Terms and abbreviations

Transcription

1 Recovery of Benefits and or lump sums and NHS Charges Z1 Last Updated July 2009 Terms and abbreviations Issued by CRU and tells the compensator which recoverable benefits and Certificate or lump sum payments have been paid (or are likely to be paid) and the total amount to be repaid. Issued by CRU and tells the compensator whether NHS treatment was Certificate of with or without admission to hospital, the number of admission days, NHS Charges ambulance charges and the amount to be repaid. Compensation Any payment made by way of compensation for an accident, injury or a payment disease (whether in money or in money's worth). The person, who caused the accident, injury or disease, or, more Compensator commonly, his insurer. CRU Compensation Recovery Unit. DSD Department for Social Development (in Northern Ireland). DWP Department for Work and Pensions (in Great Britain). A payment specifically exempt from the provisions of the 1997 Act and the Exempt payment Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 Health Service A health service hospital within the meaning of the National Health Service Hospital Act 1977 or the National Health Service (Scotland) Act Injured person The person claiming compensation. (IP) National Health Service. In Northern Ireland the term health services NHS applies. Any treatment (including examination of the traffic casualty) other than those described in Section 6 of the Road Traffic (NHS Charges) Act 1999 NHS Treatment (including any examination of the injured person) other than see Part 3 of the Health and Social Care (Community and Health Standards) Act 2003, section (7). Social security benefits (and Statutory Sick Pay paid before 6 April 1994) Recoverable listed in Schedule 2 of the Social Security (Recovery of Benefits) Act 1997 benefits and paid in the relevant period. Payments made under the Pneumoconiosis etc. (Workers' Compensation) Recoverable Act 1979, the 2008 Diffuse Mesothelioma Scheme or an ex-statutory Lump Sums payment that was paid because the person didn't qualify for a payment under the 1979 Act.

2 The period in respect of which benefits and NHS charges may be Relevant period recovered. The date on which the compensation payment is made in accordance with either the Social Security (Recovery of Benefits) Act 1997, the Road Settlement date Traffic (NHS Charges) Act 1999 and the Health and Social Care (Community Standards) Act 2003 and the Health and Social Care (Community Health and Standards) Act SSP Statutory Sick Pay. TS Tribunals Service. The Social Security (Recovery of Benefits) Act In Northern Ireland The Acts the corresponding provisions may be found in The Social Security (Recovery of Benefits) (Northern Ireland) Order The Road Traffic (NHS Charges) Act Part 3 of the Health and Social Care (Community Standards) Act 2003 In Northern Ireland the The NHS Acts corresponding Act is the Health & Personal Social Services Act (Northern Ireland) The Health and Personal Social Services (Joint Committee for Commissioning) Order Introduction and general information This Z1 is for general guidance only and should not be regarded as a substitute for the legislation. The legislation is available online at Background CRU GB operates primarily to deliver the following legislation: The Social Security (Recovery of Benefits) Act 1997, the Road Traffic (NHS Charges) Act 1999 and The Health and Social Care (Community Health and Standards) Act In 1997, legislation was passed which introduced a new recovery scheme with effect from 6 October Part IV of the Social Security Administration Act 1992, Part IV of the Social Security Administration (Northern Ireland) 1992 and Sections 2 (1)(1A)(3) and (6) of the Law Reform (Personal Injuries) Act 1948 were repealed. The Social Security Act 1998 introduced changes to the Social Security (Recovery of Benefits Act) 1997 which provide clearer grounds for review, two new grounds for appeal and for appeals to be heard by appeal tribunals instead of Medical Appeal Tribunals (MATs). These provisions are effective from 29 November The Child Maintenance and Other Payments Act 2008 introduced changes to the Social Security (Recovery of Benefits Act) 1997, which provides for the recovery of lump sum payments. These changes are effective from 1 October 2008, and apply to all cases settled on or after that date. On 5 April 1999 the Road Traffic (NHS Charges) Act 1999 came into force. This Act allows CRU to recover NHS hospital charges arising from road traffic accidents where a compensation payment is made on or after 5 April 1999.

3 On 2 April 2001 the Health and Personal Social Services Act (Northern Ireland) 2001 was introduced and allows for the recovery of health services charges by CRU in Northern Ireland. On 29 January 2007 Part 3 of the Health and Social Care (Community Health and Standards) Act 2003 which allows for the recovery of the costs of providing treatment to an injured person in all cases where that person has made a successful personal injury claim against a third party was commenced. The equivalent legislation in NI is The Recovery of Health Services NHS Charges (Northern Ireland) Order Who Administers the Scheme The Compensation Recovery Unit, which is part of the Department for Work and Pensions. The Compensation Recovery Unit (NI) is part of the Social Security Agency, which is an executive agency within the Department for Social Development (DSD). Overview Part 1 of this guide explains the recovery scheme in more detail including how the scheme applies to lump sum payments paid under the Pneumoconiosis etc. (Workers' Compensation) Act 1979 and part 4 of the Child Maintenance and Other Payments Act It also provides information on the review and appeals process. Part 2 of this guide explains the NHS charges scheme in more detail and provides details on the review and appeal procedures. The NHS30 Appeal form may be found at the back of this guide. Part 3 of this guide is for miscellaneous information including Disclosure of Information, Data Protection and Electronic Communications. The law allows us 4 weeks to issue Certificates. The period is four weeks from the day following the day on which an application is received. Certificates of NHS charges will be issued as soon as is reasonably practicable. However our aim is to issue them as soon as possible. We will acknowledge all claim notifications made on form CRU1 within 12 working days and general correspondence within 10 working days. How to contact us. Please tell us the CRU reference number if you know it. It will help us to deal with your enquiry more quickly. It consists of 3 letters followed by 3 numbers, e.g. XYZ-123. If you are unable to provide the CRU reference number please tell us the injured person s National Insurance (NI) number, full name and date of birth. If the case you are enquiring about is located on one of our specialist areas, your call may be transferred to that area.

4 Our normal business hours are Monday to Thursday 8.30am-4.30pm and Friday 8.30am- 4.00pm. Further information may be obtained from the guides below: Z2 Recovery of benefits and or lump sum payments Appeal Guide GL27 Compensation, Social Security Benefits and or Lump Sum Payments Please note: If the case is being handled by CRU Northern Ireland, please read all references to DWP in this guide as DSD and all reference to NHS as Health Services. If the case is specific to a NHS Trust in Scotland please read all reference to the Secretary of State in this guide as the Scottish Minister. Contact details for case specific NHS enquiries. You can read more about the NHS Injury Cost Recovery Scheme on the Department of Health website, and the Health and Social Care (Community Health and Standards) Act 2003 on the Office of Public Sector Information website. Schemes outside Great Britain A separate scheme exists for residents of the Isle of Man; any enquiries should be addressed to: DHSS Markwell House Market Street Douglas Isle of Man IM1 2RZ Tel: The Law The law on the recovery scheme is contained in: The Social Security (Recovery of Benefits) Act 1997 and The Social Security (Recovery of Benefits) Regulations 1997 as amended by paragraphs of Schedule 7 of the Social Security Act 1998 The Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 The Social Security and Child Support (Decision and Appeals) Regulations 1999, regulations 9, 9ZA and The Social Security (Recovery of Benefits) (Northern Ireland) Order 1997 The Social Security (Recovery of Benefits) (Northern Ireland) Regulations 1997

5 The Social Security Act 1998 The main provisions of the CRU scheme are that: a person should not be compensated twice over in respect of the same accident, injury or disease; a compensator who is, or is alleged to be, liable to any extent for the accident, injury or disease makes a compensation payment, agreed on or after 6 October 1997 and recoverable benefits and or lump sums have been paid (or are likely to be paid); to, or for, the injured person in respect of an accident, injury or disease; However where a payment was made on or after 6 October 1997 in accordance with a Court Order or agreement made before that date, the provisions of the Social Security Administration Act 1992 and the Social Security (Recoupment) Regulations will continue to apply. a compensator who makes a compensation payment after 1 October 2008, is also liable to repay any lump sums paid under the Pneumoconiosis, etc. (Workers' Compensation) Act 1979 and Part 4 of the Child Maintenance and Other Payments Act 2008 the scheme applies in the UK or elsewhere, regardless of where the compensator is based, or where the accident occurred. the 2008 mesothelioma scheme applies to those people who have contracted diffuse mesothelioma as a result of asbestos exposure in the UK. No person shall make a compensation payment (other than an exempt payment) without first applying to CRU for a Certificate. The compensator will be liable to pay the DWP an amount equal to the total amount of the recoverable benefits, however lump sum recovery cannot exceed the amount of compensation paid. CRU must issue the Certificate within 28 days from the date of receipt of a request which contains all the information. If after a Certificate has been issued, CRU become aware that a recoverable lump sum has been paid, a revised Certificate will be issued to include the lump sum amount. Under the provisions of the Social Security (Recovery of Benefits) Act 1997, and the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008, the compensator - the person who caused the injury or, more commonly, his insurer - is liable both to pay damages to the injured person and to repay benefits and or lump sums to the Secretary of State for Work and Pensions. In certain circumstances it will be possible for the compensator to deduct some or all of the amount he has had to repay to the Secretary of State from the gross compensation award, a practice known as "offsetting"

6 Where the amount of compensation relating to a particular head of compensation is less than the amount of the corresponding benefit, the compensator is still liable to repay the total amount of benefits shown on the Certificate. Under the provisions of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 the compensator must reduce the general damages element of the compensation award before reducing the special damages element of the award. Where the amount of compensation is less than the lump sum payment CRU can only recover an amount up to the equivalent of the gross compensation award. The compensator is liable to repay lump sum payments before repaying recoverable benefits When making a deduction the compensator must inform the injured person. The compensator, the injured person or his representative may ask at any time for the Certificate to be reviewed. It may only be changed if: o o o a mistake occurred in the preparation of the Certificate the amount of recoverable benefit and or lump sum on the Certificate is more than the amount due to the Secretary of State for Work and Pensions incorrect or insufficient information was provided by the person who applied for the Certificate and as a consequence the amount on the Certificate is less than the amount due to the Secretary of State If after we have looked at the Certificate again we find that there is no recoverable benefit and or lump sum due to the Secretary of State then the Certificate may be revoked. A compensator has the right of appeal but only if the claim giving rise to the compensation payment has been finally disposed of, and the liablity under section 6 of the 1997 Act or regulation 10 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 has been discharged, An injured person has a similar right, but only where his compensation payment has been reduced to take account of benefit recovery under section 8 of the 1997 Act, or to take account of lump sum recovery under Regulation 12 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations An appeal may be made on the grounds that: o o any amount, rate or period specified in the Certificate is incorrect; or benefits and or lump sums listed in the Certificate have been paid other than because of the accident, injury or disease in question, and should not have been included; or

