Benefits Resources List

Sickness

Injury Benefit

Invalidity Pension

Appeals

Maternity

Retirement

Survivors

Funeral

Disablement

 

Sickness Benefit

This gives general information on Sickness Benefit provided by the Turks and Caicos Islands National Insurance Board.  For more specific information about your case please contact an office of the National Insurance Board nearest you.


Who Can Receive Sickness Benefit

Sickness Benefit can be paid to an insured employed person between the ages of 16 and 65 years (with the exception of a public officer) who is found to be incapable of work as a result of some specific disease, or bodily or mental illness and satisfies the necessary contribution conditions.



What Are The Contribution Conditions For The Payment Of Sickness Benefit?

To qualify for Sickness Benefit, an employee or self-employed person

  • must have paid at least 26 contributions into the National Insurance Board;
  • must have paid at least 8 contributions in the first 13 weeks of the last 26 weeks just before the week in which he/she became ill and could not work;
  • must have worked immediately before the first day that he/she became ill.


When To Apply

You should apply within 6 days of becoming ill.   If the claim is submitted late, sickness benefit will be paid in arrears for six days from the date that the claim is submitted.   In exceptional cases, however, where the claimant can prove that there is good cause for claiming late, the period of 6 days may be extended to 13 weeks.  If your illness does not extend beyond three days, you are not entitled to a Sickness Benefit and therefore should not apply.


How To Apply

You can apply by first collecting a Sickness Benefit application form from the National Insurance Board's office.  Complete the application form  (we will need information from you and your employer) and return it to the Board's office along with a medical certificate from your doctor, therapist, hospital or clinic. 


What Is The Payment Period For Sickness Benefit?


Sickness Benefit is payable after the third consecutive day of your illness e.g. if you are sick for 4 days, sickness benefit is payable for one (1) day only. As from the 4th day, sickness benefit will be paid for each day that you are ill (excluding Sundays) and unable to work.  Sickness Benefit may continue for up to a maximum of 156 days.



How Much Is Sickness Benefit?


How much you can receive from the National Insurance Board depends on your average weekly earnings over a specified period.    That means the higher the earnings, the higher the benefit will be.  The weekly rate of Sickness Benefit is 60% of your average weekly earnings.  It is calculated on the average weekly earnings paid or credited on your behalf during the first 13 weeks of the last 26 weeks immediately before you became ill.   The daily rate of Sickness Benefit is 1/6th of the weekly rate.



How Is Payment Made?


Sickness Benefit schedules are prepared for beneficiaries on a weekly basis. Schedules can be collected at a convenient National Insurance Board office and must be cashed within 6 months from the date of issue.  If you prefer, you can include the name of your bank along with your current or savings account number and your benefit will be directly deposited.



Under What Conditions Is The Beneficiary Disqualified From Receiving Sickness Benefit?


The beneficiary is disqualified from receiving Sickness Benefit up to 6 weeks if:

  • he has become incapable of work through his own misconduct;
  • he fails to obtain a medical examination or take the prescribed treatment;
  • he behaves in a manner that will retard his recovery; or
  • performs remunerative work.


Duplicate Rights


When an insured person is entitled to two or more benefits paid at the same time, he/she will be entitled to receive the benefit which is payable at the highest rate.

 

If You Disagree With A Decision We Have Made


The Director decides claims for benefits.  If there is a decision to disallow your claim for Sickness Benefit, a letter explaining the decision will be sent to you.  If you disagree with the decision you may appeal to an Appeals Tribunal within 21 days from the date of the decision; in this way you will be asking for a review of your specific case.  If the decision was wrong, it will be changed.  If you are dissatisfied with the decision of the Appeals Tribunal, a further appeal can be taken to the Supreme Court, but on a point of law only.
Claimants with questions about Sickness Benefit should contact the nearest Board office.  Board offices are open to the public from 9:00 a.m. to 4:30 p.m., Monday through Friday. 

