Employment Injury Benefit

Employment Injury Benefit is a unique benefit in that it consists of four (4) categories of benefit:

Injury Allowance Benefit – payable for 52 calendar weeks.

Disablement Benefit – consists of either a monthly benefit or a lump sum payment.

Medical Expenses – a cash benefit to defray related medical expenses.

Death Benefit – monthly benefit payable to the spouse, dependent parents and dependent children.

Payment of the benefit is made to:

An insured person who suffered personal injury caused by an accident which arises out of and in the course of his/her employment.
An insured person who is required to abstain from work because they are suspected of carrying a contagious disease or who has had contact with a case of infectious disease or an insured person who is rendered incapable of work through a prescribed industrial disease caused by the nature of his job; or
To the dependents of an insured person who dies as a result of such an injury on the job.

Injury Allowance
Medical Expenses
Disablement
Death

The National Insurance Employment Injury Benefit is paid to an insured person who is rendered incapable of work through personal injury caused by an accident, which arises out of and in the course of his employment, or through a prescribed industrial disease caused by the nature of his employment.

Injury Allowance

Anyone who is in insurable employment in relation to Employment Injury Benefits (that is where a person is employed and a contribution was paid or due to have been paid for that week of employment) and:

Is away from the job because of an accident/disease that arose out of or in the course of employment;
Is required to abstain from work because they are suspected of carrying a contagious disease or who has had contact with a case of infectious disease;
Is incapable of work for a period of more than 3 days as a result of the injury or prescribed industrial disease.

A claim must be submitted to the Service Center nearest to you within 14 days of the injury for the Injury Benefit and 12 months for the Death Benefit.

Time Frames

0 – 14 days	Claim on time and can be accepted
14 days – 12 months	Claim late and may be accepted with good cause
12 months and over	Claim late and shall be disallowed

The insured person must apply for the benefit within 14 days of the date of the accident or development of the disease. Late submission of a claim can result in loss of the benefit. The date of development of the industrial disease is the date on which the insured person was rendered incapable of work as result of the disease.

NOTE: Please note: The National Insurance Board will not entertain a claim for Injury Benefit before the 4th day of incapacity.

Late Applications

You must apply on time to ensure that you receive your benefit. Failure to submit your claim to the Board within 13 weeks (3 months) of the start of your injury can result in you losing all or part of your benefit. You may lose any period that is more than 13 weeks (3 months) earlier than the date on which the Board receives your claim unless you can show there was good cause for the delay in submission. Your explanation must be submitted in writing. Even with good cause you may still lose your benefit.

Even with good cause, if your claim is made more than 12 months after the start of your injury the benefit shall be forfeited.

NI19 – Application for Injury Benefit

NI19A – Medical Certificate for continuing injury/disease

Marriage Certificate for a woman whose name has changed since her registration.
Foreign medical certificates must be accompanied by a letter of authentication.
Late Claim Letter showing good cause which caused the claim to be made late.
Original and copy of a valid PICTURE ID of both the claimant and the person submitting the claim on behalf of the claimant (where applicable) is required for acceptance of the claim.

The class of contribution in the week of the accident and the week prior will be considered. Benefit will be paid in the higher class. However, unpaid apprentices and persons in receipt of a receipt of a Retirement Pension who have returned to work will be paid in the lowest Earnings Class – Class 1.

At the end of the injury benefit period the extent of disability is immediately assessed to determine the insured person’s entitlement to Disablement Benefit.

(Not Applicable)

Medical Expenses

Medical expenses are paid for employment injury to an insured person who is rendered incapable of work through personal injury caused by an accident, which arises out of and during his employment, or through a prescribed industrial disease caused by the nature of his employment. Medical Expenses are paid to an insured person who incurs the cost of medical treatment for the personal injury or prescribed industrial disease up to a maximum of $28,125.00 per injury. Prior to March 04 2013, the maximum amount payable was $22,500.00.

Medical Expenses include the following: –

Doctor’s Fees.
The cost of Drugs and Dressings.
Hospital Expenses.
Operations.
The cost of necessary para-medical treatment e.g. physiotherapy, appliances.
The cost of travel incidental to an insured person receiving care and treatment.
Constant care and Attendance Allowance (regular or periodic care as recommended by the attending doctor).

You may make a claim for medical expenses where, as an insured person, you are eligible to receive Injury Benefit. Medical Expenses are payable for as long as you can produce evidence from the doctor that you are under treatment for the particular injury and/or disease which are derived from an accident, up to the maximum allowance of $28,125.00. Medical Expenses will not be paid in circumstances where the employer has met such costs.

