This is a quick reference guide only and is not intended to replace existing policies and procedures. See ‘what are the relevant policies and procedures’ for further details.

The HSE is committed to the health and wellbeing of employees and aims to support employees who are out of work on long term absence due to critical illness.

The granting of pay, under the various long term absence benefit schemes, is subject to full compliance with the provisions and conditions of the procedures as set out in the HSE Managing Attendance Policy, HSE Long Term Absence Benefit Schemes Guidelines, Rehabilitation Policy and other relevant policies. Failure to comply with any of these provisions may result in the scheme being withheld.

If you become unwell as a result of critical illness or serious physical injury and have supporting medical evidence for an extended period of paid sick leave, you may, on exceptional basis, be granted paid sick leave extended up to a maximum as follows:

  • A maximum of 183 days on full pay in the previous rolling one year period
  • Followed by a maximum of 182 days on half pay in the previous rolling one year period
  • Subjected to a maximum of 365 days paid sick leave in the previous rolling four year period

Time spent on paid sick leave is reckonable for pension purposes.

FAQ’s

Do I qualify?

In order to apply for Critical Illness extension of sick pay scheme, you should be under the current or recent clinical care of a consultant either as an inpatient or outpatient (this excludes employees attending primarily for report preparation or medico legal purposes) and you must fit the medical criteria below:

a) You are medically unfit to return to current duties or where practicable modified duties in the same pay grade

AND

b) The nature of this medical condition has at least one of the following characteristics:

  • Acute life threatening physical illness
  • Chronic progressive illness with well-established potential to reduce life expectancy
  • Major physical trauma ordinarily requiring corrective acute operative surgical treatment
  • In patient or day hospital care of ten consecutive days or greater (In the case of pregnancy related or assisted pregnancy related illness the requirement for hospitalisation of ten consecutive days will be reduced to 2 or more consecutive days of inpatient/hospital/clinic care)

What is the application process?

The HSE Critical Illness Application Form – HR113 https://www.hse.ie/eng/staff/resources/hr-forms/113ci.pdf  must be initiated by you the employee (or your representative) or can be initiated on  your behalf by the line manager

Employee

You must complete section 1 of the form

If due to illness you cannot complete the application form, your manager can submit the application on your behalf. In these circumstances they may contact you or your representative to advise you to submit the medical report from your treating doctor to the relevant Occupational Health Service

You as the employee must submit a specialist report to the Occupational Health Service. If submitting a GP report, the information in it must be based directly on information from your treating specialist. The treating consultant’s specialism must be appropriate to the critical illness for which you are making a claim

Occupational Health Physician

The Occupational Health Physician does not complete any part of the form

The Occupational Health Physician will consider the information provided by the treating doctor and may confer with them with your consent, if they feel this would be helpful. It is not an absolute requirement that a definitive final diagnosis has been made. The Occupational Health Physician may accept a presumptive diagnosis on a case by case basis

The Occupational Health Physician from the Occupational Health Service, will advise your line manager whether in their opinion the medical criteria are met (see ‘Do I qualify’)

Line Manager

The line manager completes section 2 on the form. They are responsible for coordinating the application

The case must be referred by your manager to the Occupational Health Service for assessment. The outcome of this assessment is included in this section

Once the line manager receives the Occupational Health opinion they must submit the form along with their recommendation on whether or not the case meets the medical criteria for approval of Critical Illness Protocol to senior management

Senior Manager

The senior manager completes section 3 of the form

Having reviewed the Occupational Health advice on whether the case fits the medical criteria, Senior Management will make their decision on whether to approve based on:

  • Occupational Health advice on whether the employee meets the medical criteria for Critical Illness Protocol

OR

  • Management discretion decision guideline

Senior Human Resources Manager

The senior HR manager will sign-off on the Critical Illness application based on the senior manager’s decision

Based on the senior manager recommendation, the Senior ER/HR manager completes section 4 of the form and informs the line manager who must advise the employee of the decision

What if I don’t fit the medical criteria?

The decision on whether to award extended paid leave is a management decision. Whilst management must primarily consider the Occupational Health Medical Advice, the protocol allows for a management discretion decision in exceptional circumstances

See HSE/HR circular 014/2018 – Critical Illness Protocol Managerial Discretion Guidelines for the Health Service

In this regard management should establish the following;

  • That there are exceptional circumstances and
  • That those exceptional circumstances relate to illness, injury or condition of the person and
  • That those exceptional circumstances warrant the granting of the extended paid sick leave

When determining if there are “exceptional circumstances” which would warrant the award Critical Illness Protocol granted on the basis of managerial discretion.