 

Injury Benefit

If you have had an on-the-job injury or are suffering from a disease that arose out of or occurred during the course of your employment, which prevents you from working, then you may be entitled to Injury Benefit. This booklet gives information on benefits provided under the National Insurance Scheme for accidents and occupational diseases. If more specific information about your case is needed, please contact any office of the National Insurance Board.


What Do We Mean By "Accident"?


Accident means an "industrial accident" arising out of and during the course of the employment of an insured person and includes an accident involving an employed person while traveling to or from the insured person's work place.
Also, an accident involving an employed person on or about any premises at which he or she is employed is considered to have arisen out of and in the course of his employment if it happens while he is taking steps onto an actual or supposed emergency at those premises, to rescue, aid or protect persons who are thought to be injured or in danger, or to prevent or minimize serious damage to property.


What Do We Mean By "Occupational Disease"?


Occupational Disease means a disease prescribed by the National Insurance Legislation in the Schedule of Diseases. The schedule describes the diseases and the occupations for which the disease is prescribed. The fact that an insured person suffers from a disease prescribed in the Schedule of Diseases does not give the insured person the right to benefits for an occupational disease. The insured person must prove that he or she worked in an occupation which is prescribed by the legislation as causing the disease.


What Benefits Are Available For Accidents And Occupational Diseases?


One or more of the following benefits may be paid as a result of an industrial accident:
Injury Benefit
Disablement Benefit
Constant Attendance Allowance
Death Benefit
Death Grant
In addition, medical treatment is provided at the expense of the Scheme.

1. Injury Benefit


WHO CAN RECEIVE EMPLOYMENT INJURY BENEFIT
Injury Benefit may be payable if an injured insured person has been certified by a Government Medical Doctor as being unable to work as a result of:
a. A personal injury suffered by an accident arising out of, and in the course of his or her job; or
b. A "prescribed disease" caused by the type of work he or she was employed to do.

WHAT ARE THE CONTRIBUTION CONDITIONS FOR PAYMENT OF INJURY BENEFIT
Unlike other benefits, there are no contribution conditions for Employment Injury Benefit; this is because you may be injured on the very first day of work.

WHEN TO APPLY
You should apply within 6 days of the date of the accident or no later than 6 days from the date the Government Medical Doctor certified that you had developed a disease arising from your job. In exceptional cases, late claims may be considered based on the reason given, in which case the period of 6 days may be extended to 13 weeks. Please note, however, that if your injury does not extend beyond three days, you are not entitled to an Injury Benefit, and therefore should not apply.

HOW TO CLAIM INJURY BENEFIT
You must apply by completing Part 1 of the form "Claim For Injury Benefit" and your employer completing Part II of the claim form before it is submitted. If you are unable to complete Part I, another person may help you. Injury Benefit forms can be collected at all National Insurance offices.
We will need certain information in order to process your application. The information includes:

  • the injured person's National Insurance Number.
  • a signed medical certificate from a Government Medical Officer stating the nature of the incapacity and the number of days you are unable to work.

HOW MUCH IS INJURY BENEFIT
How much you can receive from the National Insurance Board depends on your average weekly insurable earnings. This means the higher the earnings, the higher the benefit will be. The weekly rate of Injury Benefit is 60% of your average weekly earnings. The daily rate of Injury Benefit is 1/6th of the weekly amount. (Sundays are not included).

WHAT IS THE PAYMENT PERIOD FOR INJURY BENEFIT
Injury Benefit is payable after the 3rd consecutive day of your injury e.g. if your injury resulted in your being away from work for 5 days, Injury Benefit is payable for two (2) days only. As from the 4th day, Injury Benefit will be paid for each day (excluding Sundays) that you are ill and unable to work. Injury Benefit may continue for up to a maximum of 12 months (365 payable days).

HOW IS PAYMENT MADE
Injury Benefit schedules are prepared for beneficiaries on a biweekly basis (every two weeks). Schedules can be collected at a convenient National Insurance Board office and must be cashed within 6 months from the date of issue. If you prefer, you can include the name of your bank along with your current or savings account number, and your benefit will be directly deposited.