You must apply for the benefit within 3 months of the date on which the expenses were incurred.

Time Frames

0 – 3 Months	Claim on time and can be accepted
3 – 12 Months	Claim late and may be accepted with good cause
12 Months and over	Claim late and shall be disallowed

Late Applications

You must apply on time to ensure that you receive your benefit. Failure to submit your claim to the Board within 3 months of incurring the medical expense can result in you losing all or part of your benefit. You may lose benefit for any expense incurred that is more than 3 months earlier than the date on which the Board receives your claim unless you can show there was good cause for the delay in submission. Your explanation must be submitted in writing. Even with good cause you may still lose your benefit.

Even with good cause, if your claim is made more than 12 months after incurring the expense the benefit shall be forfeited.

To submit a claim, you must first book an appointment through our Web Appointment Portal (hyperlink portal). To ensure that your claim is accurately submitted to the NIBTT for processing, follow the Claim Guidelines (hyperlinked) when completing all claim forms before your appointment date.

NI 114 – Application for Medical Expenses.

Required Documentation

The expenses must relate to medical attention you received for injuries caused by an accident arising out of and in the course of your employment or for a prescribed industrial disease. The following documents must be submitted to support your claim:

Bills and receipts for any of the medical expenses identified above.
Foreign medical certificates must be accompanied by a letter of authentication in respect of the doctor’s status from a Notary Public in the country where medical attention was sought or a member of a Trinidad and Tobago High Commission. The responsibility for authenticating the status of the attending doctor rests with the insured.
Any referral letters to specialist or Paramedical Practitioner for foreign treatment.

The following information must be shown on the receipt from pharmacy:

Pharmacy Number.
Name of doctor.
Name of patient/claimant.
Date of prescription.

Para-medical treatment/equipment:

Effective March 01 2004, the NIBTT began accepting a certificate from a Paramedical Practitioner for Employment Injury Benefit claims only if the insured was referred by a medical practitioner with a written proof of referral.

A Paramedical Practitioner is a person who is not a Medical Practitioner but supplements and supports medical work and includes a Chiropractor, Physiotherapist, Dental Technician or Psychologist.

Required Documentation

A letter of referral from the attending doctor recommending treatment and/or equipment to be provided by a particular person/institution MUST be produced.
Where the attending doctor himself administers such para- medical treatment or provides para-medical equipment, a letter of referral is not required.
Where expenses are incurred for para-medical treatment/equipment provided while the claimant is hospitalised, such expenses must be considered.

Cost of Travel

The full name of the claimant should be written on each bill/receipt in addition to Vehicle Registration Number, Date and Amount.
The normal route-taxi fares are to be applied in normal circumstances.
Where you use your own car, reimbursement in relation to route-taxi fares will be paid.
If there is doubt whether hired transport should have been used, the claimant may be asked to obtain a statement from his doctor to this effect.
Where under Traveling Expenses a claim is made for the traveling expense of an escort, the claimant must submit a letter from the attending doctor certifying that there was a need for an escort. Where an escort is used on the day of the injury to accompany the claimant to the doctor’s office/hospital, then the above will be waived for that day only, depending on the nature and extent of the injury.

Medical Expenses – Constant Care and Attendance Allowance

Documentation

A certificate from the attending doctor, advising that constant care and attendance is required, and the period for which same is required.
A statement from the person or institution (e.g. convalescent home) providing the care, indicating the period(s) for which the services were rendered.

There are limits in each category with the maximum amount payable as medical expenses for an injury being $28,500.00.

(Not Applicable)

Disablement

The Disablement Benefit is compensation paid to an insured person for the loss of physical or mental faculties including disfigurement, whether or not it is accompanied by loss of faculties, caused by an accident on the job.

Such an accident on the job must arise out of or in the course of your employment, or through a prescribed industrial disease caused by the nature of your job. This Benefit is paid whether you return to your job or not.

The Disablement Benefit consists of two categories:

The Disablement Pension – This benefit is paid until the disability ceases.
The Disablement Grant – This grant is paid as one lump-sum payment.

An insured person who has been injured on the job and/or has received the Injury Benefit for any period, up to a maximum of 52 calendar weeks, and is medically assessed as having suffered a disability or loss of faculties based on an injury on the job.

You must apply for the benefit within 3 months of the date of the last Injury Benefit payment or from the date on which the accident occurred.