7 o o benefits and or lump sums listed which have not, and are not likely to be, paid to the injured person have been brought into account; or the compensation payment was not made as a consequence of the accident, injury or disease. 1.1 The relevant period The period in respect of which benefits, listed in Schedule 2 of the 1997 Act, may be recovered by DWP begins on: the day following an accident or injury; or in disease cases, the date that a listed benefit as shown in schedule 2, is first claimed in consequence of the disease. The period ends on: the day a compensation payment is made in final discharge of a claim; or the date an agreement is made between the compensator and injured person under which an earlier compensation payment is treated as having been made in final discharge of any claim; or the date five years after the relevant period begins, whichever comes first. Please note: 'The relevant period' is defined in Section 3 of the Social Security (Recovery of Benefits) Act Listed Benefits covered by the scheme Compensation in respect of Loss of Earnings during the relevant period may be reduced where the following benefits have been paid to meet the same need. Disability Working Allowance Disablement Pension payable under section 103 of the 1992 Act (also known as Industrial Injuries Disablement Benefit) Employment and Support Allowance Incapacity Benefit Income Support Invalidity Pension Invalidity Allowance Jobseeker s Allowance Reduced Earnings Allowance

8 Severe Disablement Allowance Sickness Benefit Statutory Sick Pay paid before 6 April 1994 Unemployability Supplement Unemployment Benefit Compensation in respect of Cost of Care may be reduced where the following benefits have been paid during the relevant period: Attendance Allowance Care Component of Disability Living Allowance (DLA Care) Disablement Pension increase for Constant Attendance Allowance Exceptionally Severe Disablement Allowance Nursing care and attendance (including Holiday/Respite care) and the inability to cook may fall within Schedule 2. Compensation in respect of Loss of Mobility may be reduced where the following benefits have been paid during the relevant period Mobility Allowance Mobility Component of Disability Living Allowance (DLA Mobility) Travel to hospital for treatment and additional costs of travel including; Vehicle/Powered wheelchair/adaptations to transport/taxi bus fares (where paid as a result of accident, injury or disease)/increased cost of car/additional travel for holiday may fall within Schedule 2. NB: Payment into court forms require the compensator to list the benefits which have been offset against the above heads of damages. Damages not within Schedule 2 Pain and suffering Loss of future earnings Cost of future care Loss of future mobility Loss of expectation of life and bereavement Loss of amenities of life Loss of society Loss of leisure Loss of specific enjoyment Loss of congenial employment Loss of benefits associated with injured person's work Loss of use of motor car Hospital visits other than for treatment Medical expenses (not included in cost of respite or nursing care and attendance) Special appliances (except as mentioned in

9 Loss of deprivation of privacy loss of mobility) Loss of marriage prospects Special diet Breakdown of marriage Special accommodation Second home on breakdown of marriage Paid help, gardener/cleaner Loss of carrying out DIY Guide dog Loss of housekeeping capacity Court protection fees Loss on the labour market Actuarial evidence and related matters (Smith v Manchester) Investment/management advice Loss of financial interest Loss of pension rights It is stressed that the above list is not definitive, nor does it purport to be an interpretation of the law. It is for general guidance only, and should be treated as such. Where the amount of compensation in respect of a particular head of compensation is less than the amount of a listed benefit to be recovered, the compensator is liable to pay the difference. He may not reduce payment against any other head of compensation to take account of the recovery of a listed benefit. Examples of Offsetting: Example 1 - Benefit recovery only An award of compensation totalling 100,000 is agreed and broken down as follows: general damages of 40,000, 30,000 in respect of loss of earnings and 30,000 in respect of loss of mobility. The CRU certificate lists Incapacity Benefit totalling 5,000, Income Support totalling 10,000 and Disability Living Allowance (Mobility Component) totalling 10,000. The compensator may not under any circumstances offset against the general damages element of the award. He may however offset the Incapacity Benefit and Income Support against the loss of earnings head of damage, as set out in section 8 and Schedule 2 of the Recovery of Benefits Act. He therefore deducts a total of 15,000 from the loss of earnings sum, leaving 15,000 to be paid to the injured person. Similarly, the compensator may offset the 10,000 DLA (Mobility) against the loss of mobility head of damage, leaving 20,000 to be paid to the injured person. The injured person has settled his claim for a total of 100,000. Following offsetting, he receives 75,000 from the compensator in addition to the 25,000 he has already received from the state benefits system. Double compensation is thereby avoided. Example 2 - Benefit recovery only An award of compensation totalling 100,000 is agreed and broken down as follows: general damages of 40,000, 30,000 in respect of loss of earnings and 30,000 in respect of loss of mobility.

10 The CRU certificate lists Incapacity Benefit totalling 20,000, Income Support totalling 50,000 and Disability Living Allowance (Mobility Component) totalling 30,000. The compensator may not under any circumstances offset against the general damages element of the award. He may however offset the Incapacity Benefit and Income Support against the loss of earnings head of damage, as set out in section 8 and Schedule 2 of the Recovery of Benefits Act. He therefore deducts a total of 30,000 from the loss of earnings sum, leaving Nil to be paid to the injured person, but the CRU certificate shows that 70,000 should be repaid to the Secretary of State. As the compensator can only offset 30,000 he is liable to pay the difference ( 40,000) himself. The compensator may offset the 30,000 DLA (Mobility) against the loss of mobility head of damage, again leaving Nil to be paid to the injured person. The injured person has settled his claim for a total of 100,000. Following offsetting, he receives only the award for general damages amounting to 40,000. Double compensation is thereby avoided. 1.3 Lump Sum payments covered by the scheme Lump sum payments made under the Pneumoconiosis etc. (Workers Compensation) Act 1979, the 2008 Diffuse Mesothelioma Scheme any ex-statutory payment that was paid because the person didn t qualify for a payment under the 1979 Act. Example of Offsetting - Lump sum and benefit recovery An award of compensation totalling 60,000 is agreed and broken down as follows: general damages of 15,000, 25,000 in respect of loss of earnings and 20,000 in respect of loss of mobility. The CRU certificate lists Lump Sums totalling 20,000, Income Support totalling 15,000, and Disability Living Allowance (Mobility Component) totalling 10,000. The compensator must offset the 20,000 Lump sum payment from the General Damages first, which would leave an outstanding balance of 5,000. He may then offset from any of the remaining heads of damage, i.e. the compensator may offset the outstanding balance of 5,000 plus the 15,000 Income Support from the loss of earnings head of damage and the 10,000 DLA (Mobility) from the loss of mobility head of damage. The injured person has settled his claim for a total of 60,000. Following offsetting, he receives 15,000 from the compensator in addition to the 45,000 he has already received from the state benefits system. Double compensation is thereby avoided.

11 Please note: Heads of Compensation are defined in Schedule 2 of the Social Security (Recovery of Benefits) Act NOTES 1. If the claim is settled for general damages only, the compensator is still liable to repay the full amount of listed benefits and or lump sum payments as shown on the Certificate. 2. The compensator cannot deduct any amount in respect of a listed benefit from the compensation awarded for general damages (pain and suffering). However they can deduct any amount in respect of a lump sum from any part of the compensation award. 3. Lump Sum Payments must be offsett against pain and suffering first. 4. Attendance Allowance was replaced by the care component of Disability Living Allowance (DLAC) from 6 April Mobility Allowance was replaced by the mobility component of Disability Living Allowance (DLAM) from 6 April Unemployment Benefit and Income Support for unemployed people was replaced by Jobseeker s Allowance on 7 October Incapacity Benefit replaced Sickness and Invalidity Benefit from 13 April Statutory Sick Pay 100 per cent of SSP paid before 6 April 1991 and 80 per cent of SSP paid from 6 April 1991 to 5 April 1994 is recoverable. Payments made after 6 April 1994 are no longer subject to recovery. 9. Disabled Persons Tax Credit, now Working Tax Credit, replaced Disability Working Allowance from 5 October No new or non-linking claims to Severe Disablement Allowance (SDA) may be accepted with an entitlement date after 6 April Customers currently in receipt of SDA will remain entitled as long as they continue to satisfy the qualifying conditions. 11. Employment and Support Allowance replaces Incapacity Benefit, and Income Support on the grounds of incapacity, for all new claims from 27 October Retirement Pension is not a recoverable benefit. However any of the benefits listed on the previous two pages which continue to be paid after retirement age will be subject to recovery. 13. Where a lump sum payment has been made to a dependant(s) of P and the compensator is making a compensation payment in respect of P under the Fatal Accidents Act, to that dependant(s), CRU will recover the lump sum amount equal to the amount of compensation paid to that dependant(s).

12 14. Pensions awarded by the Service Personnel and Veterans Agency are not a recoverable benefit, but may be adjusted to take account of a compensation payment. 15. Bereavement benefits are not recoverable; however any other benefits listed in Schedule 2 to the Social Security (Recovery of Benefits) Act 1997 which have been paid to the bereaved person may be recoverable. 1.4 Exempt payments in respect of the recovery of listed benefits and lump sum payments. Recovery will not be made from the following types of payments as listed in Schedule 1 of the 1997 Act. 1. Any small payment (defined in Part II of this Schedule). 2. Any payment made to or for the injured person under Section 35 of the Powers of Criminal Courts Act 1973 or Section 249 of the Criminal Procedure (Scotland) Act 1995 (compensation orders against convicted persons). 3. Any payment made in the exercise of a discretion out of property held subject to a trust in a case where no more than 50 per cent by value of the capital contributed to the trust was directly or indirectly provided by persons who are, or are alleged to be, liable in respect of: a. the accident, injury or disease suffered by the injured person, or b. the same or any connected accident, injury or disease suffered by another. 4. Any payment made out of property held for the purpose of any prescribed trust (whether the payment also falls within para. 3 above or not). 5. Any payment made to the injured person by an insurance company within the meaning of the Insurance Companies Act 1982 under the terms of any contract of insurance entered into between the injured person and the company before: a. the date on which the injured person first claims a listed benefit in consequence of the disease in question, or b. the occurrence of the accident or injury in question. 6. Any redundancy payment failing to be taken into account in the assessment of damages in respect of an accident, injury or disease. 7. So much of any payment as is referable to costs. 8. Any prescribed payment.