AWARD OF CREDITED CONTRIBUTIONS
For each full week (Monday thru Saturday) that your receive Injury Benefit, you are not required to pay a contribution. Instead, National Insurance will add (or credit) contribution/s to your records. These credited contributions should help you to receive future benefit payments. Note: If an accident happens while you are working, report as soon as possible, all details of the accident to your employer, or to someone in authority. If you are unable to do so, have someone report it for you. Even if the accident does not seem serious at the time, make sure it is reported. Some accidents prove to be serious later on. Your employer is required by law to keep a book in which a record of all accidents are kept.

 

2. Disablement Benefit


This section of the booklet describes the National Insurance Board Disability Benefits. It focuses on benefits for people who have worked or earned sufficient National Insurance credits to qualify for disability. Disability Benefit is one of the most complicated of all the National Insurance benefits; therefore, this booklet may not cover, in depth, all the particulars of the benefit. We recommend that you call or visit one of our offices if you have any additional questions or queries.

WHAT DO WE MEAN BY "DISABILITY"
The National Insurance Board's definition of disability refers to all disabilities that the claimant would be expected to have that will permanently keep him or her from leading a normal life and occurred as a result of a physical or mental condition arising from an industrial accident or some work related illness. All injuries may not lead to 100% disability. For example, there may be a person who, due to an industrial accident, loses two limbs, in which case he or she will be considered 100% disabled; whilst someone might lose hearing in one ear and be considered 20% disabled. Because there are different degrees of disabilities, Disablement Benefit is paid based on the severity of the disability and will only be paid if the degree of disability is more than 10%.

HOW DO YOU QUALIFY FOR DISABLEMENT BENEFIT
There are two types of Disablement Benefits:

  • Disablement Pension and
  • Disablement Grant.

The Medical Board certifies disability and allocates a certain percentage from 1-100% based on its assessment of the disablement. If the claimant's disability is greater than 10% but less than 20%, the Disablement Benefit will be a single lump-sum payment known as Disablement Grant. If the disability is 20% or more, you will be paid a monthly Disablement Pension.

HOW MUCH IS THE DISABLEMENT GRANT
The amount of disablement grant will be equal to: 220 x Average Weekly Insurable Earnings x Degree of Disablement.

WHEN DOES YOUR DISABILITY PENSION START
Disability Pension can begin at any time after the 3rd day following the day in which the employment accident occurred. In most cases, however, the claimant receives Injury Benefit during the period his or her injuries are being assessed by the Medical Board. Injury Benefit ceases when a decision is made on the degree of disability. From such time the claimant will receive Disablement Benefit.

HOW MUCH WILL YOU RECEIVE
You can obtain a personalized estimate of benefits due you from the Benefit/Records Department of the National Insurance Board. There are also tables available which give the degree of disability prescribed for certain accidents. The general rate is calculated as follows:

Degree of Disability

Disablement Pension

(1) 100%

60% of average weekly insurable earnings

(2) 20% or more, but less than 100%

The weekly rate of disablement pension will be calculated in proportion to the degree of disablement.

A beneficiary of Disablement Pension who ordinarily receives less than 60% of his or her weekly insurable earnings will be entitled to 60% of average weekly earnings if:

1. he or she is receiving approved hospital or treatment related to the accident;
2. he or she is attending a course of full-time occupational training or rehabilitation;
3. he or she is deemed permanently incapable of work as a result of his or her disablement.

AWARD OF CREDITED CONTRIBUTIONS
For each full week (Monday thru Saturday) that you receive Disablement Pension assessed at 100%, you are not required to pay a contribution. Instead, National Insurance will add (or credit) contributions to your records. These credited contributions should help you to receive future benefit payments.

SUCCESSIVE ACCIDENTS
If you suffer personal injury as a result of an accident on your job and then suffer personal injury as a result of another accident on the job, you will again be entitled to receive Injury Benefit or Disablement Benefit. However, the total amount payable will not be more than 60% of your average weekly insurable earnings.

DUPLICATE RIGHTS
You will not for the same period be entitled to receive Injury Benefit and Disablement Pension but will receive the benefit which is payable at the higher rate.

