Statutory Sick Pay and Universal Credit: How to Request a Review

The intersection of health, work, and financial stability has never been more precarious. In a world still grappling with the aftershocks of a global pandemic, the rise of long-term health conditions like Long COVID, and a cost-of-living crisis squeezing household budgets, understanding your rights to financial support is not just important—it’s essential. For many in the United Kingdom, the safety nets are Statutory Sick Pay (SSP) from employers and Universal Credit (UC) from the Department for Work and Pensions (DWP). But what happens when the support you receive doesn’t reflect your reality? What if a decision seems wrong, unfair, or is based on incorrect information? You have the right to request a review. This process, known as a ‘Mandatory Reconsideration’ for UC and a dispute process for SSP, can be daunting. This guide aims to demystify it, empowering you to challenge a decision with confidence.

Understanding the Foundations: SSP and UC Explained

Before diving into the review process, it's crucial to understand what these benefits are and how they interact.

What is Statutory Sick Pay (SSP)?

SSP is a weekly payment from your employer to employees who are too ill to work. It is not a means-tested benefit, meaning your savings or partner's income do not affect eligibility. However, it has strict qualifying criteria: * You must be classified as an employee and have done some work for your employer. * You must earn an average of at least £123 per week (as of the 2023/24 tax year). * You must have been ill for at least 4 days in a row (including non-working days).

SSP is paid at a fixed rate of £109.40 per week (2023/24) for up to 28 weeks. It is taxable. The first three days of your illness are typically unpaid 'waiting days,' unless you were eligible for SSP within the last 8 weeks and that period ended.

What is Universal Credit (UC)?

Universal Credit is a means-tested benefit for people of working age who are on a low income or out of work. It replaces several older benefits, including Income Support and Housing Benefit. Your monthly payment is calculated based on your circumstances, including your income, capital (savings), housing costs, and whether you have children or a disability.

Crucially, if you are too ill to work or have a health condition that limits your ability to work, you can be placed in a different "work-related activity group" through a process called the Work Capability Assessment (WCA). This can significantly increase your UC payment through added amounts like the LCWRA (Limited Capability for Work and Work-Related Activity) element.

The Critical Interaction Between SSP and UC

If you claim UC while receiving SSP, the DWP will treat your SSP as income. This means your UC payment will be reduced, pound for pound, by the amount of SSP you receive. For many, this interaction is a source of confusion and financial strain. A problem with your SSP—such as your employer wrongly refusing to pay it—can therefore have a direct and immediate negative impact on your UC award.

When Should You Request a Review?

You cannot challenge a decision simply because you don’t like it. You need valid grounds. Common scenarios include:

For Statutory Sick Pay (SSP)

• Your employer refuses to pay SSP: They might claim you don’t qualify, perhaps disputing your earnings level or the nature of your illness.
• Your employer stops paying SSP too early: For instance, they cease payments before the 28-week period is up without you returning to work.
• Errors in payment amount: They pay you less than the legal weekly rate.
• Disputes over fit notes: Your employer rejects a fit note (often still called a 'sick note') from your doctor.

For Universal Credit (UC)

• A Work Capability Assessment (WCA) decision: You are found "Fit for Work" when you believe you should be placed in the Limited Capability for Work (LCW) or LCWRA group.
• Sanctions: Your benefits are reduced or stopped for allegedly failing to meet your claimant commitments.
• Income or capital miscalculation: The DWP has incorrect information about your earnings, savings, or other income (like SSP), leading to an underpayment.
• Eligibility decisions: You are denied UC altogether based on criteria you believe you meet (e.g., your immigration status, or being in full-time education).
• Housing cost elements: Your payment for rent is calculated incorrectly.

The Step-by-Step Guide to Requesting a Review

The processes for SSP and UC are different. It is vital to follow the correct procedure for each.

Challenging a Statutory Sick Pay Decision

If your employer refuses to pay you SSP, they must provide you with form SSP1, explaining the reason for the refusal. Keep this document.

