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Industrial Injuries Disablement Benefit claim forms

Industrial Injuries Disablement Benefit claim forms to print and fill in with a pen.

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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.

To get more information or printed copies of the forms, read the Industrial Injuries Disablement Benefit guide.

Published 1 October 2013
Last updated 20 November 2018 + show all updates
  1. Updated the claim forms (English and Welsh) for diseases caused by work.
  2. Replaced forms BI100A and BI100AW for accidents caused by work - telephone numbers updated to freephone numbers.
  3. Replaced form BI100PD to claim Industrial Injuries Disablement Benefit for diseases. The changes include a change the name of prescribed disease 'emphysema' to 'chronic obstructive pulmonary disease (COPD)'.
  4. Published revised version of form BI100a - Accidents: Industrial Injuries Disablement Benefit (accidents) claim form - English and Welsh.
  5. Changed Barrow Industrial Injuries Disablement Benefit mailing address on form BI100PD form - English and Welsh versions.
  6. First published.