3. Constant Attendance Allowance


If you are 100% disabled and require the constant personal attendance of another person, you may qualify for a Constant Attendance Allowance which is fifty dollars ($50) per week once it is determined by the Director that you are entitled to the allowance.


4. Medical Treatment


If you are injured on the job, you will be provided with medical treatment at a Government hospital or clinic. National Insurance will pay all the expenses. Medical Treatment includes the following:
a. Medical, surgical and dental treatment (including specialist care as an inpatient or outpatient) at Government hospitals, clinics and other similar institutions;
b. Supply, maintenance, repair and renewal of dental appliances; spectacles, artificial limbs and other appliances; and
c. Essential medicines prescribed by a doctor. At the time of the accident your employer should arrange your transportation from the place of injury to the nearest Government hospital or clinic.
The National Insurance Board will reimburse you for reasonable traveling expenses with regard to the particular employment injury. Receipts must be sent to the National Insurance Board.

DISQUALIFICATION FOR INJURY BENEFIT AND DISABLEMENT BENEFIT
A person will be disqualified from receiving Injury Benefit or Disablement Pension for such period not exceeding six weeks as the Director may direct, if:

a. after the Director has required him to submit himself to medical or other examination or to medical treatment, he refuses or fails without good cause to follow the instructions of the Director;
b. he or she refuses or fails without good cause to follow the instructions of the medical authority;
c. he or she works on a day for which the Injury Benefit was claimed;
d. he or she behaves in a manner likely to retard recovery; or
e. he or she fails without good cause to attend vocational training or a rehabilitation course after the Director has required him to attend.
A person may be disqualified for receiving any benefit for any period during which he is undergoing imprisonment. However, if he wholly supported a wife and children, an amount not exceeding one half of the amount of benefit may be allowed.

Death Benefit


Note: If your death is a result of an injury or disease arising out of your job, your dependents will receive Death Benefit, which is similar to Survivors' Benefit except it includes a Parent's Pension referred to as Parent's Death Benefit. A Parent's Death Benefit is paid if the parent shows to the satisfaction of the Director that he or she was wholly and mainly maintained by the relevant person at the time of his death. (See separate booklet, "Survivors' Benefits")

Death Grant


Death Grant is payable in respect of the death of:
1. an employed person who dies as a result of an accident or occupational disease; or
2. a person who at the date of death was entitled to death benefit; or
3. a dependent of a person entitled to death benefit.

APPEALS
If your claim is disallowed, you may appeal the decision within 21 days to an Appeals Tribunal. If we are wrong, the decision will be changed. However, if you are dissatisfied with the decision of the Appeals Tribunal, you may take your case to the Supreme Court on a point of law only.
Please Note: This information provides a general overview only of the National Insurance Board's Employment Injury Benefits. It is not intended to cover all provisions of the law. For more specific information, write, visit or contact the National Insurance Board.

 

Invalidity Pension

What We Mean By "INVALIDITY"?


It is very important to understand how the National Insurance Board defines "invalidity."  Invalidity under the National Insurance Scheme is based on your inability to work.  You will be considered for Invalidity Pension if you cannot do the work you did before, and if you cannot adjust to other work because of a specific disease or bodily or mental disablement, which is likely to be permanent.  An insured person claiming for Invalidity Pension must have been deemed incapable of work at least 26 weeks prior to the week in which the benefit is claimed.


Who Can Get Invalidity Pensions


Invalidity Pension can be paid to any insured person between the age of 16 and 60,who becomes an invalid and satisfies the necessary contribution conditions. An insured person can receive Invalidity Pension benefit until age 60.  When he or she reaches 60, the Invalidity Pension automatically converts to Retirement Pension, but the amount remains the same.

What Are The Contribution Conditions For The Payment Of Invalidity Pensions


To qualify for Invalidity Pension, the contribution conditions are:

  • that the insured person has paid at least 150 contributions into the scheme;
  • that he or she has at least 60 contributions or credits in the last 3 consecutive contribution years in which he or she became an invalid; and
  • that he or she has 8 contributions or credits in the first 13 weeks of the last 26 weeks immediately before the week in which incapacity leading to permanent incapacity commenced.

