ESA contribution based with PHI do I qualify?

[Mark-s]

Hi

I am a disabled person with a Company Permenant Health Insurance policy, premiums paid by the company . This is paid throgh my salary payslip, tax and nics taken at source. The polcy pays 70 percent of my salary with a reduction taken out to reflect any benefits I get. I was on IB and was transferred onto ESA support group back in April 2013. The problem is that I have been called in by the Fraud department of the DWP for alleged fraud with an interview under caution regrding my ESA a very frightening experience on Friday this week

. I have not committed any fraud, filled in the forms correctly ,disclosed everything and am genuinely ill and disabled I lost the use of my right hand side due to a malignant brain tumour and am still being treated. I can only think that it is something to do with my PHI. Please help,has anyone else had this problem? This is obviously very distressing.I rely on the ESA and DLA to manage, sorry for the length of this post. Please help.

[honeybee13]

Hello and welcome to CAG, Mark-s.

 

I was in a similar position to you, I had company PHI and IB and it was fine. I'm not really up to speed on PHI and ESA, but we have people who are and I hope they will see your thread.

 

You have between now and Friday to organise your arguments and I expect the guys will help you. Please bear with us until they're able to get here, I know some are night owls.

 

I'll keep an eye on your thread.

 

My best, HB

[Mark-s]

Thanks HB I do hope so, as you would expect it is very upsetting to be accused of something when you have followed the rules...await all the help I can get.

[Mark-s]

Hi

I am in the process of sorting all this out. The nub of it is that I receive PHI (premiums paid by employer) via my employer, I am still employed and under contract, the likelihood of me returning to work because of my illness is slim.

 

 

There is not any clarity from DWP about claims for ESAcont, under these circumstances, there is plenty of information IF I am dead, or dismissed from my employment.I am also receiving DLA higher component.

 

 

Please, please can anyone clarify the situation for me?Thanks.

[honeybee13]

Hello there, I'm sorry you haven't had other replies yet.

 

Do you know if the PHI policy has an offset for the State benefits they assume you will receive? That was the case with my PHI. And if you're on contribution based [CB], commonsense would say that you can have ESA. I'd like people with more knowledge than me to comment though.

 

HB

[Mark-s]

Thanks HB

There is an offset of state benefits % of salary less Long Term Incapacity Benefit (LTIB) at date of disability, and its is confirmed in documentation I have. The policy document is with my employer, as they pay the premiums to the insurer, the PHI provider. I do not have an updated benefit calculation from the insurer since IB has been replaced by ESA.

There is nothing in the new ESA (cont) guidelines, the assumption being that the IB rules apply. I don't want to assume anything. I have just been to my solicitor, who unfortunately is not a specialist in welfare benefits, so she had nothing to offer. I do hope someone on this forum can offer some advice.

[estellyn]

Is this a scheme where your employer pays insurance so they can pay out sick pay to the employee? If so it shouldn't have any effect on your cont based esa, but you may need some documentation from your employer to confirm that this is what it is.

[**Margaret**]

:Mark-s:

 

You (and Jobcentreplus?) are trying to sort a problematical issue in an already technically complex benefit. Ill understood by decision makers who don't get enough training, and Jobcentreplus legal whizz kids who don't always know any better either.

 

First thing you need to clarify with the insurance company (probably via your employer) is whether the policy is income protection (sick pay) or permanent health insurance. For calculations of entitlement to employment n support, income protection is completely disregarded, which is why there's no reference to it in any guidance. Jobcentreplus have a wide definition of permanent health insurance, but they can't consider deductions from employment n support cos of it, while a claimant's still an employee.

 

https://www.gov.uk/government/publications/decision-makers-guide-vols-8-and-9-employment-and-support-allowance-staff-guide

(Chapter 44, sections 44651 - 44723)

 

A significant number of claimants find themselves in your situation, and the incidence is higher among claimants with conversion awards. Decision makers frequently forget, or weren't told in the first place that; pre April 01 claim forms for incapacity benefit didn't ask for details of health insurance and pensions, or that they're disregarded for former recipients of incapacity benefit who're also in receipt of the highest rate care component of disability living allowance.

 

Presume you're still waiting for the outcome of your interview. Hope that what I've written gives you a starting point to defend yourself against whatever Jobcentreplus allege you've done. It may help you to know that Jobcentreplus have to prove intent to secure a conviction for fraud.

 

Best wishes, Margaret.

 

 

 

 

[Mark-s]

Thanks Margaret and estellyn.

It is PHI and not sick pay.Premiums paid by my employer.

I was on IB and migrated to contESA in april last year.I am in the support group because of the illness, and I have a contract with my employer for my job if I ever return.

I have read the decision makers forms, but there is no clarity in relation to my situation, I either need to be dead or my contract of employment to have ended for the pension (that is how they consider PHI) to be disregarded.

Please can you give me the specific refence.Thanks.