13 The following trusts are prescribed for the purpose of paragraph 4 of Schedule 1: and may be found in Regulation 2.1 of the Social Security (Recovery of Benefits) Regulations 1997, and Regulation 7 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations a. the Macfarlane Trust established on 10th March 1988 partly out of funds provided by the Secretary of State to the Haemophilia Society for the relief of poverty or distress among those suffering from haemophilia; b. the Macfarlane (Special Payments) Trust established on 29 January 1990 partly out of funds provided by the Secretary of State for the benefit of certain persons suffering from haemophilia; c. the Macfarlane (Special Payments) (No. 2) Trust established on 3 May 1991 partly out of funds provided by the Secretary of State for the benefit of certain persons suffering from haemophilia and other beneficiaries; d. the Eileen Trust established on 29 March 1993 out of funds provided by the Secretary of State for the benefit of persons eligible for payment in accordance with its provisions; e. a trust established out of funds provided by the Secretary of State in respect of persons who suffered, or who are suffering, from variant Creutzfeldt-Jakob disease for the benefit of persons eligible for interim payments in accordance with its provisions; (Statutory Instrument 2001 No. 1118, which amends the 1997 Regulations). f. a trust established out of funds provided by the Secretary of State in respect of persons who suffered, or who are suffering, from variant Creutzfeldt-Jakob disease for the benefit of persons eligible for payments, other than interim payments, in accordance with its provisions. (Statutory Instrument 2001 No. 1118, which amends the 1997 Regulations). o The following payments are prescribed for the purposes of paragraph 8 of Schedule 1 of the 1997 Act, and Regulation 7 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations o o o any payment made under the Vaccine Damage Payments Act 1979(c) to or in respect of the injured person; any award of compensation made to or in respect of the injured person under the Criminal Injuries Compensation Act 1995(d) or by the Criminal Injuries Compensation Board under the Criminal Injuries Compensation Scheme 1990 or any earlier scheme; any payment made to the injured person in respect of sensorineural hearing loss where the loss is less than 50 db in one or both ears;

14 o o o o o any contractual amount paid to an employee by an employer of his or hers in respect of a period of incapacity for work; any payment made under the National Health Service (Injury Benefits) Regulations 1995(e) or the National Health service (Scotland) (Injury Benefits) Regulations 1974(f); any payment made by or on behalf of the Secretary of State for the benefit of persons eligible for payment in accordance with the provisions of a scheme established by him on 24th April 1992 or, in Scotland, on 10th April 1992 any payment made from the Skipton Fund, the ex-gratia payment scheme administered by the Skipton Fund Limited, incorporated on 25 March 2004, for the benefit of certain persons suffering from hepatitis C and other persons eligible for payments in accordance with the scheme's provisions. any payment made from the London Bombings Relief Charitable Fund, the company limited by guarantee (number ) and registered charity of that name established on 11th July for the purpose of (amongst other things) relieving sickness, disability or financial need of victims (including families or dependants of victims) of the terrorist attacks carried out in London on 7th July NB. For Northern Ireland only: any payment made to or for the injured person under Article 14 of the Criminal Justice (Northern Ireland) Order 1994 (compensation orders against convicted persons). Please note: Where it is clear that the compensation claim falls into one of the above categories, you do not need to send form CRU1 to us. 1.5 Exempt trusts and payments, which only apply to the recovery of listed benefits any payment to the extent that it is made - i. in consequence of an accident under the Fatal Accidents Act 1976(a) or ii. in circumsatances where had an action been brought, it would have been brought under that Act any payment to the extent that it is made in respect of a liability arising by virtue of Section 1 of the Damages (Scotland) Act 1976(b); any payment made under the Fatal Accidents (Northern Ireland) Order 1977(c) any compensation payment made by British Coal in accordance with the NCB Pneumoconiosis Compensation Scheme set out in the Schedule to an agreement made on the 13 September 1974 between the National Coal Board, the National Union of Mine Workers, the National Association of Colliery Over-men Deputies and Shot-firers and the British Association of Colliery Management;

15 the UK Asbestos Trust established on 10 October 2006, for the benefit of certain persons suffering from asbestos-related diseases or the EL Scheme Trust established on 23 November 2006, for the benefit of certain persons suffering from asbestos-related diseases. Where compensation is paid under any of the above, for any of the following diseases; Mesothelioma Pneumoconiosis (including silicosis, asbestosis, kaolinosis) Diffuse pleural thickening Primary carcinoma of the lung Byssinosis a form CRU1 must be completed to enable a Certificate to be issued which will provide details of any Lump sums paid. Please note: The Social Security (Recovery of Benefits) Act 1997 Schedule 1 Part 1, the Social Security (Recovery of Benefits) Regulations 1997 Regulation 2 and Regulation 7 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 lists all exempt payments and trusts. 1.6 DWP right to inspect records The Social Security Administration Act 1992 Section 110, gives DWP inspectors the right to examine the records of compensators and employers to verify that they are complying fully with the provisions of the Social Security (Recovery of Benefits) Act How the recovery scheme works The main procedures for compensators 1. compensation claim received; 2. check the details to be given to CRU (name, address, date of birth, National Insurance number etc); 3. notify CRU of the claim within 14 days. A form CRU1 is provided for this purpose (also available electronically see Section 13 ); 4. receive acknowledgement of notification (form CRU4); 5. when ready to make an offer of compensation, return form CRU4 to apply for a Certificate; 6. receive acknowledgement of application, CRU 5 (if not received within 14 days check with CRU);

16 7. receive Certificate (if not received by date given on acknowledgement check with CRU). A copy will be sent to the injured person or his representative; 8. pay compensation and, if any deductions have been made in accordance with either the 1997 Act, or the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 you must inform the injured person; 9. notify CRU of the result of the claim, even if it is unsuccessful, by returning the form CRU102 that accompanies the Certificate. Ensure that any changes to your reference number are clearly noted; 10. notify CRU of the date the compensation payment is made in final discharge of the claim, 11. the compensator becomes liable to pay the full amount of the recoverable benefits and or lump sum payments to the CRU immediately before making the compensation payment; 12. pay the total amount of recoverable benefits and or lump sum shown on the Certificate to the DWP. The CRU may enforce this debt through the courts at any point from the fifteenth day following the date the compensation was paid. Please note: Payment should not be sent to CRU if a compensation payment has not been made to the injured person. The CRU Process 1. Compensator receives a claim for compensation 2. Compensator completes a CRU1 form and sends to CRU 3. CRU4 form sent to Compensator by CRU 4. Compensator is ready to settle claim and returns CRU4 requesting a Certificate. 5. CRU gathers benefit and or lump sum payment information, relating to the injured person and his accident, injury or disease 6. Certificate of benefit and or lump sum payment issued to Compensator and copy to injured person or his representative 7. Compensator pays final compensation to the injured person 8. Compensator notifies the CRU of the date the compensation payment was made in final discharge of the claim and repays the total amount of benefits and or lump sums to the CRU. CRU may enforce this debt through the courts at any point from the 15th day following the date the compensation was paid. 2. Guidance for compensators

17 2.1 Recovery procedures When you receive a claim for compensation, send form CRU1 to CRU within 14 days. This does not mean that you have accepted any liability for the accident, injury or disease. We will send you form CRU4 to acknowledge that we have received the CRU1. You will need to return form CRU4 to us when applying for a Certificate, or a Certificate of NHS Charges. If you do not have a Certificate or a Certificate of NHS Charges when you are ready to settle the claim, you must apply for one by returning form CRU4. We will acknowledge receipt of your request. If you have not received the acknowledgement within 14 days, please let us know. We will issue the Certificate within 4 weeks of receiving a request (see also Section 2.10 Having a certificate renewed). The Certificate will specify the total amount of recoverable benefits and or lump sums or NHS Charges. In the case of recoverable benefits and lump sum payments, you become liable to pay CRU immediately before you pay any compensation payment. We will send a copy of the Certificate to the injured person or his representative. Help us to help you In order for us to provide a prompt and accurate service it is essential that you tell us about claims as early as possible. If you delay sending us the information on form CRU1 this may cause difficulties and further delay when you request a Certificate. We need to notify the Department's benefit paying offices that a compensation claim has been made as soon as possible. Failure to notify CRU at the early stage of a claim for compensation may mean archived records need to be retrieved from remote storage and you may have to wait longer for an urgently required Certificate. 2.2 Completing form CRU1 Please complete the form as fully as possible. It will save further enquiries later on. You must tell us the following information when someone claims compensation from you: the injured person's full name and address (if the injured person has previously been known by a different name, e.g. a maiden name, it would be helpful if you could tell us); their date of birth; National Insurance Number, if known; the date of the accident, incident or injury; a full description of the nature of the accident, incident, injury or disease;

18 whether the accident was a Road Traffic Accident (RTA) which occurred prior to 29 January 2007 only; if the person attended a NHS hospital because of the RTA, or the injury or incident which occurred on or after 29 January 2007 (at any time for any treatment, examination etc.); the full name and address of the hospital(s) or trust(s) the injured person attended or was admitted to (in order of attendance); if you are claiming an exemption under the Road Traffic Act 1988 (section 144) you must state the category of exemption (See Para. 7.5) for RTA's prior to 29 January whether or not the injured person was employed at the date of incident; details of the injured person s employment if known (only where the date of incident is before 6 April 1994); the reference number you use to identify the case. If your reference number changes before the claim is settled, you should inform us of the new reference number; in order to help us process the claim, please tell us whether the claim is public liability (P), motor (M), employer (E), clinical negligence (C) or other (O); if a claim is registered as 'M' liability but the accident occurred during a person's employment you must notify CRU of that fact. The injured person may have claimed Industrial Injuries Disablement Benefit; if the claim is "P", "M", "O" or "C" and the date of incident is before 6 April 1994 you should give us the name and address of the injured person s employers at the time of the accident, injury or disease. We may then obtain information about Statutory Sick Pay (SSP); in "E" liability cases the compensator must provide the SSP information when applying for a Certificate, if SSP was paid prior to 6 April 1994; if a solicitor is acting on your behalf you must show his name, address and reference number on form CRU1. This will ensure that correspondence is sent to the correct address. If you take over a claim from another compensator, please notify us in writing and if form CRU 1 has not previously been submitted, attach a completed form CRU1 to your letter Failure to provide the essential information listed above could delay the issue of the Certificates. Additional supplies of form CRU1 may be obtained by completing an ion order form and returning it by either or Fax as shown on the order form.

