http___www.welfare.ie_ga_Pages_injurybenefit.aspx_1.xml
1.1 2.1 3.1 4.1 5.1 6.1 7.1 8.1 9.1 10.1 11.1 12.1 13.1 14.1 14.2 15.1 16.1 17.1 18.1 19.1 20.1 21.1 22.1 23.1 24.1 25.1 26.1 28.1 29.1 30.1 30.2 31.1 32.1 33.1 34.1 34.2 35.1 36.1 37.1 38.1 39.1 39.2 40.1 40.2 40.3 40.4 41.1 42.1 43.1 44.1 44.2 44.3 44.4 45.1 46.1 47.1 48.1 49.1 50.1 51.1 52.1 54.1 55.1 56.1 57.1 57.2 58.1 59.1 60.1 61.1 62.1 63.1 63.2 63.3 64.1
Internal Guidelines used in processing claims Table of Contents Description of Scheme Information Leaflet Legislation Administration Qualifying conditions Medical expenses covered under the Scheme Claims Investigation Decisions How payment is made Description of Scheme Medical Care is one of the benefits available under the Occupational Injuries Scheme. Under the Scheme payment is made in respect of certain medical expenses which are considered to be reasonably and necessarily incurred as a result of an occupational accident or development of a prescribed occupational disease, but only to the extent that such expenses are not covered under the Health Service Executive or under this Department's Treatment Benefits Scheme. Information Leaflet The SW 34 information leaflet summarises this scheme. Legislation The main legislation covering this scheme is contained in Chapter 13 of the Social Welfare Consolidation Act 2005 as amended and SI No 102 of 2007 Social Welfare (Consolidated Occupational Injuries) Regulations 2007. Administration The Scheme is administered by the Occupational Injuries Medical Care Section, Department of Social Protection, Áras Mhic Diarmada, Store Street, Dublin 1 LoCall: 1890 928 400 (from the Republic of Ireland only). or 00 353 1 704 3000 (from outside the Republic of Ireland) Qualifying conditions The Scheme only applies to Occupational accidents and prescribed occupational diseases under the Occupational Injuries Scheme. (See the Sections which deal with Injury Benefit and Disablement Benefit.) The accident or disease must have arisen out of employment insurable at PRSI Class A, B, D, J or M. In the case of Class B contributors, payment is only made in respect of the cost of treatment provided subsequent to 26 weeks from the date of accident/contraction of the disease. Medical expenses covered under the Scheme Payment is made in respect of treatment which is considered to be reasonably and necessarily incurred as a result of an occupational accident or of the development of a prescribed disease and is made only to the extent that such treatment is not covered under the Health Service Executive or under the Department's Treatment Benefits Scheme. Subject to these provisions, the following are the expenses covered under the Scheme. - Visits by or to a G.P. - G.P. Prescriptions - Certain medical and surgical appliances including prosthetic and aural appliances, prescribed by a G.P. including repair and replacement. - Certain dental and optical treatment and appliances - Certain treatment by members of professions allied to the medical profession where prescribed by a G.P. such as chiropractors and acupuncturists. Treatments which are available under the Health Acts in a publc hospital e.g. Physiotherapy, X-ray, MRI Scan, Apecialist Consultations are excluded from the Medical Care Scheme. - Certain travelling expenses to and from the place where medical care is provided. If the person uses their own car, payment is made at a fixed rate per mile. If a taxi is used and if the Department is satisfied that its use was necessary, payment of the full cost is met. Travelling expenses may be paid for travel to both public and private appointments. If the person needs ongoing treatment because of the occupational accident/prescribed disease, payment of medical expenses incurred will continue to be made under the Scheme. PART 2: CLAIMS, INVESTIGATION AND DECISION PROCEDURES Claims A claim should be made within six weeks of the start of medical treatment. This is normally six weeks from the date of the accident or of the development of the disease. If a claim is made at a later date, payment can be made in respect of the treatment provided up to 12 months before the date on which the claim is made. (See Guideline " Claims and Late Claims" for more details on the further backdating of claims). Claim forms are available from: Medical Care Section Department of Social Protection, Áras Mhic Dhiarmada, Store Street, Dublin 1 LoCall: 1890 928 400 (from the Republic of Ireland only) or 00353 1 704 3000 (from outside the Republic of Ireland) Documentary evidence of treatment provided must be submitted with the claim. Investigation In the majority of cases, a claim to Injury Benefit would already have been made and questions regarding the accident or disease would have been investigated as is described in the separate guideline " OIB/Injury Benefit" . If a claim to Injury Benefit has not been made, the accident or disease will be investigated in a similar manner to that for Injury Benefit. Questions as to whether certain treatments applied for should be covered under this scheme may be referred for the opinion of the Departments Medical Advisor before a decision is made. Decisions There is no right of appeal on a claim to Medical Care to the independent Social Welfare Appeals Office but a request for an administrative review may be made to the Medical Care Section. PART 3: PROCEDURES FOLLOWING AWARD How payment is made Payment is normally made directly to the person concerned. The preferred payment option is by Electronic Fund Transfer (EFT) directly into a Bank or Building Society account. Payment can also be made by cheque or in cash at a Post Office. If necessary payment may be made to the Health Service Executive or to an employer, at the employee's request, if treatment expenses are covered by the employer.
