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SI 81 of 1980 Regulation 11 Paragraphs (1) (a), (2) (a), (3) (a) & (b) and (4) (a)
Sickness Benefit & Injury Benefit Late Claims
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11 (1) (a) “in the case of sickness or injury benefit, the period of four days from the earliest day in respect of which the benefit is claimed”.
11 (2) “Subject to paragraphs (3) and (4), a person failing to make a claim for benefit within the time prescribed in paragraph (1) shall be disqualified for receiving (a) in the case of sickness or injury benefit, benefit in respect of any day more than four days before the date on which the claim is made”;
11 (3) “Subject to paragraph (4) in any case where a claim is not made within the time prescribed in paragraph (1) if the claimant proves that (a) “on a date earlier than the date on which the claim is made, apart from satisfying the condition of making the claim, he was entitled to the benefit and (b) throughout the period between the earlier date and the date n which the claim was made there was good cause for delay in making such claims, he shall not be disqualified under paragraph (2) for receiving any benefit to which he would have been entitled if claim had been made on the earlier date.”
11 (4) “No sum shall be paid (a) by way of sickness benefit, maternity allowance or injury benefit in respect of any period more than thirteen weeks before the date on which the claim therefore is duly made.”
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New Policy
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- Claims will not be disallowed because they are submitted late. Payment of certain periods will be disqualified but, as long as the claimant meets the qualifying conditions of SI 82 of 1980, the claim will be allowed. (See Proper Application of SI 81 of 1980 Regulation 11 below.)
- The date the claim is first made is crucial in determining if a claim is late. This date, therefore, will be clearly indicated in the upper right hand corner of the claim form or in the space provided on the claim form.
- All late claims will be governed by, and paid in accordance with, SI 81 of 1980 Regulation 11 (1), (2), (3) and (4).
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Proper
Application of SI 81 of 1980 Regulation 11
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- SSB will be guided by Regulation 11 (1) in determining if a claim is submitted late.
- In accordance with Regulation 11 (2), every claimant who submits a late claim will be disqualified (not disallowed) from receiving benefit for any period more than four days before the date the claim is made. The period not disqualified can, therefore, be paid automatically if the claimant meets the qualifying conditions for the benefit claimed.
- In order to receive benefit for any period prior to four days before the claim is made, the claimant must provide, in writing to SSB, good cause for the delay in making the claim as required by Regulation 11 (3). If good cause for delay is submitted by the claimant, SSB will proceed to pay the period prior to four days before the claim was made. SSB will determine if the reason given by the claimant constitutes good cause for delay, as per current policy on approval of late claims.
4. Any late claim paid under 3 above will be paid in accordance with Regulation 11 (4).
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