19 A Word template version of the CRU1 can also be obtained from: Tel: Fax: Obtaining a Certificate When we receive form CRU1 we will send you a form CRU4 which you may use to apply for a Certificate. Please do not ask for a Certificate until you are ready to settle the claim. Important: Only return form CRU4 to us when you are ready to settle the claim. Statutory Sick Pay (SSP) Employer liability cases only In all employer liability cases where the date of incident is prior to 6 April 1994 (or in disease cases where SSP may have been paid before that date) you should ask the relevant employer for details of any SSP that the injured person was paid as a direct result of the accident, injury or disease. Complete form CRU4 to show the gross amount of SSP. Make sure you do not include any Occupational Sick Pay that may have been paid together with the SSP. The amount shown on the Certificate will include 100 per cent of SSP paid before 6 April 1991 and 80 per cent of SSP paid from 6 April 1991 to 5 April SSP information for periods on or after 6 April 1994 is not required, as the benefit is not recoverable after that date. 2.4 Urgent requests for Certificates If you need a Certificate urgently (e.g. because of an imminent court hearing) we will do our best to issue one as soon as possible. It may not be possible to issue the certificate immediatley but we will send it as quickly as possible. 2.5 The Certificate The Certificate will include: details of the injured person's identity and where appropriate the date of the incident which gave rise to the compensation claim; the total of each recoverable benefit paid up to a specified date; the total amount of each recoverable lump sum paid the rate expected to be paid for a short future period if benefit is still in payment; the date the Certificate ceases to be valid; the total amount we require to be repaid;

20 a note to say whether any of the above amounts or dates have been estimated. Where there was no valid Certificate in issue at the time the claim was settled and compensation paid, a Certificate will be issued by CRU, but it will only be valid for the day the claim settled. The validity period of a Certificate varies according to circumstances. It is important to check each Certificate to establish how long it is valid for. 2.6 Powers to Estimate The law allows us to estimate any amount, date or period specified in the Certificate (Social Security (Recovery of Benefits) Act 1997, Section 5(4)) also Reg 4(1)(a) and 9(3) of the The Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations Issue of the Certificate We will send the Certificate to you and at the same time we will send a copy to the injured person or his representative. Write to us if you have any queries about the Certificate. We will issue a further Certificate if necessary (see also Section 6, Reviews and appeals). 2.8 Increase of recoverable benefits included on Certificates After a Certificate has been issued we may become aware that further recoverable benefits have been paid. These benefits would have been included in the Certificate had we been aware of them at the time it was issued. During the validity of a Certificate the amount of recoverable benefit shown cannot be increased, except where the compensator has provided us with incorrect or insufficient information. If recoverable benefits are inadvertently omitted from a Certificate, and a compensation payment is not made during the period of validity of that Certificate, the additional benefits will be shown on any later Certificate. In order to give as much notice as possible of this, we will notify you in writing if we become aware that a future Certificate will be affected in this way. 2.9 Increase of lump sums included on Certificates If we become aware that recoverable lump sums have been paid after a Certificate has been issued, we will issue a revised Certificate to include the lump sum amount and the revised Certificate will supercede any previous certificate Having the Certificate renewed The compensator should only request renewal Certificates when he is ready to settle the claim. Persistent requests for renewal Certificates when the claim is not ready to be settled generates extra work and expense for everyone and may cause delays.

21 We cannot issue a new Certificate until the current one expires. Where it is clear that the case is very near settlement and that the current Certificate will expire before the settlement takes place you may request a renewal Certificate. Renewal Certificates will be issued within four weeks of the expiry of the current Certificate What to do after the Certificate is issued Please tell us as soon as possible when you know the outcome of the claim even if it is unsuccessful. Form CRU102 should be used for this purpose. Failure to do this may result in you incurring costs for the retrieval of files from storage. CRU will not pay the retrieval costs where a compensator has not informed us of the date the compensation payment was made in final discharge of the claim. If no notification has been received about the outcome of a compensation claim after two years, automatic follow up action will be taken to obtain the result of the claim. A form CRU250 will be issued and should be completed and returned immediately. When compensation has been paid you MUST send us the form CRU102, together with a cheque for the amount specified on the Certificate. Cheques should be crossed and made payable to "Department for Work and Pensions only" (in Northern Ireland "Social Security Agency only"). Do not send a cheque before sending form CRU102. Please ensure the correct CRU reference number is shown on the remittance advice note, along with your claim reference number and if possible the incident/accident date or the name of the injured person. You may send one cheque in respect of any number of claims. In order that we may allocate a bulk payment correctly to each case, the cheque MUST be accompanied by a schedule detailing ALL the CRU reference numbers and the AMOUNT DUE for each individual case. The total amount on the schedule should be checked to ensure the cheque is for the correct amount. If you choose this option you should bear in mind that the liability to pay DWP arises immediately before making the compensation payment, and the CRU may enforce this debt through the courts at any point from the fifteenth day following the date the compensation was paid Penalty for default The DWP may take action against you to secure payment of the recoverable amount if: you make a compensation payment but do not apply for a Certificate; and/or you fail to repay us the specified amount. If you obtain a Certificate and make the appropriate compensation payment but fail to pay the DWP, we will send you a reminder. Payment must be made immediately you receive the reminder. If your records show that you have already sent us a payment, then you should provide us with the details, e.g. the cheque number and the date it was cashed. If you have not sent us a payment because you do not agree with the amount on the Certificate, then you may request a review (see also Section 6).

22 In accordance with Section 7-(3)(4)(5) of the 1997 Act, and Regulation 11 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008, failure to pay DWP the amount shown on the Certificate may result in legal action being taken against you. Please refer to the Social Security (Recovery of Benefits) Act 1997, Section 6 - Liability to pay the Secretary of State amount of benefits, and Section 7 - Recovery of payments due under section 6. Also Regulation 10 - Liability to pay Secretary of State amount of lump sum payments and Regulation 11 - Recovery of payment due under Regulation Requests and notifications not appropriate for CRU 3.1 Professional negligence Form CRU1 need not be submitted for a compensation claim arising from alleged professional negligence. CRU does not pursue this type of case and cannot issue a Certificate. If details of benefits paid are required, a request should be made to the relevant DWP benefit paying office. If you have already sent us a CRU1 for such a case please let us know as soon as possible. The claim can be settled without further reference to CRU. However, if compensation is also to be paid as a result of the original accident, injury or disease, form CRU1 must be submitted by the compensator. 3.2 Compensation for criminal injuries The Compensation Recovery Scheme does not apply to criminal injuries cases. If details of benefit are required they should be obtained from the relevant DWP benefit paying office. For information go to the Criminal Injuries Compensation Scheme website 3.3 Requests for details of benefits paid prior to the date of accident, injury or disease We cannot provide details of benefits paid before the date of incident, or give any estimate of which benefits might have been payable had the incident not occurred. CRU can only provide details of benefits paid as a result of an accident, injury or disease for which compensation has been claimed. 4. Complex Cases 4.1 Interim Payments When a compensator makes an interim compensation payment, he will be liable to repay to the DWP all recoverable benefits paid during the relevant period and all lump sum payments paid up to the date of the interim payment. If the compensator makes any further payments, or an agreement that a previous payment was in final settlement of the claim, he will be liable to repay any further benefits and or lump sums paid.

23 However, before making any further payment, or reaching an agreement that a previous payment was in final settlement of the claim, the compensator: should apply for a fresh Certificate. This Certificate will show details of all recoverable benefits and or lump sums and the balance to be paid by the compensator. In cases where there are recoverable benefits and a further compensation payment is made, the compensator: may aggregate the payments already made with the payments about to be made to CRU and the injured person; and use these aggregate amounts when calculating the reductions that may be made under Section 8 of the 1997 Act, see also Regulation 9 of the Social Security (Recovery of Benefits) Regulations In cases where there are recoverable lump sums and a further compensation payment is made, the compensator: may aggregate the payments already made with the payments about to be made to CRU and to P, and use these aggregate amounts when calculating the reductions that may be made under Regulations 10 and 14 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations Multiple compensators Normally when there is more than one compensator involved in a claim for compensation they will act together so that only one compensation payment is made to the injured person and the DWP. However, where this does not happen compensators will be liable to repay any benefits and or lump sums, which have not already been repaid. Each compensator may make only those reductions to the injured person's compensation allowed by Section 8 of the 1997 Act and Regulations 10 and 11 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 in relation to the compensation he is paying to the injured person and the benefits and or lump sum he is repaying to DWP. The Health and Social Care (Community Health and Standards) Act 2003, gives provision for apportionment of liability to pay NHS charges where more than one compensator is involved. If evidence is provided to enable the CRU to determine the liability, of each compensator, we can apportion the amount of relevant NHS charges that would be payable if there were only one compensator. NOTE

24 Apportionment cannot be applied to the Social Security (Recovery of Benefits) Act Structured Settlements When a compensator, in final settlement of a claim, enters into an agreement for the making of periodical compensation payments (whether of an income or capital nature) or for the making of such payments and lump sum payments and those payments would fall to be treated as compensation payments: The date of the agreement will be classed as the day of a single compensation payment and liability will end at that time, if it has not done so already. Any further payments made otherwise than under the agreement will be disregarded for the purpose of determining the end of the relevant period in relation to that further payment. 4.4 Payments into court (England, Wales and Northern Ireland) Where compensation is paid into court the compensator remains liable to repay any recoverable benefits and or lump sums due, to the DWP. The compensator must obtain a Certificate and lodge it with the payment into court. The payment into court should be net of any recoverable benefits and or lump sums and net of any allowable deductions specified in Schedule 2 of the 1997 Act (see Section 1.2, Listed benefits covered by the scheme, and Section 1.3, Lump Sum Payments covered by the scheme). The relevant period for recovery of benefits ends on: the day the payment into court is made - but only where the payment in is accepted within 21 days after the injured person is notified that the payment in has been made; or if accepted outside of the 21 days, the date on which application to the court for payment out is made. in cases where the payment is made in accordance with an order of the court, the date of that order The compensator becomes liable to pay the full amount of recoverable benefits and or lump sums to the DWP once he is notified that the payment into court, or any part of it, has been paid out to the other party. Please note: Section 16 of the Social Security (Recovery of Benefits) Act 1997 and Regulation 8 of the Social Security (Recovery of Benefits) Regulations 1997 refer to Payments into court. Please note