1.1 2.1 3.1 4.1 4.2 5.1 6.1 7.1 8.1 9.1 10.1 11.1 12.1 12.2 13.1 14.1 15.1 16.1 16.2 17.1 18.1 18.2 19.1 20.1 21.1 22.1 23.1 24.1 25.1 26.1 26.2 27.1 28.1 29.1 29.2 30.1 31.1 32.1 33.1 34.1 35.1 35.2 36.1 37.1 38.1 39.1 40.1 40.2 41.1 42.1 42.2 43.1 44.1 45.1 46.1 47.1 48.1 49.1 50.1 51.1 52.1 53.1 54.1 55.1 56.1 57.1 58.1 59.1 60.1 61.1 62.1 63.1 64.1 65.1 66.1 67.1 68.1 69.1 70.1 71.1 72.1 73.1 74.1 75.1 75.2 76.1 77.1 77.2 78.1 79.1 80.1 81.1 81.2 82.1 83.1 84.1 85.1 86.1 87.1 88.1 89.1 90.1 91.1 92.1 95.1 96.1 97.1 98.1 99.1 100.1 101.1 102.1 103.1
Eolas Sochar Díobhála Ceann de na sochair é an Sochar Díobhála atá le fáil de réir Scéim na Sochar Gortuithe Ceirde. Íocaíocht sheachtainiúil é a dhéantar leat má tá tú neamhábalta chun na hoibre de bharr: - Timpiste le linn na hoibre - Timpiste agus tú ag taisteal (ar thuras gan bhriseadh) go díreach go dtí nó ag teacht go díreach ón obair - Galar ceirde Is éard atá i ngalar ceirde galar a thagann ort le linn do chuid fostaíochta nó de dheasca na hoibre a dhéanann tú, mar shampla, de dheasca na teagmhála le gníomhaithe fisiceacha nó ceimiceacha. Tá liosta ag an Roinn Coimirce Sóisialaí a leagann amach na Galair Cheirde. Le go bhfaighfeá Sochar Díobhála ní mór duit a bheith neamhábalta ar an obair de dheasca na timpiste nó an ghalair ar feadh breis agus 3 lá (seachas Dé Domhnaigh nó laethanta saoire íoctha). Mar sin féin, fiú amháin mura bhfuil tú neamhábalta ar an obair le breis agus 3 lá, tá tú i dteideal ráiteas a dhéanamh gur tharla timpiste cheirde. Cosnaíonn sé seo na cearta a bheidh agat ina dhiaidh sin ar shochair de réir Scéim na Sochar Gortuithe Ceirde mar ní i gcónaí a thagann an bhreoiteacht ná an neamhábaltacht chun cinn láithreach de dheasca timpistí nó galar ceirde. Rialacha Ranníocaíochtaí árachais sóisialta (ÁSPC) Daoine atá cumhdaithe ag an ÁSPC Aicme A, D, J nó M, tá siad cumhdaithe go hiomlán maidir le Sochar Díobhála. Is é sin le rá, tá beagnach gach fostaí in Éirinn cumhdaithe maidir le Sochar Díobhála. Ní gá duit a bheith faoi árachas de réir Aicme A, D, J nó M le haon achar ama ar leith le go mbeidh teideal agat ar Shochar Díobhála. Beidh tú incháilithe má tá tú neamhábalta chun na hoibre de dheasca timpiste nó galair cheirde Caithfidh do bhreoiteacht nó do neamhábaltacht maireachtáil níos faide ná 3 lá (seachas Dé Domhnaigh nó laethanta saoire íoctha). Achar aimsire a n-íoctar an Sochar Díobhála Ní íoctar an Sochar Díobhála na chéad 6 lá de do bhreoiteacht nó de do neamhábaltacht. Nóta: ó 6 Eanáir 2014 síníodh é seo ó 3 lá go dtí Is féidir an íocaíocht a dhéanamh ar feadh chomh hard le 26 sheachtain ó dháta na timpiste nó ó theacht chun cinn an ghalair. Má tá tú fós neamhábalta ar an obair tar éis na tréimhse 26 sheachtain, b’fhéidir go mbeidh teideal agat ar Shochar Breoiteachta, Liúntas