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Industrial Injuries Disablement Benefit claim forms (8 June 2020)
Form
Industrial Injuries Disablement Benefit claim forms
- English
- Cymraeg
Industrial Injuries Disablement Benefit claim forms to print and fill in with a pen.
Published 1 October 2013
Last updated 8 June 2020 — see all updates
From:
Department for Work and Pensions
Documents
Accidents: Industrial Injuries Disablement Benefit claim form
Ref: BI100APDF, 220KB, 27 pages
Diseases: Industrial Injuries Disablement Benefit claim form
Ref: BI100PDPDF, 123KB, 26 pages
Occupational deafness: Industrial Injuries Disablement Benefit claim form
Ref: BI100ODPDF, 191KB, 4 pages
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Occupational deafness: guidance on completing the claim forms (BI100PD and BI100OD)
HTML
Dupuytren’s contracture: guidance on completing the claim form (BI100PD)
Ref: PD A15HTML
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