25 A Part 36 Offer without a payment into court does not end the relevant recovery period. (See section 3 of the 1997 Act regarding the end of the relevant period) 4.5 Insurer's liability Further information about cases where the amount of benefits to be repaid and the amount of the compensation exceed the insurers maximum liability may be obtained from CRU. 4.6 Clinical negligence Claims involving clinical negligence may be particularly difficult. We therefore have a small team of specialists who deal with these cases. This is because they need to decide how much of the benefit was paid as a result of the negligence. It is important that form CRU1 is submitted in clinical negligence claims as soon as you have been notified of the claim. This will enable us to provide a prompt and accurate service. Please contact our Clinical Negligence Team if you have any queries about this complex area of work. 4.7 Goodwill payments A goodwill payment, usually in the form of gift vouchers or the like, is sometimes made in response to a complaint about a product or incident; for example, if someone slips in a retailers premises and suffers only minor injury, inconvenience or embarrassment or if the consumption of foodstuffs is alleged to have caused a stomach complaint. If such a payment is made at the time of the complaint or incident, CRU does not need to know about it. However, if such a payment is made at a later date, benefits may have been claimed in the meantime. In these cases, a form CRU1 must be submitted, especially if there is a claim in respect of loss of earnings, cost of care or loss of mobility. For NHS charges, where incidents or injuries were caused on or after 29 January 2007, in accordance with The Health and Social Care (Community Health and Standards) Act 2003, the term "compensation payment" includes not just payments of money but payment in money's worth, which might include, for example, provision of free rehabilitation services. It does not, however, capture ex gratia payments where there can be no legal liability to make payment. 4.8 Professional negligence Where a claim is made for professional negligence and the particulars of claim, statement of claim or letter before action includes a claim for compensation as a result of the original accident, injury or disease, form CRU1 must be submitted and any listed benefits and or lump sum paid in consequence of the original accident, injury or disease will be recoverable. 4.9 Property damage only claims

26 You must notify CRU on form CRU1 if a claim for property damage includes a claim for loss of earnings, loss of mobility, cost of care or any other element of compensation. 5. Guidance for injured person's representatives The compensator will give us your details when he notifies us of the compensation claim. You should always give the compensator your client's full name, address, date of birth and National Insurance number. You should also provide as much information as possible about the injured person's injuries or nature of the disease. If your client has had a road traffic accident or attended hospital for an injury on or after 29 January 2007, it is essential that you provide details of the hospital(s) attended, and whether the accident happened during the course of the injured person's employment. If you give incorrect or incomplete details it may cause delay or inaccuracies in calculating the amount of recoverable benefit and or lump sum payment. If the injured person has been known by any other name, e.g. maiden name, please give details. The compensator must request a Certificate before he pays compensation. You cannot request a Certificate, but you will be sent a copy of the Certificate. If the injured person disagrees with the amount of benefit and or lump sum specified on the Certificate, they may ask for it to be reviewed (see Section 6 Reviews and Appeals). If necessary a fresh Certificate will be issued. The injured person may also appeal against a Certificate. An appeal cannot be made until after final settlement of the claim and the compensator has repaid the total amount of recoverable benefits and or lump sum payments to the Secretary of State. An injured person may only appeal if the amount of compensation he or she receives has been reduced by the compensator to take account of benefit and or lump sum recovery in accordance with section 8 of the 1997 Act and Regulation 12 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations The law only allows the compensator to apply for a Certificate. If you need to know the amount of benefits and or lump sums your client has received you may ask us for a statement of benefits and or lump sums. If you are pursuing a claim for professional negligence or criminal injuries compensation, or need benefit details outside the five-year statutory period on behalf of your client please contact the injured person's benefit paying office. Please note: Regulation 4 of the Social Security (Recovery of Benefits) Regulations 1997 and Regulation 16 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations 2008 refers to Information to be provided by the injured person. 6. Reviews and appeals

27 6.1 Reviews The compensator, the injured person, or either party's representative may ask CRU to review any aspect of a Certificate at any time. Please put your request in writing giving the reasons why you think the Certificate is wrong. A review may be made on the following grounds: that it was issued in ignorance of, or based on a mistake as to, a material fact; or a mistake was made (whether in computation or otherwise) in its preparation; or incorrect or insufficient information was supplied to the Secretary of State by the person who applied for the Certificate and in consequence the amount of benefit/lump sum specified in the Certificate was less than it would have been had the information supplied been correct or sufficient; or a ground for appeal is satisfied under section 11 of the Act. When we review a Certificate we look at all the benefits and or lump sum payments we have listed as recoverable, the amounts paid, and the period over which they have been or are likely to be paid. Any errors, omissions or other changes, which may affect the outcome of the review, will be taken into account, even if unrelated to your reasons for requesting the review. Once the review is complete, we will either confirm in writing that the Certificate is correct or revoke the Certificate and issue a fresh one. If a revised Certificate is issued it will cover the same period as the Certificate it replaces. We will issue a fresh Certificate showing an increase in the amount of recoverable benefits only where the variation is required because the person who applied for the Certificate, supplied us with incorrect or insufficient information. Where this happens, the compensator will be liable to pay the difference to CRU. Lump Sums If we become aware that recoverable lump sums have been paid after a Certificate has been issued, we will issue a revised Certificate to include the lump sum amount and the revised Certificate will supercede any previous certificate. 6.2 Appeals Leaflet Z2 explains how to appeal against a Certificate. It also contains the form that can be used. An appeal against a Certificate may be made on the grounds that: any amount, rate or period specified in the Certificate is wrong; the Certificate shows benefits and or lump sums which were not paid as a result of the accident, injury or disease;

28 benefits and or lump sum payments listed which have not and are not likely to be paid to the injured person have been brought into account; the compensation payment made was not as a consequence of the accident, injury or disease. Please note: Any requests for appeal that do not comply with the above grounds will be regarded as invalid and referred to the Tribunals Service for authority to proceed. An appeal may only be made after final settlement of the compensation claim and payment of recoverable benefits and or lump sum payments has been made. An appeal must be made within one month of the date on which the compensator makes the full payment of recoverable benefits and or lump sums to the Secretary of State. For appeal purposes, orders for provisional damages in personal injury cases made under or by virtue of section 32A(2)(a) of the Supreme Court Act 1981, section 12(2)(a) of the Administration of Justice Act 1982, or section 51(2)(a) of the County Courts Act 1984, are to be treated as having been finally disposed of. Late appeals are determined by the chairperson of the Tribunals Service and may be accepted where there are special circumstances for lateness. Late appeals cannot be accepted 13 months after the date the right to appeal arose. An appeal may be made by a compensator or by an injured person whose compensation payment has been reduced by the compensator to take account of benefit/lump sum recovery, in accordance with section 8 of the 1997 Act and Regulation 12 of the Social Security (Recovery of Benefits) (Lump Sum Payments) Regulations Appeals are heard by an independent tribunal administered by the Tribunals Service. The tribunal may decide that the amount on a Certificate is correct or that the amount may be either increased or decreased. Following the decision CRU will either confirm or revoke the Certificate and issue a fresh one. Where the amount on a Certificate is increased following an appeal the compensator will be liable to pay the balance of recoverable benefits and or lump sum payments to the DWP. Where the amount on a Certificate is reduced, the balance will be refunded to the compensator. Where the compensator has offset some of the amount on a certificate (see examples of offsetting in Section 1.2, Listed benefits covered by the scheme) against the compensation paid to the injured party, some or all of the refund may need to be passed on to the injured party. Any party may make an appeal to the Social Security Commissioners against the decision of an appeal tribunal on the grounds that the decision was erroneous in law. Such an appeal may only be brought with leave of the Appeal Tribunal Chair or the Commissioners.

29 Application for leave to appeal to the Commissioners should be made to the Tribunals Service. Please note: Sections of the Social Security (Recovery of Benefits) Act 1997 and Regulations 9 and of the Social Security and Child Support (Decision and Appeals) Regulations 1999 contain information regarding Reviews and Appeals. 7. The Law - NHS Charges 7.1 The law on the NHS Charges scheme in GB is contained in: The Road Traffic Act 1988 The Road Traffic (NHS Charges) Act 1999 and The Road Traffic (NHS Charges) Regulations 1999 [S.I No. 785] as amended by SI 2006 no 3388 and, in Scotland, by SSI 2001/466, 2002/56 and 528, 2004/76 and 2005/123. The Road Traffic (NHS Charges) (Reviews and Appeals) Regulations 1999 [S.I.1999 No.786] The Health and Social Care (Community and Standards) Act 2003, part 3 The Personal Injuries (NHS Charges) (General) and Road Traffic NHS Charges) (Amendment) Regulations [SI2006 No. 3388]. The Personal Injuries (NHS Charges) (Reviews and Appeals) and Road Traffic (NHS Charges) (Reviews and Appeals) (Amendment) Regulations [S.I No. 3398] The Personal Injuries (NHS Charges) (Amounts) Regulations [S.I No.115]. The Road Traffic (NHS Charges) (Reviews and Appeals) (Scotland) Regulations 1999 [S.I No.1843 (S.111)] The Personal Injuries (NHS Charges) (General) (Scotland) Regulations 2006 [S.S.I No. 592] The Personal Injuries (NHS Charges) (Reviews and Appeals) Scotland [Regulations S.S.I No. 593] The Personal Injuries (NHS Charges) (Amounts) Scotland [Regulations S.S.I No 588]. The Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2008 S.I No.252 and in Scotland S.S.I. No 96.

