Form

Mesothelioma payment claim form

Claim form for a payment for mesothelioma or another lung disease.

• From: Department for Work and Pensions
• Published: 1 October 2013
• Last updated: 2 October 2023 — See all updates

Documents

Mesothelioma and other lung diseases interactive claim form

PDF, 394 KB, 16 pages

Details

Read the diffuse mesothelioma payment guidance for information about eligibility and how to claim.

Use this form to claim a payment for mesothelioma or another lung disease. 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:

• use a desktop or laptop computer

• 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:

• saved onto your computer

• opened in a recent version of PDF reader

The form will not save in:

• versions of Acrobat Reader older than version XI

• 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 IIDB Centre.

Contact the DWP Online Helpdesk, if you are having technical difficulties:

• downloading the form

• navigating around the form

• printing the form

DWP online helpdesk

Email [email protected]

Telephone 0800 169 0154

Monday to Friday 8am to 6pm

Closed weekends and all public and bank holidays

Find out about call charges

If you need this form in a different format

Contact the IIDB Centre to ask for:

• a printed copy of the form

• a different format, such as large print, braille or audio CD

Published 1 October 2013
Last updated 2 October 2023 + show all updates

1. 2 October 2023

   Updating Welsh to match changes to English page

2. 13 July 2023

   Updated the Mesothelioma payment claim form.

3. 30 January 2023

   DWP have introduced a new Mesothelioma and other lung diseases 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.

4. 1 October 2013

   First published.