NHS Injury Allowance Explained: 85% Pay for Work-Related Illness

Most NHS staff are never told about injury allowance, and it is one of the least discussed parts of the Handbook. This guide explains who qualifies, how the 85% is worked out, how it changes the sick pay picture and how to claim. It is based on Section 22 and the connected paragraphs of Section 14 (England text, amendment 63). Trust procedures for claiming vary, and this is general information rather than HR or legal advice.

What injury allowance is

Section 22 says injury allowance is paid to eligible employees who, due to a work-related injury, illness or other health condition, are on authorised sickness absence or a phased return to work with reduced pay or no pay (para 22.1). It is a top-up: it does not replace sick pay, it adds to it when your pay has dropped, and it works alongside Section 14 (sickness absence) and the local absence procedures (para 22.2).

Who qualifies (Handbook 22.3 to 22.7)

• ✓ Work-related condition (para 22.3): an injury, disease or other health condition wholly or mainly attributable to your NHS employment, sustained or contracted in the discharge of your duties, or an injury not sustained on duty but connected with or arising from your employment.
• ✓ No minimum service (para 22.6): it does not depend on how long you have worked in the NHS.
• ✓ Evidence (para 22.5): you must provide all relevant information, including medical evidence, in your possession or that can reasonably be obtained.
• ✓ The decision (para 22.4): the employer determines attribution, should seek appropriate medical advice, and must use the civil standard of proof: on the balance of probability, meaning more likely than not.

It is not available in these circumstances (para 22.7):

• ✕ Injury while on a normal journey travelling to and from work, except where the journey is part of your contractual NHS duties.
• ✕ Sickness absence as a result of disputes relating to employment matters, conduct or job applications.
• ✕ An injury, disease or condition due to or seriously aggravated by your own negligence or misconduct.

Some examples of where Section 22 can apply, depending on the evidence: an injury from an assault by a patient, a needle-stick injury, a back injury from moving and handling, or an infection or other disease contracted through the work. Whether a particular case meets the "wholly or mainly attributable" test is a judgement on the evidence, so do not assume you are in or out without asking.

How much: the 85% top-up

The allowance tops up your sick pay, or your earnings when on reduced pay including on a phased return, so that your income reaches 85% of pay (para 22.8). Three details matter:

• • Which pay: 85% of pay as defined in para 14.4. For staff covered by that paragraph, which includes those absent from work-related injuries who are determined eligible for injury allowance, pay is calculated on the basis of what you would have received had you been at work, including regularly paid supplements such as recruitment and retention premia, payments for work outside normal hours and high cost area supplements, based on the previous three months or another locally agreed reference period. Staff on other terms may be on the pay point basis in para 14.5. Ask your payroll which applies to you.
• • State benefits count: the calculation includes any contributory state benefits you receive, which are offset at the rate you actually receive them. Other benefits and payments are ignored (paras 22.8 and 22.10).
• • You must claim and declare benefits (para 22.11): you are required to claim any contributory state benefits you may be entitled to and declare them to your employer, because overpayments are recovered.

While you are on full sick pay, your pay is above 85%, so there is nothing to top up. The allowance starts to matter when your pay falls to half pay, or to nothing when sick pay is exhausted.

Worked example: Band 6

This illustration uses the 2026/27 Band 6 starting salary of £39,959 (basic pay only, from the England pay scales on this site). Weekly pay is £768.44, and 85% of that is £653.18. It assumes the half-pay and no-pay stages of sick pay and no contributory benefits. Your own full pay under para 14.4 may be higher if you regularly receive supplements.

The figures are gross and illustrative. How Statutory Sick Pay, which can be paid alongside half pay up to full pay (para 14.6), is treated in your trust's calculation is a matter for payroll, so ask for the working. Use the sick pay calculator to see how long full and half pay last for your service.

How long it lasts

Up to 12 months per episode, subject to local absence management, return to work and rehabilitation policies (para 22.12). It can also be paid during an employer-approved phased return where your pay is reduced (para 22.13), and the clock runs the same way. It stops when you return to full pay. The Handbook does not define a new episode, so if the same condition flares up later, ask HR in advance how your trust treats it.

Why it matters for your sick pay

Three connected rules in Section 14 are worth knowing:

Para 14.20 also says staff on sickness absence due to a work-related injury, disease or condition may be entitled to injury allowance. If your sick pay has run out, see our guide to what happens when NHS sick pay runs out, which covers half pay reinstatement under para 14.10 and what comes next. For the general scale, see NHS sick pay explained.

How to claim, step by step

Section 22 does not prescribe a claim form, so the process is set by each trust. A sensible sequence:

If your claim is refused

Where you disagree with the employer's decision on attribution, you are entitled to appeal through local grievance procedures (paras 22.4 and 22.16). Practical steps:

• ✓ Ask for the decision and the reasons in writing, and what medical advice was used.
• ✓ Check that the balance of probabilities test (more likely than not) was applied, not a higher standard.
• ✓ Get further medical evidence on cause if you can, from your GP, specialist or occupational health.
• ✓ Raise a formal grievance if needed, with your union representative. See the grievance procedure guide and staff representation.
• ✓ If your absence is also leading to capability action, make sure the work-related cause is on the record and see our guide to dismissal guidance.

Tax, pension and overpayments

• • Tax and NI: injury allowance is subject to income tax and National Insurance (para 22.9).
• • Pension: it is not subject to pension contribution deductions (para 22.9). How it counts for pension benefits is a question for NHS Pensions. See NHS Pension and long-term sickness.
• • Overpayments: an employer can seek to recover overpayments, and where recovery is necessary should take into account the period the overpayment was in place when agreeing repayments (para 22.15). See our guide to overpayments of NHS wages.
• • Pay protection: if you have to move permanently to a lower-paid job because of the injury, you receive protected pay equal to the local provision during organisational change (para 22.14). See NHS pay protection.
• • Damages from a third party: if you receive damages for an accident, para 14.16 says you are not entitled to sick pay as such, and employers advance sick pay on the basis that you repay it. Speak to your union if you are bringing a claim.

The older Injury Benefits Scheme

You may see references to the NHS Injury Benefits Scheme run by the NHS Business Services Authority, which includes Temporary Injury Allowance and Permanent Injury Benefit. NHSBSA says Temporary Injury Allowance was replaced on 31 March 2013 by the injury allowance in Section 22, and that Permanent Injury Benefit is no longer available for people who sustain an injury or contract a disease due to NHS employment on or after 31 March 2013, with the scheme closing on 31 March 2038. For injuries after that date, Section 22 is the route. See the NHSBSA pages on Temporary Injury Allowance and Permanent Injury Benefit.

Related guides

This page is general information about Section 22 of the NHS Terms and Conditions of Service Handbook and is correct to the best of our knowledge as of October 2026. Wales, Scotland and Northern Ireland use the same Section 22 but their Section 14 wording and paragraph numbers differ, and trust procedures vary. It is not legal or HR advice. FrontlinePay is independent and is not affiliated with the NHS, NHS Employers or the NHS Business Services Authority.