30 The Road Traffic (NHS Charges) Act 1999 scheme applies where a person (the traffic casualty) has suffered an injury or fatal accident, as a result of the use of a vehicle on a road and received treatment at a NHS hospital, and subsequently makes a successful claim for compensation for that injury or death. A compensator who is, or is alleged to be liable for the road traffic accident then, makes a compensation payment(including an interim payment) on or after 5 April 1999 is liable for repayment of NHS charges. Where a road traffic accident occurred before 29 January 2007, in accordance with Section 1(3) of the Road Traffic (NHS Charges) Act A compensation payment means: a payment made by an authorised insurer under or in consequence of a policy issued under section 145 of the Road Traffic Act 1988, a payment made by the owner of the vehicle, in a case where the vehicle is one in relation to the use of which a security under Part VI of that Act is in force, a payment made by the owner of the vehicle who has made a deposit under that Part, or a payment made in pursuance of a compensation scheme for motor accidents. The Health and Social Care (Community Health and Standards) Act 2003, part 3, applies if a person makes a compensation payment to or in respect of any other person (the injured person ) in consequence of any other injury, whether physical or psychological, suffered by the injured person, and the injured person has received NHS treatment at a NHS hospital and/or has been provided with NHS ambulance service. Where an incident or injury occurred on or after 29 January 2007, in accordance with Section 150(3), the Health and Social Care (Community Health and Standards) Act 2003, compensation payment means - a payment including a payment in money s worth, made: a. By or on behalf of a person who is, or is alleged to be, liable to any extent in respect of the injury, or b. In pursuance of a compensation scheme for motor accidents, but does not include a payment mentioned in Schedule 10. It is not mandatory for a compensator to apply for a Certificate of NHS charges prior to making a compensation payment; however, if a compensator makes a compensation payment he must apply for a Certificate of NHS charges. For road traffic accidents before 29 January 2007, the main recoverable liability is motor, in accordance with the Road Traffic (NHS Charges) Act For incidents or injuries occurring on or after 29 January 2007 the main areas of recoverable liability include motor, employer, public and product liability, but this list is not exhaustive.

31 From incidents occurring on or after 29 January 2007, the 2003 Act extends to almost ALL compensators and not just insurance companies and those holding a security or deposit in accordance with the 1988 Act. The provisions under the 2003 Act are not restricted to payments made as a result of insurance and it is the person making the payment in the primary compensation claim who will be liable for the NHS Charges. It also brings provision for the establishment of a scheme to recover costs of providing treatment to an injured person in all (not just motor liability) cases where that person has made a successful personal injury claim against a third party on or after 29 January The 2003 Act extends to foreign compensators, incidents and injuries abroad etc. providing NHS treatment is provided in England, Scotland or Wales. The 2003 Act does not extend to disease cases, unless the disease in question is attributable to the injury suffered by the injured person. The 2003 Act has introduced the collection of ambulance journey charges, which are applicable per person per ambulance journey. Under the 2003 legislation NHS Trusts or Health Boards who are also the compensator are exempt from repaying their own NHS Charges but are liable to repay any other NHS Trusts or Health Boards NHS charges up to the maximum amount. NHS Trusts or Health Boards are not exempt from paying ambulance costs. After receiving a completed request CRU will issue the Certificate of NHS charges as soon as is reasonably practicable. The compensator will be liable to pay DWP the amount shown on the Certificate of NHS charges within fourteen days of making the compensation payment if a valid Certificate is held, or within fourteen days of the issue of the Certificate. CRU will refund the NHS charges to the responsible body of the hospital and ambulance service that provided treatment, within forty days of receipt. The compensator may ask for the NHS Charges Certificate to be reviewed if: a mistake occurred in the preparation of the Certificate; the amount specified in the Certificate is in excess of the amount due to the Secretary of State or Scottish Ministers; incorrect or insufficient information was supplied to the Secretary of State or Scottish Ministers by the person who applied for the Certificate and in consequence the amount specified in the Certificate was less than it would have been had the information supplied been correct or sufficient or; it appears that a ground for appeal is satisfied. For incidents occurring on or after 29 January 2007, there is a time limit for requesting a review. An application must be made in writing and sent to the CRU, no later than 3 months after:

32 the date on the certificate. If later, the date on which the compensation payment was made. If, after we have looked at the Certificate again, we find that there are no recoverable NHS charges the Certificate will be revoked. Further information on reviews of NHS charges may be found in 11.1 of this guide. After all liability has been discharged, a compensator has the right of appeal against the Certificate of NHS Charges. An appeal may be made on the grounds that: An amount specified in the Certificate is incorrect; An amount so specified takes into account treatment which is not NHS treatment received by the injured person, in respect of his injury, at a health service hospital; or From 29 January 2007, a non-nhs ambulance service provides service to the injured person as a result of his injury, both treatment and ambulance services, as mentioned above, or; that the payment on the basis of which the Certificate was issued is not a compensation payment. For incidents occuring on or after 29 January 2007, there is, in exceptional circumstances, the provision to apply for a waiver on excessive hardship grounds, prior to appeal. Further information on appeals against NHS charges may be found in 11.2 of this guide. 7.2 The law on the Health Services Charges scheme in Northern Ireland (NI) is contained in: The Health and Personal Social Services Act (Northern Ireland) 2001 The Road Traffic (Health Services Charges) Regulations (Northern Ireland) 2001 [S.I No. 125] The Road Traffic (Health Services Charges) (Appeals) Regulations (Northern Ireland) 2001 [S.R No. 299] Amendment Regulations from [S.R No.434], [S.R No.52], [S.R No. 373], [S.R No.89], [S.R No.60], [S.R No. 67] The Recovery of Health Services Charges (Northern Ireland) Order 2006 The Recovery of Health Services Charges (General) Regulations (Northern Ireland) 2006 ][S.R No. 536].

33 The Recovery of Health Service Charges (Amounts) Regulations (Northern Ireland) [S.R No. 507]. The Recovery of Health Service Charges (Reviews and Appeals) Regulations (Northern Ireland) 2007 [S.R No. 24]. The Recovery of Health Service Charges (Amounts) (Amendment) Regulations (Northern Ireland) 2008(S.R 2008 No.90) Part II of the Health and Personal Social Services Act (NI) 2001, which equates to the Road Traffic (NHS Charges) Act 1999, introduced changes in respect of the recovery of health services hospital charges arising from road traffic accidents. The administrative arrangements introduced by the Act apply to all compensation payments made on or after 2 April 2001 irrespective of the accident date. However, the charges vary depending on the accident date. The main differences between the legislation applied in CRU (GB) and CRU (NI) are: as a result of a road traffic accident, where a compensator makes a compensation payment (including an interim payment) on or after 2 April 2001 he is liable to repay the appropriate charges in accordance with the Act. CRU (NI) may increase the amount specified in a Certificate on review without having to be satisfied that the compensator has provided incorrect or insufficient information. This will enable CRU (NI) to collect the correct amount when someone other than the compensator makes a mistake. CRU (NI) cannot recover a Health Services hospital charge in respect of treatment provided without admission to hospital prior to 2 April In Northern Ireland an incident attracting a Health Services hospital charge may occur on a road or other public place. 7.3 The relevant period The period in respect of which NHS Charges may be recovered by DWP begins on the first day of treatment following the incident. The period ends on: the day a compensation payment is made in final discharge of a claim provided the compensation payment is made on or after 5 April 1999; or the date an agreement is made under which an earlier compensation payment is treated as having been made in final discharge of any claim provided the date is after 5 April 1999; or when the appropriate tariff limit is reached. 7. The Law - NHS Charges

34 7.4 NHS Charges Tariff The amount to be charged will depend on when the incident or injury occurred. The charges will relate to either treatment provided without admission to hospital or treatment provided with admission to hospital, but not both. With admission charges are calculated according to the number of nights the injured person stays in hospital. This is subject to a minimum of one day when the casualty is released on the day of admission; this is known as a day case. Where the casualty is admitted to hospital on one day and discharged on another day, the day of discharge is disregarded. Therefore, only one day of treatment will be charged. Ambulance charges are recoverable for each ambulance journey to hospital, or transfer between hospitals, where treatment of the injuries for which compensation is awarded.(i.e. if a patient is taken by ambulance to Accident and Emergency at a hospital A ( 159), transferred and admittted to hospital B ( 159) and then transferred again to a specialist unit in hospital C ( 159) all 3 ambulance charges would be recoverable a total of 447). The ambulance charge is incorporated in the NHS capped tariff amount. Any recovery of NHS ambulance charges will be repaid direct to the NHS ambulance trust connected to the hospital or in Scotland to the Scottisj ambulance service. Charges will not be collected for charity funded air ambulances in England and Wales, however, they can be collected for the Scottish Ambulance Service, If they are used to transport a patient to a Scottish hospital. The following table can be used as a quick reference guide: NHS Treatment and Ambulance Journey Charges England and Wales Incident date (on or after) Outpatient Inpatient Cap Ambulance Charges (per person per journey) Pre , , , , , , , , , , NHS Treatment and Ambulance Journey Charges Scotland

35 Incident date (on or after) Outpatient Inpatient Cap Ambulance Charges (per person per journey) Pre , , , , , , , , , , Exempt Payments The following classes of compensation payment are exempt from the requirement to pay NHS Charges for road traffic accidents which occur before 29 January 2007: Any compensation payment made by a compensator who, in accordance with Section 144 of the Road Traffic Act 1988, has an exception from the requirement to hold third party insurance for his motor vehicles, Any compensation payment made: o o in pursuance of a compensation scheme for motor accidents by the Motor Insurers Bureau, and in respect of an accident occurring before 5 April 1999; by members acting as Domestic Regulations insurers if a declaration is held under Section 152 of the Road Traffic Act 1988 and the accident is before 5 April Details of exempted NHS payments for incidents occurring on or after 29 January 2007, please refer to Part 3 and Schedule 10 of the Health and Social Care (Community Health and Standards) Act A compensator who is exempt will not be issued with a Certificate of NHS charges, unless we have been notified of the exemption after a Certificate of NHS charges has been issued. In these circumstances, CRU will revoke the NHS Certificate and issue a NHS Certificate advising that no payment is due. You must therefore inform CRU if you receive a Certificate of NHS Charges on a compensation payment that is exempt. In Northern Ireland the relevant legislation is Part VIII of the Road Traffic (Northern Ireland) Order Guidance for compensators 8.1 Recovery procedures