The Manager will consider the following three sources of information to inform the decision making process to award Critical Illness Protocol:

  • The Occupational Physicians Report
  • Relevant Information from the individual
  • Relevant HR information

Can I appeal?

Yes. If you believe you did fit the medical criteria set out and have further medical evidence from your specialist to support that, you may submit this to the original Occupational Health service for reassessment

If you believe you did fit the medical criteria based on existing medical evidence, you can request a medical appeal through the Workplace Health & Wellbeing Unit (see www.workwell.ie for contact details)

The medical evidence will be submitted to an alternative HSE Occupational Health Specialist for assessment. This appeal will ordinarily be a file only review and only one appeal can be made

Management discretion decisions may be appealed using the Grievance Procedure

Should there be a delay in your manager referring you to the Occupational Health Service of the organisation or a delay in being seen by the Occupational Health Service there will be no financial loss to you if you are later awarded the exceptional extended paid sick leave

How long does the process take?

The process is dependent on timely application and the provision of relevant medical documentation. Critical illness cases are prioritised for processing at all levels of management, however early application following diagnosis of a critical illness is recommended

Does it affect my pension/superannuation?

Time spent on paid sick leave is reckonable for pension purposes

What payment will I be eligible to get?

Paid sick leave extended up to a maximum as follows:

  •  A maximum of 183 days on full pay in the previous rolling one year period
  •  Followed by a maximum of 182 days on half pay in the previous rolling one year period
  •  Subjected to a maximum of 365 days paid sick leave in the previous rolling four year period

All HSE employees are required to provide notification to the HSE of the amount of Illness Benefit/Occupational Injury Benefit that they are eligible to receive from Department of Employment Affairs and Social Protection (DEASP) during periods of medically certified absences.   See HSE HR Circular 005/2018 https://www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-005-2018-re-changes-to-payment-of-hse-sick-pay-and-occ-injury-benefit-by-deasp.pdf

Will there be a monitoring process?

If you are absent from  work with a critical illness, on-going Occupational Health assessment under the Managing Attendance policy will be decided on a case by case basis, based on your fitness to attend for assessment

Once medically fit to do so you must attend for Occupational Health assessment and participate in the rehabilitation process in line with their medical recommendations, in order to facilitate a return to work as soon as possible and to comply with the Managing Attendance policy

What happens when the Critical illness extended sick leave payment is exhausted?

In advance of the termination of the payment, you and your manager may consider applying for Temporary Rehabilitation Remuneration (TRR) – Your line manager should request advice from occupational health on whether there is any reasonable prospect of you returning to work within a foreseeable time-frame (See TRR FAQ)

What are the relevant HSE Policies and Procedures?

HSE Managing Attendance Policy

HSE Rehabilitation of Employees Back to Work after Illness or Injury Policy

HSE Long Term Absence Benefit Schemes Guidelines

HSE HR Circular 020/2013 – New Public Service Sick Leave Scheme – 1st January 2014 https://www.hse.ie/eng/staff/resources/hr-circulars/circular0202013.pdf

HSE HR Circular 005/2014 – Public Service Management (Sick Leave) Regulations 2014 https://www.hse.ie/eng/staff/resources/hr-circulars/00514.pdf

HSE HR Circular 014/2018  re Public Service Sick Leave Scheme Changes to the Critical Illness Protocol (CIP) provisions from 31st March 2018  https://www.hse.ie/eng/staff/benefitsservices/timeoff/hr-circular-014-2018-re-public-service-sick-leave-scheme-changes-to-the-critical-illness-protocol.pdf

HSE HR Circular 005/2018 – HSE Sick pay and Illness/Occupational Injury Benefit Payments from DEASP https://www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-005-2018-re-changes-to-payment-of-hse-sick-pay-and-occ-injury-benefit-by-deasp.pdf

Where can I find further information?

Talk to you manager and local HR service

Contact the HSE HR helpdesk at 1850 444 925 or email [email protected]

Where can I find further support?

See www.workwell.ie for information on supports for employee including a contact list for counselling in your service area