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This guide is for:
If you suffer an injury or illness at work that prevents you from working, first speak to your employer or former employer about making an injury benefits application.
You complete Part 1 of the CSIBS1 application form and send it to your employer.
Your employer will complete Part 2 of the form and send it to us with the supporting evidence listed on the form.
10 working days after we receive the form - we will check the information supplied by your employer. If there is any missing information, we will request this from your employer.
Once all the required information is received, we will either make a decision, or refer the application to the Scheme Medical Adviser (SMA) for their assessment.
We will contact you and your employer to confirm the decision or tell you that we have referred your application to the SMA.
Up to 3 months after referral to the SMA - the SMA may contact your doctor or contact you to make an appointment. It can take several months to complete the medical assessment based on how quickly your doctor replies to the SMA. The SMA will then send the medical assessment report to us. The SMA will also provide you with a copy of the report if requested in your application. You have 5 working days from when you receive the report to submit any queries to the SMA.
Ten days after we receive the medical report - when we receive the medical assessment report from the SMA, we will confirm a final decision to you and your employer in writing. If the application is approved, further information on the payment process will be provided as show in Step 9. If rejected, the reason and the appeals process will be explained.
If you application is approved, we will contact your employer to request that you are paid for any absences up to 182 days.
10 days after we receive the medical report
If your application is approved, we will post some forms to you to complete. You should complete and return them to us as soon as possible.
8 days after we receive your forms
We will arrange for injury benefits to be paid monthly for the length of your absence. Your employer should advise us when you have returned to work. Payments will then stop.
10 days after receipt of the medical report
If your application is approved, we will post some forms to you to complete. You should complete your forms and return them to us as soon as possible. You will need to provide details of any Employment and Support Allowance and Industrial Injuries Disablement Benefit.
8 days after we receive your forms
We will arrange for injury benefit to be paid monthly for life as well as a one-off lump sum payment.
We will contact you every year to update your details.
You can request a review (informal appeal) if your application was rejected because your injury was ‘not qualifying’ or 'against the level of impairment on a permanent award' (for injuries before 1 April 2003). There are no time limits on informal appeals.
You can request an appeal of the levels of impairment or apportionment for permanent awards (for injuries after 31 March 2003). There is a twelve-month deadline on appeals.
Please refer to the Medical Reviews and Appeals Guide for more information.
You and your employer need to complete a CSIBS2 appeal form and provide medical evidence.
10 days after we receive the application- we will refer the appeal to the Scheme Medical Adviser (SMA) for their medical assessment and will contact you and your employer to confirm the referral.
Up to 3 months after the SMA referral - the SMA will review the medical evidence and will provide you with an copy of the medical report if this was requested in your application.
10 days after we receive the medical report - we will receive the medical assessment report from the SMA and confirm a final decision to you and your employer.
If the appeal is approved, further information on the payment process will be provided.
If the appeal is rejected, you may be able to submit further appeal applications and you should refer to the Medical Reviews and Appeals Guide for details.