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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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Occupational deafness: Industrial Injuries Disablement Benefit claim form

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Details

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 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.

More information

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

Published 1 October 2013
Last updated 8 June 2020 + show all updates
  1. Added claim form and guidance notes to claim Industrial Injuries Disablement Benefit for occupational deafness.

  2. Added form A15, Dupuytren’s Contracture notes.

  3. Updated the claim forms (English and Welsh) for diseases caused by work.

  4. Replaced forms BI100A and BI100AW for accidents caused by work - telephone numbers updated to freephone numbers.

  5. 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)'.

  6. Published revised version of form BI100a - Accidents: Industrial Injuries Disablement Benefit (accidents) claim form - English and Welsh.

  7. Changed Barrow Industrial Injuries Disablement Benefit mailing address on form BI100PD form - English and Welsh versions.

  8. First published.