NHS injury allowance: how the top-up works, with a calculator

Last updated 27 September 2026 · By Mustafa Bilgic · Rules from sections 14 and 22 of the NHS Terms and Conditions of Service Handbook, Statutory Sick Pay from GOV.UK

Because full sick pay is already above 85% of pay, the allowance usually starts when your sick pay drops to half pay or runs out. The calculator works through your absence month by month: it applies the NHS sick pay scale for your length of service, adds Statutory Sick Pay and any contributory benefit, and tops each month up to 85% until the 12-month limit is reached.

Sick pay and when the allowance starts

The injury allowance does not add extra sick leave. It sits on top of the normal NHS sick pay scale, which depends on your reckonable service. While you are on full pay your income is above 85%, so nothing is paid. The NHS Employers guide gives the example of an employee with six months of full pay and six months of half pay, who triggers the allowance at the point he moves from full pay to half pay.

Your sick pay for an absence is worked out by taking the paid sick leave you had in the previous 12 months off your entitlement. An absence caused by a work-related injury, disease or health condition that qualifies for the allowance is ignored in that count, so time off for a work injury does not eat into your sick pay for later illnesses. If earlier absences have already used up your sick pay, the allowance can start from the first day. The calculator takes earlier paid sick leave off full pay first, then half pay.

Who qualifies for NHS injury allowance

Section 22 covers employees whose injury, disease or other health condition is wholly or mainly attributable to their NHS employment. It must have been sustained or contracted in the course of their duties, or be an injury not sustained on duty but connected with or arising from their employment. The NHS Employers guide gives examples: a physical or psychiatric injury from a specific incident or series of incidents, a disease such as hepatitis C after a needlestick injury that appears years later, a road accident while travelling on official duty, and being assaulted on the way home from work by a former patient. Payment does not depend on length of service. Three situations do not qualify:

• an injury on a normal journey to and from work, unless the journey is part of your contractual NHS duties;
• sickness absence resulting from disputes about employment matters, conduct or job applications;
• an injury, disease or condition caused or seriously aggravated by your own negligence or misconduct.

The guide adds that the allowance is unlikely to be paid where the condition is attributable to another cause, such as the natural progression of a pre-existing condition, normal wear and tear or an injury that is not work-related. Your employer decides whether the condition is attributable to your NHS work, taking appropriate medical advice, for example from occupational health. It uses the civil standard of proof, the balance of probabilities, so the question is whether it is more likely than not. You have to provide the relevant information you have or can reasonably get, including medical evidence. If you disagree with the decision, you can appeal through your employer's local grievance procedure.

How the allowance is worked out

The allowance tops up your sick pay, or your earnings on a phased return, to 85% of pay as defined in paragraph 14.4. For absences that qualify for the allowance, pay means 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, normally based on the previous three months. The guides of NHS Employers and of Scotland's terms and conditions committee list what counts towards the 85%:

You must claim any contributory state benefits you may be entitled to and tell your employer when you receive them, and an employer will recover any overpayment. Statutory Sick Pay in 2026/27 is £123.25 a week, or 80% of your normal weekly earnings if that is lower, for up to 28 weeks. New Style Employment and Support Allowance for a person aged 25 or over is £95.55 a week in 2026/27 before any component. The allowance is subject to income tax and National Insurance but not to pension contribution deductions.

How long injury allowance lasts

The allowance is limited to up to 12 months per episode, subject to your employer's absence management, return to work and rehabilitation policies. The 12 months count the months in which the allowance is paid, not the months of absence: the NHS Employers guide explains that after a return to work, any unused allowance, up to 12 months in total, can top up pay if the original injury causes further absence. It also says there is no right to use the full 12 months. The allowance stops when any of these happens:

• the 12-month maximum is reached;
• your pay is no longer below 85%;
• you return to your substantive job or are redeployed;
• your contract of employment ends, which may give access to ill health retirement if you are in the NHS Pension Scheme.

If you return on a phased basis and your pay is reduced during an agreed rehabilitation period, the allowance can top it up to 85%, within the same 12 months. Where a further work-related injury or condition makes the original one worse, a new episode may begin. If you have to move permanently to a lower-paid job because of the injury, you get a period of protected pay on the same terms as local pay protection during organisational change.

Injuries before 31 March 2013: Temporary Injury Allowance

For injuries and diseases from before 31 March 2013, the old NHS Injury Benefits Scheme applies instead. Its Temporary Injury Allowance is also paid by employers and also tops income up to 85% of average pay, and NHS Business Services Authority says it stops when you return to work or leave employment. The Scottish Public Pensions Agency notes that the new allowance differs in being limited to the employment contract and to 12 months for each injury or disease. Like the new allowance, Temporary Injury Allowance is taxed and subject to National Insurance but not pension contributions. The same scheme can pay Permanent Injury Benefit if an injury from before that date permanently reduces your earning ability by more than 10%. NHS Pensions only considers applications received after 30 March 2018 where there is evidence of a delayed onset of symptoms, and access to the scheme closes on 31 March 2038.

England, Wales, Scotland and Northern Ireland

Section 22 of the handbook refers to the sickness absence sections for England, for Wales and for Scotland and Northern Ireland, which all use the same sick pay scale. The Scottish Public Pensions Agency confirms that in Scotland the injury allowance replaced Temporary Injury Benefit from 31 March 2013. In Northern Ireland the HSC Pension Service says a new injury allowance scheme was introduced on 31 May 2013.

Injury allowance and compensation claims

The allowance does not require anyone to be at fault: the test is whether the condition is wholly or mainly attributable to your NHS employment. If someone else caused your injury and you claim damages, the handbook says you are not entitled to sick pay for the absence if damages are received from a third party: your employer advances the sick pay and you repay it when the damages are paid. For a claim against your employer see claiming against your employer, and for lost income in a claim see loss of earnings claims. You may also be able to claim Industrial Injuries Disablement Benefit from the Department for Work and Pensions.

Worked example

A nurse with more than five years of service earns £36,000 a year, or £3,000 a month, and is off for 12 months after a back injury from lifting a patient. The allowance tops income up to £2,550.00 a month. Months 1 to 6 are on full pay, so nothing is paid. In month 7 she gets half pay of £1,500.00 and the last two weeks of Statutory Sick Pay, £246.50, so the allowance is £803.50. In months 8 to 12 it is £1,050.00 a month. Over the absence she receives £6,053.50 of injury allowance, and six of her 12 months are used. This example is our calculation from the handbook rules and the 2026/27 SSP rate.

Sources and methodology

The calculator applies paragraphs 14.2, 14.6 and 14.7 and paragraphs 22.8 to 22.13 of the handbook, counts Statutory Sick Pay as sick pay as the NHS Employers and STAC guides say, and counts the 12 months as months in which the allowance is paid, as in the NHS Employers examples. It was tested on those examples and on the SSP, benefit and phased return rules. A month is treated as 52/12 weeks for SSP and weekly benefits.

• NHS Terms and Conditions of Service Handbook, sections 14 and 22, NHS Employers.
• Injury allowance: a guide for employers, NHS Employers (PDF).
• Injury allowance: guide for staff, Scottish Terms and Conditions Committee (PDF).
• Statutory Sick Pay and benefit and pension rates 2026 to 2027, on GOV.UK.
• Temporary Injury Allowance and About the Injury Benefits Scheme, NHS Business Services Authority.
• Injury benefits, Scottish Public Pensions Agency, and Ill health and injury benefits, HSC Pension Service.

Frequently asked questions

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