Industrial Injuries Disablement Benefit claim forms
Use these forms to claim Industrial Injuries Disablement Benefit for an accident or disease caused by work.
Documents
Details
Read the Industrial Injuries Disablement Benefit guidance before using these forms.
For help and advice on the information you need to put on the form or about the benefit you want to claim, contact the Barnsley IIDB Centre.
Use form BI100A to claim Industrial Injuries Disablement Benefit for an accident caused by work.
Use form BI100PD to claim Industrial Injuries Disablement Benefit for a disease caused by work.
Claiming for occupational asthma or allergic rhinitis
You should complete forms BI100PD and BI100OAE.
Claiming for occupational deafness
If you are claiming because you have occupational deafness, read the occupational deafness guidance before completing form BI100PD and BI100OD.
Claiming for Dupuytren’s Contracture
If you are claiming because you have Dupuytren’s Contracture, read the Dupuytren’s Contracture guidance before completing form BI100PD.
Before you start this form
If you’re using a mobile phone or tablet
You cannot complete the form using a mobile phone or tablet. You have to either:
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use a desktop or laptop computer
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print the form and complete it by hand
If you’re using a desktop or laptop computer
Use a PDF reader to open and fill in this form. You can download a free PDF reader online.
If you are using screen reader software to access the form, we recommend that you review all of the notes and the questions on the form before you complete it. As you complete the form, you will be guided through the questions based on the responses you provide.
Do not use your computer’s browser or, if you are an Apple Macintosh user, the Preview application.
You can save data typed into this form if you use a PDF reader. This means that you do not have to fill in the form in one session.
There are reliability issues with some assistive software, which may mean the form will not save properly.
This form will only save if it is both:
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saved onto your computer
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opened in a recent version of PDF reader
The form will not save in:
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versions of Acrobat Reader older than version XI
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some other PDF readers, for example Preview on a Mac or Foxit on a PC
If you need this form in a different format
Contact the Barnsley IIDB Centre to ask for:
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a printed copy of the form
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a different format, such as large print, braille or audio CD