1. Initial Discussion: Always try to resolve the issue informally first. Speak to your manager or HR department. There may have been a simple administrative error.
2. Formal Dispute: If an informal chat doesn’t work, you need to contact HM Revenue & Customs (HMRC). You cannot appeal directly to a tribunal; you must go through HMRC first.
3. Contacting HMRC: You will need to call the HMRC Statutory Payments Dispute Team. Be prepared to provide your National Insurance number, your employer’s details, and the dates of your sickness.
4. HMRC’s Role: HMRC will contact your employer to get their side of the story. They will then make a formal decision on whether you are entitled to SSP. They will inform both you and your employer of their decision in writing.
5. Appeal to Tribunal: If you disagree with HMRC’s decision, you then have the right to appeal to an independent tribunal within 30 days.

Requesting a Mandatory Reconsideration for Universal Credit

This is the mandatory first step for challenging any UC decision. You cannot appeal to a tribunal until you have gone through this process and received a Mandatory Reconsideration Notice.

1. Act Quickly: You usually have one calendar month from the date of the decision on your journal to request a Mandatory Reconsideration. You can ask for a late review, but you must have a good reason for missing the deadline.
2. How to Request It: The best way is to send a message through your online UC journal. Clearly state that you are requesting a "Mandatory Reconsideration" of the decision dated [date of decision]. You can also call the UC helpline, but it is always better to have a written record.
3. Provide Your Reasons: This is the most critical part. Clearly explain why you think the decision is wrong. Be specific and factual. For a WCA decision, describe how your condition affects you and why you believe you meet the criteria for LCW or LCWRA. Use the descriptors from the WCA to frame your argument. Gather supporting evidence: new or existing fit notes, letters from doctors or specialists, hospital reports, and personal statements.
4. The Reconsideration Process: A different DWP case manager will review your file and all the new evidence you have submitted. This process can take several weeks, sometimes longer.
5. The Outcome: You will receive a Mandatory Reconsideration Notice in your journal. This letter will state whether the original decision has been changed or upheld.
6. Next Steps: Appeal: If you are still dissatisfied, you can now appeal to the independent First-tier Tribunal (Social Security and Child Support Tribunal) within one month. You usually do this online via the GOV.UK website.

Gathering Your Evidence: Building a Strong Case

A review is only as strong as the evidence that supports it. Do not assume the decision-maker knows anything about your situation.

• Medical Evidence is Key: Fit notes are essential, but go further. Provide detailed letters from your GP, consultant, psychiatrist, physiotherapist, or any other medical professional involved in your care. Ask them to specifically address how your condition affects your ability to perform tasks related to work.
• Keep a Diary: A personal diary detailing your symptoms, bad days, and how they impact your daily life (e.g., "could not prepare a meal due to dizziness," "severe pain prevented concentration for more than 10 minutes") can be powerful, firsthand evidence.
• Correspondence: Keep copies of all letters, emails, and journal messages. Note down dates, times, and the names of anyone you speak to on the phone.
• Witness Statements: If a friend, family member, or carer helps you, ask them to write a short statement describing the help they provide and the limitations they observe.

Where to Find Help and Support

You do not have to navigate this complex system alone. Free, expert help is available.

• Citizens Advice: Offers free, confidential, and impartial advice on benefits. They can help you understand the decision, gather evidence, and even help you write your Mandatory Reconsideration request.
• Turn2us: A national charity that helps people in financial need. Their website has a brilliant benefits calculator and information on grants.
• Advance Local Welfare Rights Units: Many local councils have their own welfare rights teams who can provide specialist advice and representation.
• Mental Health and Specific Condition Charities: Organizations like Mind, Rethink Mental Illness, Scope, and McMillan Cancer Support often have dedicated benefits advisors who understand the specific challenges faced by people with those conditions.

The path to securing the correct amount of financial support when you are unwell can feel like a labyrinth designed to discourage you. Bureaucratic language, tight deadlines, and the sheer stress of managing a health condition can be overwhelming. Yet, these systems have built-in checks and balances for a reason. A significant number of Mandatory Reconsiderations are successful, leading to changed decisions. By understanding your rights, meticulously gathering evidence, and seeking support, you can level the playing field. It is not about gaming the system; it is about ensuring the system does what it was designed to do: provide a vital lifeline when you need it most. Your health and your financial well-being are worth the fight.