36 When you receive a claim for compensation, send form CRU1 ensuring that where appropriate it contains the name and address of the hospital where treatment was provided as a result of the incident (road traffic accidents only for incidents occurring pre 29 January 2007). CRU1 must be submitted within 14 days. This does not mean that you have accepted liability for the accident. We will send you form CRU 4 to acknowledge that we have received the CRU1. You will need to return it to us when applying for a Certificate of NHS Charges. You do not need a Certificate of NHS charges prior to making a compensation payment. However, if all particulars are provided in accordance with the legislation, Whenever a certificate is requested we will also provide a Certificate of NHS charges. (A copy will not be sent to the injured person or his representative.) We will issue the Certificate of NHS charges as soon as is reasonably practicable after receiving your request (see also 8.3). The Certificate of NHS charges will specify the name of the responsible body (the NHS Trust or Health Board or Ambulance Trust) at which the treatment took place, the number of days of admission, and the appropriate NHS treatment and ambulance charges. You must pay the DWP the amount shown on the Certificate of NHS charges within fourteen days of making the compensation payment if a valid Certificate of NHS Charges is held, or within fourteen days of receiving the Certificate of NHS Charges. You must advise CRU of the date the compensation payment was made and the type of payment made eg. interim payment. You can also advise CRU of any contributory negligence settlement. You should use the form CRU102 that accompanied the Certificate for this purpose. Please note: PAYMENTS SHOULD NOT BE SENT TO CRU IF A COMPENSATION PAYMENT HAS NOT BEEN MADE TO THE INJURED PERSON. 8.2 Completing form CRU1 Details about how to complete this form may be found at para The Certificate of NHS Charges The Certificate of NHS charges is completely separate to the Certificate. The Certificate does not cover both schemes. A Certificate of NHS charges must always be obtained when you make a compensation payment. The Certificate of NHS Charges will include: details of the injured person s identity and the date of accident which gave rise to the compensation claim;

37 the name of the responsible body (NHS Trust or Health Board) at which the treatment took place; details of treatment povided, either with (and the number of days) or without treatment if applicable, the name of the responsible Ambulance Trust who provided the service the date the Certificate of NHS Charges ceases to be valid; the total NHS charges due to be repaid up to the maximum recoverable amount. If there is more than one compensator involved the 2003 Act makes provision for NHS Charges to be apportioned between the compensators for those incidents occurring on or after 29 January 2007 If you have any queries with the Certificate of NHS Charges please contact CRU and if necessary we will issue a further Certificate. You can find more information in Reviews and Appeals. 8.4 Increases in Certificate After a Certificate of NHS Charges has been issued we may become aware that further NHS charges are applicable which should have been included in the Certificate of NHS Charges had we been aware of them at the time of issue. The amount to be repaid cannot be increased once a Certificate of NHS Charges has been issued until that Certificate of NHS Charges expires, except where the compensator has provided us with incorrect or insufficient information. If NHS charges are inadvertently omitted from a Certificate of NHS Charges, and a compensation payment is not made during the period of validity of that Certificate of NHS Charges, the additional charges will be shown on any later Certificates of NHS Charges. 8.5 Having the Certificate renewed When a Certificate has expired a further Certificate may be requested. We cannot issue a new Certificate until the current one expires. We will issue a new Certificate as soon as is reasonably practicable. All Certificates of NHS charges now issued will be for the life of the claim. If the compensator advises that no NHS treatment was provided no payment is due and no NHS certificate will be issued. 8.6 What to do after the Certificate is issued Please tell us as soon as possible when you know the outcome of the compensation claim even if it is unsuccessful. Form CRU102, which accompanies the Certificate should be used for this purpose.

38 If no notification has been received about the outcome of a compensation claim after two years, automatic follow up action will be taken to obtain the result of the claim. A form CRU250 will be issued and should be completed and returned immediately. When compensation has been paid you must send the amount specified on the Certificate to DWP within 14 days of making the compensation payment if a valid Certificate is held, or within 14 days of receiving the Certificate. Payments should be by crossed cheque, payable to Department for Work and Pensions only (in Northern Ireland Social Security Agency only.) You may include payment for benefit recovery and NHS charges in the same cheque. You may send one cheque in respect of any number of payments. Send a schedule with the bulk payment giving details of the amount involved, the date and type of compensation payment and quoting the CRU reference number along with your claim reference number for each individual case. If you choose this option you should bear in mind that the liability to pay any individual amount within 14 days of making the compensation payment still applies. 8.7 Penalty for default Further information on this heading may be found at para Requests and notifications not appropriate to CRU NHS Charges cannot be recovered for claims arising from: Professional negligence claims Compensation for criminal injuries claims Further information may be found at section 3 of this booklet. 10. Complex cases 10.1 Multiple Compensation Payments When a compensator makes a compensation payment he will be liable to repay any NHS charges incurred up to the date of that payment. If the compensator makes any further payments, or an agreement that a previous payment was in final settlement of the claim provided it was on or after 5 April 1999, they will be liable to repay any further NHS charges, which have not already been repaid. However, after making any further payment, or an agreement that a previous payment was in final settlement of the claim, the compensator: Will be liable to repay any further NHS charges in the relevant period; and Should apply for a fresh Certificate of NHS charges. This Certificate will show details of all NHS charges and the balance to be paid by the compensator.

39 10.2 Structured Settlements Further information on this heading may be found in Part 1 Para Payments into Court (England and Wales) Where compensation is paid into court the compensator remains liable to repay any NHS charges to the DWP. Where a payment into court is made, the making of the payment is treated as a compensation payment, the day the payment into court is made but only where the payment in is accepted within 21 days after the injured person is notified that the payment in has been made; or If accepted outside of the 21 days, the date on which application to the court for payment out is made. In cases where the payment is made in accordance with an order of the court, the date of that order; or the date that the payment in is accepted by consent between the parties. The compensator must apply for a Certificate of NHS charges not later than 14 days after he is notified that the payment into court has been accepted. The settlement date means the date on which the person making the payment into court is notified that it has been accepted Fatal Accidents & The Fatal Accidents Act Incidents occuring prior to 29 January 2007 Where a compensation payment is made in accordance with the Fatal Accidents Act 1976 the compensator is liable to repay any NHS charges due as a result of the road traffic accident. NHS charges will not be levied when the victim is certified as dead on arrival at a NHS hospital. Any payment in consequence of an action under the Fatal Accidents Act 1976 is exempt from benefit recovery action. However, if any of the action is being brought under the Law Reform (Miscellaneous Provisions) Act 1934, a CRU1 needs to be completed Incidents occuring on or after 29 Januay 2007 Where a compensation payment is made is for an accident, incident or injury, which occurred on or after 29 January 2007, NHS charges will not be recoverable for fatal accidents. 10. Complex cases 10.5 Injured person resident in Northern Ireland or GB

40 Resident in Northern Ireland (NI): Where the injured person is a resident of Northern Ireland, for benefit recovery purposes the claim is handled by the Northern Ireland Compensation Recovery Unit (CRU NI), however where treatment has been provided at a hospital in England, Scotland or Wales, the DWP Compensation recovery Unit (CRU GB) will recover the NHS charges. The following procedures are in place: On receipt of a CRU1 from the compensator the claim will be taken onto both GB and NI systems, and you will be notified that this has been done. Each claim will have 2 reference numbers, one relating to CRU (GB) and one relating to CRU (NI). CRU (GB) will issue a Certificate of NHS charges while CRU (NI) will issue the Certificate of recoverable benefits. You will be liable to repay any NHS charges to CRU (GB) and any benefit recovery to CRU (NI). Where a Northern Ireland resident holds an insurance policy under the Road Traffic (NI) Order 1981 and causes an injury to a person on a road in GB, and the injured person receives NHS treatment in GB, CRU (GB) cannot recover the NHS charges. This is because the relevant policies are not held under the Road Traffic Act However, where an incident or injury has occurred on or after 29 January 2007, in accordance with the 2003 Act, liability to pay NHS charges extends to foreign compensators, accidents abroad etc. providing NHS treatment is given in England, Scotland or Wales. Where an injured person makes a compensation claim for personal injury and has received inpatient treatment as a result of that injury at a hospital in both Great Britain and Northern Ireland. NHS Charges will be recoverable under both The Health and Social Care (Community and Standards) Act 2003 and The Recovery of Health Services Charges (Northern ireland) Order Resident in Great Britain (GB): Where the injured person is a resident of GB for benefit recovery purposes the claim is handled by CRU (GB); however, where treatment has been provided at a hospital in Northern Ireland, CRU (NI) may recover the Health Services charges. The following procedures are in place: On receipt of a CRU1 from the compensator the claim will be taken onto systems, (GB and NI) and you will be notified accordingly. Each claim will have 2 reference numbers, one relating to CRU (GB) and one relating to CRU (NI).

41 CRU (NI) will issue a Certificate of health service charges while CRU (GB) will issue the Certificate of recoverable benefits. You will be liable to repay any health service charges to CRU (NI) and any benefit recovery to CRU (GB). Where a GB resident holds an insurance policy under the Road Traffic Act 1988 and causes an injury to a person on a road or other public place in Northern Ireland, and the injured person receives health services treatment, CRU (NI) cannot recover the health services charges. This is because the relevant policies are not held under the Road Traffic (NI) Order Where an injured person makes a compensation claim for personal injury and has received inpatient treatment as a result of that injury at a hospital in both Great Britain and Northern Ireland. NHS Charges will be recoverable under both The Health and Social Care (Community and Standards) Act 2003 and The Recovery of Health Services Charges (Northern ireland) Order Emergency Treatment Fee (ETF) The collection of the Emergency Treatment Fee (ETF) by NHS hospitals was abolished for claims settled on or after 5 April However, other parties, for example General Practitioners who provide immediately necessary treatment to a road traffic accident casualty, may continue to collect this charge. Under the terms of Section 158 of The Road Traffic Act 1988, the emergency treatment fee was levied on the user of a vehicle in respect of each person who required immediately necessary treatment as a result of a road traffic accident. The emergency treatment fee is a separate fee levied under the 1988 Act, and could be recovered along with any outpatient or inpatient treatment charges where a compensation payment was made prior to 5 April Please note: Previous payments of ETF to NHS hospitals, whether by the driver or his insurer, does not eliminate or reduce the liability to pay "without admission" charges Pre Paid NHS Charges Where a NHS hospital invoice has been raised and sent to an insurer prior to 5 April 1999 and a compensation payment was made on or after 5 April 1999 the compensator will still need to apply for a Certificate of NHS charges under the new scheme. He will be liable to repay the tariff in accordance with the Road Traffic (NHS Charges) Act Where the compensator has already paid NHS charges under the Road Traffic Act 1988, and advises CRU of the amounts paid (excluding any emergency treatment fee) CRU will confirm with the NHS trust that payment has been received. Where the trust confirms receipt of payment the appropriate NHS charges will be reduced by the amount already repaid direct to the NHS trust Ministry of Defence (MoD) hospitals

