rules. It will be very interesting to see how many try it on with the ESA.

Have you contacted the insurance ombudsman, as they should be able to give you some advise!!!

All the best.

Radhika.

I'm also interested in this area. Essentially, are you asking generally whether anyone who is still employed but who is on sick leave can receive ESA? Or is it specifically about people who are still employed but on sick leave and also getting PHI? If you let me know what is the IB regulation you refer to which specifically allowed this which may be missing from the ESA regs I can have a look.

Purdiepoodle wrote:

Hi, I also receive phi and IB, my phi is paid for and provided by my employer, and i have been receiving both since 2005. After my assessment when I was declared fit to work I appealed and am still awaiting my tribunal, in the meantime i have done a lot of digging. I am finding one major problem, the IB rules specifically included entitlement for those of us who were employed, to receive IB, and indeed most PHI schemes seemed to take this into their income calculation ie a % salary less IB. Unfortunately having been through the legislation this very important sentence does not appear to be embodied in the new ESA rules.