Time Frames

0 – 3 Months	Claim on time and can be accepted
3 – 12 Months	Claim late and may be accepted with good cause
12 Months and over	Claim late and shall be disallowed

You must apply on time to ensure that you receive your benefit. Failure to submit your claim to the NIBTT within 3 months of the start of your disability can result in you losing all or part of your benefit. You may lose any period that is more than 3 months earlier than the date on which the NIBTT receives your claim unless you can show there was good cause for the delay in submission. Your explanation must be submitted in writing. Even with good cause you may still lose your benefit.

NI119 Disablement Benefit Claim Form

(Not Applicable)

The loss of benefit will be as follows:-

In the case of Disablement Grant.
The entire Grant, unless the claimant can show that, throughout the period between the effective date of the contingency and the date on which the NIBTT received the claim, good cause existed for delay in submission of the claim.

In the case of Disablement Pension.
The loss of benefit for any period more than 6 months from the date on which the NIBTT receives the claim. Even with good cause you may still lose your benefit. If your claim is made more than 12 months after the start of your disablement, you shall lose the benefit.

Disablement Pension

You will receive a disablement pension if your doctor assesses the extent of loss of faculties or disability as 20% and over.

Where your assessment is a multiple of five, for example 25%, it will be treated as the next highest percentage that is a multiple of 10, in this case 30%.

Similarly, where your assessment is not a multiple of five it will be treated as the nearer percentage, which is a multiple of 10. For example, an assessment of 28% will be treated as 30% but an assessment of 24% will be treated as 20%.

If you are receiving a Disablement Pension and are hospitalised for necessary care, your disablement will be assessed as 100% during the period of hospitalisation.

How To Apply?

Submit your claim to the NIBTT Service Centre most convenient to you. There, one of our customer service representatives will accept your claim for processing.

How Much Will Be Paid?

You will be paid a percentage of the Injury Benefit you were receiving based on your Earnings Class. The percentage paid will be the percentage of disability assessed by your doctor.

For How Long Will Disablement Pension Be Paid?

You will receive your benefit for as long as the disability continues. The NIBTT may review a medical assessment of disablement and pay that later assessment if it is different from the earlier one.

Disablement Grant

This benefit is one lump-sum payment made where the extent of disablement is assessed at less than 20%. Where your disablement is assessed at 3% or less, 3% will be paid.

How much will be paid?

The lump-sum payment will be paid. The formula for calculating the Disablement Grant is: n% Disablement x number of weeks of Disability not exceeding 365 weeks x half the assumed earnings.

If you are already in receipt of Disablement Benefit and submit a subsequent claim for Disablement arising out of a new injury for which you are assessed at 20% or more, you shall be required to be re-assessed to establish a total permanent partial disability taking into account all injuries suffered and the current Disability Benefit revised to reflect the new assessment.

Death

The Death Benefit is a payment or periodical payments made to specific survivors of a deceased insured person who died as a result of an accident or of a prescribed industrial disease arising out of or in the course of employment.

You can claim the Death Benefit if you are one of the following five types of dependants:-

Widow legal/common law
Widower legal/common law
Children
Orphans
Dependent parent(s)

In order to qualify the dependents must provide documentary evidence to prove their relationship to the deceased insured person.

Widow/Widower

The benefit is paid to the lawful spouse of the Insured person (the spouse is lawful even if separated from the Insured person).

Common-Law Spouse

As a Common-Law Spouse you will be paid the benefit if both you and the Insured person were legally single persons, living together as husband and wife up to the date of death of the insured person for a minimum of 3 years. A single person is one who was never married or, if married, was released from the marriage due to death of the Insured person or a decree of divorce absolute. A Common Law spouse may be either nominated or not nominated as beneficiary by the insured prior to his or her death. The official Nomination of Beneficiary form is Form NI42.

Where you were not nominated as beneficiary you must provide alternative evidence of nomination and evidence of cohabitation for 3 years prior to the death of the insured person.

When To Apply?

You must apply for the benefit within 12 months of the date of death of the insured person.

Time Frames

0 – 3 Months	Claim on time and can be accepted
3 – 12 Months	Claim late and may be accepted with good cause
12 Months and over	Claim late and shall be disallowed

Late Applications

You must apply on time to ensure that you receive your benefit. Failure to submit your claim to the Board within 12 months from the date of death of the insured person may result in the benefit being paid from the date it was received by the Board, unless you can show there was good cause for the delay in submission. Your explanation must be submitted in writing.

