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Communtity Law Manual | Work & Income | You’ve got a serious illness, injury or disability

Types of benefits

You’ve got a serious illness, injury or disability

If you’re sick or injured or have a disability, the main benefit you should apply for is the Supported Living Payment.

You may also be able to get a separate Disability Allowance to cover ongoing disability costs, see below, “Help with ongoing disability costs: Disability Allowance”.

Main benefit for illness, injury or disability: Supported Living Payment

Who qualifies for the Supported Living Payment?

Social Security Act 2018, ss 34–37, 40–42; Disabled Persons Employment Promotion Act 1960, s 2 (definition of “sheltered workshop”)

You can get the Supported Living Payment if you’re 16 or older and you’re permanently and severely restricted in your ability to work because of an illness, injury or disability.

You must be unable to regularly work more than 15 hours a week in “open” employment (see below), and this incapacity must be expected to continue for at least two years. You also have to be 16 or older to get this benefit.

“Open” employment means employment that isn’t “sheltered” employment. Work and Income interprets “sheltered employment” to mean “Employment conditions that have been designed to cater for the needs of a person’s disability or illness”. This includes, but isn’t limited to, what is also called “sheltered workshops” (which are now called “contracted business enterprises” by Work and Income).

In practice, Work and Income gives a broad interpretation to the words “sickness, injury or disability”, to include conditions that develop over time.

A doctor will need to assess you and certify that you qualify on the grounds above. If your own doctor has certified that you qualify, Work and Income can require you to see another one from a panel of doctors called “designated doctors”. If you and Work and Income disagree on which designated doctor should assess you, Work and Income will decide who it will be.

You’ll also qualify for the Supported Living Payment if you’re totally blind and 16 years old or older.

Although no work-test obligations apply to the Supported Living Payment, you can be required to prepare for work-test obligations.

Challenging a refusal to grant the Supported Living Payment

If Work and Income refuse to grant you the Supported Living Payment on medical grounds, you can apply for a review by a Medical Appeal Board.

If you’re refused on the basis that your income is too high, you can apply for a review by a Benefit Review Committee.

See “Challenging Work and Income decisions: Reviews and appeals” in this chapter.

Help with ongoing disability costs: Disability Allowance

About the Disability Allowance

Social Security Act 2018, ss 17, 84–89, 368–371, 425, Sched 4

The Disability Allowance reimburses you (pays you back) for the costs of goods and services that a doctor confirms have a direct therapeutic value for an ongoing health issue.

To qualify, you must have a disability that:

  • is likely to continue for at least six months, and
  • has reduced your independent functioning to the extent that you need ongoing support to undertake the normal functions of life or need ongoing supervision or treatment by a health professional.

The disability does not have to restrict your work capacity.

If it’s not possible to know whether your disability is likely to continue for at least six months, Work and Income can still grant you the allowance if it’s reasonably possible that the disability will last for six months, provided you would otherwise qualify. The allowance can also be granted if your life expectancy is less than six months.

The doctor who assesses you doesn’t need to specify the costs involved, but they do have to specify the goods or services that you need.

What costs can I claim for?

There are no types of goods or services that you cannot claim the Disability Allowance for, but you can’t “double-dip” – in other words, if the cost is already covered by a District Health Board, ACC or a health insurance policy, you can’t also claim it under the Disability Allowance. However, if the DHB, ACC or insurance only pays part of the costs, you can claim the part that’s not covered.

Although no types of costs are excluded, the Disability Allowance is usually granted for costs such as doctor visits, prescriptions, alternative treatments (for example, physiotherapy and acupuncture) and special foods. Also covered are telephone rental, transport for appointments, and power costs, if these are more than what is normal for a similar-sized household.

Note: Work and Income has specific procedures for determining whether the Disability Allowance will cover excess power costs, but Work and Income staff often fail to follow all of the steps. It is also becoming common for Work and Income’s Regional Health Advisors to be asked to make recommendations about the appropriateness of certain items. However, the Work and Income case manager deciding your application isn’t bound to follow the recommendation, and if you’re refused cover for certain costs on the basis of one of those recommendations, you can still seek a review of the decision on the basis that Work and Income didn’t follow the statutory criteria, see “Challenging Work and Income decisions: Reviews and appeals” in this chapter.

The allowance is paid as a weekly amount, up to a maximum set by the Social Security Act. If your actual costs are more than the maximum, the difference can be covered by Temporary Additional Support, see “Temporary Additional Support: Extra ongoing help with hardship” under “Other benefits and allowances”.

Because the Disability Allowance is a “reimbursement” system (that is, it pays you back for what you’ve spent), you need to show you are spending the money on the goods and services concerned, by providing invoices, quotes or receipts.

Income test for the Disability Allowance

Social Security Act 2018, s 422, Sched 3, cl 9

The Disability Allowance is income-tested, with the income threshold varying depending on the size of your household. If your income is more than the relevant threshold, you will not receive any Disability Allowance. However, some of your income may be exempted from the income test if you’re severely disabled and the income is coming from your own efforts – that is, wages, salary or commissions.

Challenging decisions about the Disability Allowance

Decisions about whether particular costs can be claimed for a Disability Allowance can be reviewed by a Benefit Review Committee, see “Challenging Work and Income decisions: Reviews and appeals” in this chapter.

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