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Application form for Social Welfare Services OB21 Disablement Benefit and/or Incapacity Supplement under the Occupational Injuries Scheme How to complete application form for Disablement Benefit and/or Incapacity Please tear off this page and use as a guide to filling in this form. Please use Black ball point pen. Please use BLOCK LETTERS and place an X in the relevant boxes.

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If you have 100% disablement, your maximum personal pension is €251. Up to 19% disablement: A lump sum may be payable, up to a maximum of €17,560.

It can be paid to you if you suffer a loss of physical or mental faculty because of an accident at work, an accident travelling directly to or from work, or a prescribed disease contracted at work. Payment is only made where the level of disablement following the accident or disease is assessed at 15% or more.

Injury Benefit is a weekly payment if you are unfit for work due to the accident or disease. Payment is normally made from the 4th day of incapacity for work. Injury Benefit can be paid for up to 26 weeks from the date of your accident or development of the disease (not the date you apply).

If you have between 104 and 259 weeks PRSI contributions paid, you can claim Illness Benefit for up to 52 weeks (312 payment days). If you have 260 weeks PRSI paid since you first started work you can claim Illness Benefit for a maximum of 2 years (624 payment days).

Injury Benefit is a weekly payment if you are unfit for work due to the accident or disease. Payment is normally made from the 4th day of incapacity for work.

This form is used to apply for Disablement Benefit and/or Incapacity Supplement under the Occupational Injuries Scheme. Application Form: Disablement Benefit and/or Incapacity Supplement under the Occupational Injuries Scheme (OB21) Edition: September 2021.

Injury Benefit is paid if you are unfit for work due to an accident at work or while you are travelling to or from work. Under the Medical Care Scheme you can claim certain medical costs that are not paid by the Health Service Executive (HSE) or covered by the Treatment Benefit Scheme.

Rate of Injury Benefit Maximum personal rateIncrease for an adult dependantIncrease for a child dependant€220€146Child aged under 12 €42 (full rate) €21 (half rate) Child aged 12 and over €50 (full rate) €25 (half rate) 3 Jan 2023

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232