NI117 Employment Injury Death Benefit Claim Form

Employer’s Responsibility

The employer must certify that death occurred as a result of the accident/prescribed industrial disease.

Supporting Documentation

Death Certificate of deceased insured person
Birth Certificate of widow and eligible children
Medical Certificate for mentally or physically disabled child
Medical Certificate for pregnant spouse, certifying pregnancy and expected date of confinement.
N.I. Registration Card of deceased and
Marriage Certificate for Legally Married Persons
Original and copy of a valid PICTURE ID of both the claimant and the person submitting the claim on behalf of the claimant (where applicable) is required for acceptance of the claim.

For Common Law (Nominated)

Evidence of single status of claimant and deceased
Decree Absolute or relevant Death Certificate if either party was previously married to another person.

For Common-Law Situations (Not Nominated)

Evidence of single status of claimant and deceased
Evidence of common-law relationship, i.e. evidence of three years of cohabitation up to the time of death
Decree Absolute or relevant Death Certificate if either party was previously married to another person.

For Dependent Parents

Evidence of support of dependent parent
Birth certificate of the deceased

For Common Law (Spouse)

The following are some examples of documents you may use as alternative evidence of nomination.

Will – claimant is indicated as spouse/beneficiary.
Employer’s Pension Plan – claimant recorded as spouse/beneficiary.
Life Insurance Policy – claimant indicated as spouse/beneficiary.
Credit Union document – claimant indicated as spouse/beneficiary.
Deed – in both parties names.
Birth Certificate of child – both parties named.
Joint Account – Statement in both parties names
Statutory Declarations from 3 prominent people in the community to attest to knowledge of common law relationship

In addition, such claims will be advertised in the newspaper once per week for three consecutive weeks. If no objection is lodged by a spouse of either party and all other qualifying conditions are met, you will be paid the benefit as the widow/widower of the deceased insured.

Alternative Evidence of Paternity for Child Allowance

The following are some examples of documents you may use as alternative Evidence of Paternity when the father’s name is not inserted on the Birth Certificate of the child.

Marriage Certificate of Parents.
Paternity order given by a court.
Adoption Certificate where child is adopted.
Evidence of pregnancy at date of death of insured father and birth certificate when child is born.

How Much Will Be Paid?

The value of the Death Benefit will be determined by the rate of contribution paid by your spouse in the week of his or her death arising out of the injury on the job or to the rate of Employment Injury Benefit that your spouse was receiving.

Payments are made in the following categories: –

A Widow Or Widower’s Pension to a surviving spouse – legal or common law.

A Child Allowance to a dependent child/step-child, adopted child of the deceased insured person. Effective from March 04, 2013 a child will receive a minimum of $600.00 per month.

A Dependent Parent’s Allowance is paid to a parent who was wholly or mainly maintained by the deceased insured. Effective March 04, 2013 the dependent parents will each receive a minimum of $300.00 monthly if one parent is alive he or she will receive $600.00 monthly.

For How Long Will The Benefit Be Paid?

Effective 1st March 2004:

The Widow is paid for life or until she remarries. The benefit will be stopped upon remarriage. A remarriage grant will then be paid.
The widower is paid for life or until he remarries. The benefit will be stopped upon remarriage. A remarriage grant will then be paid. The remarriage grant is equal to 52 weeks of benefit.
Children will be paid until age 19 years or until the cessation of disability where the child’s disability occurred before 19th birthday provided also that such disabled child is unable to work.

Children must be legally single (unmarried). A stepchild is a child of the surviving spouse who was resident in the home at the time of the death of the insured person and who was wholly or partially maintained by the insured person.

The benefit will also be paid to a child who was in the mother’s womb at the time of the father’s death.

You will receive an allowance for that child from the first day of the contribution week of date of his or her birth.

The dependant parent will be paid for life or until he or she remarries.

In cases where the benefit is paid to both parents and one parent dies, the total benefit will be paid to the surviving parent.

Remarriage Grant

The Remarriage Grant is a category of Survivor’s Benefit. Should you remarry while still receiving your payment as the surviving spouse of a deceased insured person you will be paid a Remarriage Grant.

A lump-sum payment is paid on remarriage of of a person who was in receipt of the widow or widower’s pension or Death Benefit equal to 12 months or 52 weeks payment of the particular Survivor’s Benefit.

You will no longer receive a pension for yourself but you will continue to receive payments for any dependent children who are still eligible for a child allowance.

(Not Applicable)

Frequently Asked Questions

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