Míchumais nó Liúntas Leasa Forlíontach. B’fhéidir freisin go mbeidh teideal agat ar Shochar Míchumais má chailleann tú aon chumas corpartha nó meabhrach de dheasca na timpiste nó an ghalair. Ina mhalairt de chás, mura bhfuil tú incháilithe do Shochar Breoiteachta ná d’íocaíocht leasa shóisialaigh eile agus go bhfuil tú ag fáil Sochair Mhíchumais, b’fhéidir go mbeidh tú incháilithe don Fhorlíonadh Éagumais. Obair agus oiliúint athshlánaithe Féadfaidh tú páirt a ghlacadh in oiliúint nó obair pháirtaimseartha atá ina n-oiliúint nó obair athshlánaithe agus Sochar Díobhála a fháil. Más mian leat páirt a ghlacadh i gcúrsa oiliúna nó chun tabhairt faoi obair athshlánaithe, ní mór duit cead scríofa a fháil roimh ré ón Roinn Coimirce Sóisialaí. Ní gá duit cead scríofa roimh ré a fháil chun tabhairt faoin méid a leanas: - obair éadroim nach n-íoctar aisti, nó nár ghnách go n-íocfaí aisti - obair a dhéantar mar chuid de chóireáil fad atá tú in ospidéal nó ina macasamhail d’institiúid agus nuair nach sáraíonn na tuillimh €50.00 sa tseachtain - obair faoi scéim a mheastar atá carthanúil ó thaobh cineáil de, nuair nach sáraíonn na tuillimh €50.00 sa tseachtain Sochar Cumais Pháirtigh Má fuair tú Sochar Díobhála don tréimhse uasta 6 mhí agus má aistríodh thú chuig Sochar Breoiteachta, féadfaidh tú iarratas a dhéanamh ar Shochar Cumais Pháirtigh. Rataí Ráta an tSochair Dhíobhála 2015 Féadfaidh tú méadú ar d’íocaíocht a fháil do dhuine fásta cleithiúnach agus do leanaí cleithiúnacha. Conas iarratas a dhéanamh Níor mhór duit cur isteach ar an Sochar Díobhála faoi cheann 21 lá ón lá ar éirigh tú tinn, nó d’fhéadfá sochar a chailleadh. Le cur isteach ar an Sochar Díobhála, níor mhór duit dul chuig an dochtúir agus Teastas Dochtúra Leasa Shóisialaigh Tosaigh a fháil. Is éard atá sa Teastas Dochtúra Leasa Shóisialaigh Tosaigh foirm iarratais agus teastas dochtúra le chéile le haghaidh an tSochair Dhíobhála. Cuir ar aghaidh é chuig an Rannóg Shochair Dhíobhála (féach ‘Cá háit a ndéanfaidh mé iarratas' anseo thíos) Níor mhór duit Teastas Dochtúra Idirmheánach a chur isteach gach seachtain chomh fada agus a bheidh tú neamhábalta ar an obair. Féadfaidh tú Teastas Dochtúra Idirmheánach a fháil ó do dhochtúir. Cá háit a ndéanfaidh mé iarratas Féadfaidh tú do Theastas Dochtúra Leasa Shóisialaigh Tosaigh agus do Theastas Dochtúra Idirmheánach a thabhairt isteach chuig an Oifig Áitiúil Leasa Shóisialaigh is gaire duit nó iad a phostáil chuig: Rannóg Shochair Dhíobhála An Roinn Coimirce Sóisialaí PO Bosca 1650 Baile Átha Cliath 1 Éire Lena thuilleadh faisnéise a fháil, téigh i dteagmháil leis an Oifig Áitiúil Leasa Shóisialaigh nó leis an Rannóg Sochair Dhíobhálacha Ceirde: Rannóg Díobhálacha Ceirde An Roinn Coimirce Sóisialaí Áras Mhic Dhiarmada Sráid an Stórais Baile Átha Cliath 1 Éire