Industrial Injuries Disablement Benefit claim forms
Industrial Injuries Disablement Benefit claim forms to print and fill in with a pen.
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Read the Industrial Injuries Disablement Benefit guidance before using these forms.
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.
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
Help using this PDF claim form
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.
Contact the DWP Online Helpdesk, if you are having technical difficulties:
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downloading the form
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navigating around the form
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printing the form
DWP online helpdesk
Email dwponline.helpdesk@dwp.gov.uk
Telephone 0800 169 0154
Monday to Friday 8am to 6pm
Closed weekends and all public and bank holidays
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
Last updated 19 February 2024 + show all updates
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Updated Accidents: Industrial Injuries Disablement Benefit interactive claim form (BI100A), Accidents: Industrial Injuries Disablement Benefit notes, Diseases: Industrial Injuries Disablement Benefit interactive claim form (BI100PD), Diseases: Industrial Injuries Disablement Benefit notes -- English and Welsh.
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Updated Accidents: Industrial Injuries Disablement Benefit interactive claim form (BI100A - 9/23) and notes (BI100 notes - 9/23) English and Welsh (Welsh version not interactive).
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Updated the form: Diseases: Industrial Injuries Disablement Benefit interactive claim form and also Diseases: Industrial Injuries Disablement Benefit notes.
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Updated the form: Diseases: Industrial Injuries Disablement Benefit interactive claim form.
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DWP have introduced a new Industrial Injuries Disablement Benefit interactive claim form. We have also provided new guidance about how to use the form, what to do if you cannot access the form, and how you can request a different format if you need to.
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Added claim form and guidance notes to claim Industrial Injuries Disablement Benefit for occupational deafness.
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Added form A15, Dupuytren’s Contracture notes.
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Updated the claim forms (English and Welsh) for diseases caused by work.
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Replaced forms BI100A and BI100AW for accidents caused by work - telephone numbers updated to freephone numbers.
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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)'.
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Published revised version of form BI100a - Accidents: Industrial Injuries Disablement Benefit (accidents) claim form - English and Welsh.
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Changed Barrow Industrial Injuries Disablement Benefit mailing address on form BI100PD form - English and Welsh versions.
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First published.