How Much Is Invalidity Pension


The weekly rate of Invalidity Pension payable to an insured person who has paid a total of 500 contributions or credits is 30% of his or her average weekly earnings and will increase based on the amount of contributions paid in excess of 500 contributions.
Here is how Invalidity Pension is calculated:
Step 1 - We use the last three (3) contribution years to calculate your average weekly earnings.

Step 2 - To find your average weekly earnings, we add the earnings for the three (3) years in step1 and divide the total by the number of weeks for which contributions were paid for that period.

Step 3 - We multiply your average earnings by 30%.
As pension cheques are paid on a monthly basis, we convert the weekly benefit to monthly by multiplying the weekly rate by 52 and dividing the result by 12.


Supplementary Benefit


If upon calculating Invalidity Pension we find that you have more than 500 contributions, the initial pension rate of 30% of your average weekly earnings may increase up to a maximum of 60%.  The initial pension rate plus the supplement will be calculated as follows:
For every 50 contributions above the initial 500, the pension will increase by 2%, up to 750 contributions.  For example, if you have 750 contributions, your pension would be 40% of your average weekly earnings; this is calculated as follows:

1.    (750-500) ¸50 = 5
2.     5 x 2% = 10%
3.    30% + 10% = 40%

For every 50 contributions above 750, the pension will increase by 1%.  However, no matter how many units of 50 contributions you have above 750, the maximum Invalidity Pension amount is fixed at 60% of the average earnings.   If you have 950 contributions, your calculation will be as follows:

1.   750 = 40%
2.     (950 - 750)÷50 = 4
3.     4 x 1% = 4%
4.     40% + 4% = 44%

Minimum Invalidity Pension


If after having done our calculations, we find that your weekly Invalidity Pension is less than $50 you will be awarded the minimum Invalidity Pension, which is $62.30 per week or $270.00 per month.

Special Credits


When an insured person satisfies the contribution conditions for Invalidity Pension he or she shall be credited with a contribution for every contribution week falling in the period between the week of invalidity and the week just before he or she reaches the age of 60. These special credits are taken into account only for the purpose of assessing the amount of Invalidity Pension.

How Do You Apply


You can claim Invalidity Pension by completing and submitting an Invalidity Pension application form, which can be collected at the nearest Board's office.  When you apply for Invalidity Pension we will need certain information to process your application.  The information required includes:

  • your National Insurance number
  • your birth certificate or passport;
  • names, addresses, and telephone numbers of doctors, hospitals, clinics and institutions that treated you to date and dates of treatment;
  • a report from your doctors, therapists, hospitals and clinics; and
  • a summary of where you worked and the type of work you did.


What Is The Time Limit For Claiming Invalidity Pension


Claims for Invalidity Pension must be submitted within 3 months from the date of which the claimant becomes entitled to the pension.  If a claim is submitted late, Invalidity Pension can be paid 3 months in arrears from the date of the claim.  In exceptional cases the period of 3 months may be extended to 6 months if the claimant can prove that there was good cause for the delay in claiming. 

How Is Payment Made


Invalidity Pension cheques are prepared for beneficiaries on a monthly basis.  Cheques can be collected at a convenient National Insurance Board office and must be cashed within 6 months from the date of issue.  We are encouraging new claimants to submit the name of their bank along with their current or savings account number so that benefits can be deposited directly to their bank account.  The procedure is simple and safe and eliminates the need to collect your cheque at the Board's office and then take it to the bank to be cashed.



DUPLICATE RIGHTS
Where an insured person is entitled to two (2) or more benefits paid periodically at the same time, he or she will receive the benefit payable at the highest rate.


Appeals


Whenever a decision is made concerning your benefit, we will send you a letter explaining our decision.  If you disagree with our decision, you can ask for your case to be reviewed and an Appeals Tribunal will hear your case.  If our decision was wrong, we will change it.  However, if you are still dissatisfied with our decision, you may take the grievance to the Supreme Court, but only on a point of law.



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