42 The NHS recovery scheme does not include Ministry of Defence (MoD) hospitals Contributory Negligence Where a road traffic accident occurred before 29 January 2007, contributory negligence is not taken into account in the calculation of Certificates of NHS Charges. If an incident or injury occurred on or after 29 January 2007, the 2003 Act makes provision to take into account contributory negligence in all cases where it is a factor in the primary compensation claim. The Personal Injuries (NHS Charges) (General) Regulations and Road Traffic (NHS Charges) (Amendment) Regulations [S.I No. 3388] and The Personal Injuries (NHS Charges) (General) (Scotland) Regulations 2006 [S.S.I No. 592], set out the requirements needed to be shown when all parties to the primary compensation claim have reached an agreement on contributory negligence. Regulations 2 & 3 specify requirements needed by the CRU to confirm agreements. If the appropriate documentation is supplied to the CRU, the NHS charges certificate can be reduced by the same proportion. Evidence required: Where contributory negligence claims are in respect of a court ruling, judgement or order, (section 153(3) of the Health and Social Care (Community health and Standards) Act 2003 refers), the compensator should provide the following evidence; a. a statement of the proportion by which the damages payable in respect of the claim are to be reduced, to reflect the injured person s share in the responsibility for the injury in question, and b. a copy of the order, judgement, minute or document which provides for that reduction. For contributory negligence claims that have been settled by an arrangement other than described in section 153(3), the person applying for the reduced certificate should send a report containing the information listed below and signed by the parties to the agreement to the Compensation Recovery Unit. Information in the report should include; a. a statement that it was agreed by or on behalf of the injured person and the person who proposed to make a compensation payment that the damages payable under the settlement were to be reduced to reflect the injured person s share in the responsibility for the injury in question. b. A statement as to how that agreement was reached; c. The amount of damages payable under the settlement had there been no such agreement; d. The amount or proportion by which it was agreed that the damages were to be reduced; and

43 e. The names of all those involved in the settlement process. 11. Reviews and Appeals 11.1 Reviews The compensator may ask CRU to review any aspect of a Certificate of NHS charges at any time. For road traffic accidents which occurred pre 29 January 2007, there is no time limit to make a request for a review of NHS charges. For incidents or injuries after 29 January 2007, there is a time limit of 3 months from the date on the certificate, or if later, no more than 3 months from the date the compensation payment was made. The request must be in writing clearly stating the grounds on which a review is being sought. A review may be requested on the following grounds: A mistake (whether in computation or otherwise) occurred in the preparation of the Certificate of NHS Charges; the amount specified in the Certificate is in excess of the amount due to the Secretary of State or Scottish Ministers; incorrect or insufficient information was supplied to the Secretary of State or the Scottish Ministers by the person who applied for the Certificate of NHS Charges and in consequence the amount specified in the Certificate of NHS Charges was less than it would have been had the information supplied been correct or sufficient; it appears that a ground for appeal is satisfied. When we review the Certificate of NHS Charges we will look at all the NHS charges recorded and the information provided by the NHS Trust, Ambulance trust or Health Board. Any errors omissions or other changes which may affect the outcome of the review will be taken into account, even if unrelated to your reasons for requesting the review. If there is no apparent reason to change the decision we will contact the appropriate NHS Trusts, Ambulance trusts or Health Boards. We will ask them to check all records to confirm that the treatment details provided to CRU are correct and relate to the incident for which compensation is being sought. Once the review is complete we will either confirm in writing that the Certificate of NHS Charges is correct or revoke the Certificate of NHS Charges and issue a fresh one. If a revised Certificate of NHS Charges is issued it will cover the same period as the Certificate of NHS Charges it replaces. We will issue a fresh Certificate of NHS CHarges showing an increase in the amount of NHS charges only where the variation is required as a result of incorrect or insufficient information supplied by the compensator. Where this occurs the compensator will be liable to pay the difference to DWP Appeals

44 A compensator has the right of appeal against the Certificate of NHS Charges if he thinks that the previous decision is incorrect. You should use form NHS30 37KB to lodge your appeal. If you prefer we may send the form to you by as a Word document. An appeal against a Certificate of NHS Charges may be made on the grounds that either: an amount specified in the Certificate of NHS Charges is incorrect; an amount so specified takes into account treatment which is not NHS treatment received by the injured person, in respect of his injury, at a health service hospital; or From 29/01/2007, the ambulance which transported and or treated the injured person, is not an NHS ambulance service, or; Both treatment and ambulance services as mentioned above, or; that the payment on the basis of which the Certificate of NHS Charges was issued is not a compensation payment. An appeal can only be made after final settlement of the compensation claim. Full payment of recoverable NHS charges and all recoverable benefits must have been repaid to CRU. However, for incidents occuring on or after 29 January 2007, in cases where payment of the amount specified in the NHS certificate would cause exceptional financial hardship the requirement to repay prior to appeal may be waived. An application for a waiver must be sent to the CRU with particulars of the exceptional financial hardship that would be caused by payment of the amount (or amounts) specified in the certificate. This application should be sent to CRU, not later than 3 months after the date on which the compensation payment was made. An appeal for Road Traffic Accidents prior to 29 January 2007, must be made within three months of the date on which the compensator makes the full payment of NHS charges to the Secretary of State or the Scottish Ministers. For incidents on or after 29 January 2007, the time limit for application is no later than 3 months from the date on the certificate of NHS Charges, or if later, no more than three months from the date the compensation payment was made. For appeal purposes, orders for provisional damages in personal injury cases made under or by virtue of section 32A(2)(a) of the Supreme Court Act 1981, section 12(2)(a) of the Administration of Justice Act 1982, or section 51(2)(a) of the County Courts Act 1984, are to be treated as having been finally disposed of. Late appeals may be accepted but only where there are special circumstances for the delay. No appeal may be accepted if it is made 1 year or more after the date the right to appeal arises.

45 Appeals involving English and Welsh NHS Trusts will be heard by an independent tribunal administered by The Tribunal Service. Appeals involving Scottish Health Boards will be heard by the Road Traffic (NHS Charges) Appeal Tribunal for Scotland. The tribunal may decide that the amount on a Certificate of NHS charges is correct or it may either increase it or decrease it. Following the decision CRU will either confirm the Certificate, issue a fresh one or revoke the Certificate of NHS Charges. If a waiver of payment of NHS charges was granted, pending the appeal, and the tribunal decision confirms the amount, the appellant will be liable to pay the NHS charges to DWP. Where the amount on a Certificate of NHS Charges is increased following an appeal the compensator will be liable to pay the balance of NHS charges to DWP. Where the amount on the Certificate is reduced, the balance will be recovered from the NHS Trust, Ambulance trust or Health Board and will be refunded to the compensator. An appeal to the High Court (England and Wales) or the Court of Session (Scotland), against the decision of an appeal tribunal, may be made by the compensator, the Secretary of State, or the Scottish Ministers on the grounds that the decision was erroneous in law. The appeal tribunal will send details of how to appeal and time limits to you when your appeal has been heard. In accordance with the Health and Social Care (Community Health and Standards) Act 2003, an Appeal may be made to a Commissioner against any decision of an appeal tribunal, under Section 158, on the grounds that the decision was erroneous in point of law. 12. Disclosure of Information The claimant may apply for access to all DWP records. In certain circumstances this information may be provided to an Appointee appointed by the Secretary of State or an attorney under Power of Attorney. A solicitor representing the claimant may have copies of documents relating to DWP records following an incident/condition for which compensation has been claimed providing a written letter of authority from the claimant is produced. A request for access to DWP records by a defendant or his representative (following a claim to compensation) will be denied unless a court order which identifies specifically the document required is produced. However, the Social Security (Recovery of Benefit) Act 1997 allows the defendant to have 'particulars' of benefits shown on a Certificate of Recoverable Benefits. This may mean a full explanation of the benefit award but not necessarily copies of the documents concerned. If a claim has been settled and no further compensation is to be paid, consideration will be given to the release of copy documents. If the compensation claim is ongoing written authority from the claimant must be obtained before consideration is given to the release of copy documents.

46 If a claimant contacts the Department directly (and not through a solicitor) then the full DWP records may be released. If there is agreement for the defendant to see these records, it is the responsibility of the claimant to forward the documents. Where compensation is sought for professional negligence and the particulars of a claim are such that the Social Security (Recovery of Benefits) Act 1997 does not apply, benefit information will not be supplied to the Defendant as "offsetting" is not appropriate under the 1997 Act. 13. CRU GB Electronic Communications CRU has developed a number of electronic methods of communicating with Insurance Companies, as part of the E-government initiative. Claims Underwriting Exchange Personal Injury (CUE PI) Database We have an electronic link with the Claims Underwriting Exchange (CUE) PI Anti-Fraud Database. Whilst conducting anti fraud searches on the database CUE users can also do the following electronically: Register claims (CRU1 s), Request Certificates/Statements (CRU4), Receive CRU Certificates (CRU100) with or without financial data, Receive NHS Certificates (NHS100) with/without NHS treatment and ambulance charges, Advise us when a case is settled (CRU102), The electronic link with the CUE PI database is being developed furhter and will soon allow CUE users to do the following: Receive CRU Certificates (CRU100)with financial data Receive the 2-year reminder (CRU250), and Receive requests for payment (CRU18 series) Electronic Data Interchange (EDI) We can exchange data electronically between our Computer system and the Computer systems held within certain insurance companies. At the moment we can offer you the opportunity to do the following business transactions via this electronic method: Register Claims (CRU1), Request Certificates/Statements (CRU4),

47 Receive certain types of Certificates (CRU100), Receive NHS Certificates (NHS 100) with/without NHS charges, Advise us when a case is settled (CRU102). The CRU e-service The CRU Internet site provides the facility to: Request a Certificate (CRU4), and Advise us when a case is settled (CRU102), As part of our long-term e-business strategy we hope to be able to offer you the following: Make payments via ACT or Direct Debit, If you would like more information on these initiatives please contact the IT Project Manager at [email protected].