@MMUNICA'ON WORKERS UNION

Transcription

1 @MMUNICA'ON WORKERS UNION COMMUNICATION WORKBRS UNION LEGAL SERVICES DEPARTMENT Dear Colleague Form LS 18 I am sorry to lealn that that you have been involved in an accident. The Legal Services Depaftment of your Union will make every effort to ensure that you receive the best advice and assistance to enable you to recover any damages or benefits to which you may be entitled. PLEASE READ THIS ENTIIIE LETTER CAREFULLY. It contains impoltant information about your entitlements. Remember that your Union will assist you in accidents on and off duty. SECTION 1 All legal services are provided at the absolute discretion of the National Executive Council of the Union and/or its duly appointed Legal Officer. Assistance will only bc provided if you co-operate fully with your Local Branch Official, Union Headquarlers and the Uniou's appointed Solicitors. It is your responsibility to ensure that your Claim Form arives at the Union's Legal Services Department and that you receive a written acknowledgement. If you move fi'om the address given on the Claim Form you must notify, in writing, both Union Headquarters and your Local Branch Official of your new address. If you leave your employmcnt you rnust remain a member of the Union, failing r,vhich the Union cannot continuc to suirport your claim. Never voluntcer tbr rnedical letiremcnt. Seek erdvice fl'om CWU Fleaclquartcrs. SECTION 2 - CLAIM FOR D,,\hzIAGES To rccover darnages we mus;t provc that. somconc else was at tault. If yolr wish to purstic il claim for danrages please complrlc lhc attached I-S3 Form and return it to youl l,ocal Braitch Official asi s()o1.1 as possible. Your llranch Ofl'icial will scnd the form to us ancl we will wlitt: lo you at your honre address io acknowleclgc Leceipi of the forrn. S/e will then pass tlte 1.S3 Form to onc of oul Panel Solicitors to invcsiigato fhe r:ircnmstances of yo'rr acciclcnf ancl where possible pulslre a r;lairn lbt da,nages on youl' behalf. To assist with the funding of this sorvicc our Panel Soiicitorr; will pay a i'r;tblral lbt: to lhc Union ol':t; in rcspcct 1;f t:trery claim they accept. If you do not reccive an acl<norytretlgernent within 28 days, wi'ifo to Union F{eaclqrial'fct's, RtrMilMiSEIt if is your r'e:;po'nsitrilil:y to ensure that tire fcrna :rrrives in tlrc i,egal Services llepal'tment.

2 SECTION 3 - ACCIDENTS ON DUTY If you are injured as a result of an accident on duty you may be eligible to make a claim under the following three schemes. 1. PERSONAL INJURY THIRD PARTY CLAIMS Make sure your accident has been recorded in your Employers Accident Book. If it has not been, do so now. Complete Form LS3, as detailed above. Your claim will be passed on to the Union's Solicitors and they will investigate the merits of any claim. 2. INDUSTRIAL INJURIES BENEFIT This is a State Benefit. To rnake a claim you must register your accident with the Depaftment lbr Work and Pensions as an industrial injury. If you are still suffering the effects of your injuries 15 weeks after the date of the accident, apply to the Department for Work and Pensions for Disablement Benefit. Your Local Branch Official will help you to do this. Make sure you let your Local Branch Offlcial have a copy of any assessment that you receive from the Department for Work and Pensions. 3. (a) POST OF'FICtr PERSONAL ACCIDENT BENEFIT SCHEME (on DUry only) This is an in-house scheme provided by Royal Mail. All Employees can claim if their accident results in death or permanent physical injury. Claims must be registered with Royal Mail within 6 months of the accident. For further details contact your Local Branch Official. 3. (b) BT PERSONAL ACCIDENT INSURANCE SCI{EME (ON/OFF DUTY) This is an in-house scheme provided by BT. Claims are processed via an Insurance Company appointed by B'f and ciaims must be registered with them within two yezrrs of the accident. For further cletails contact your Local Branch Offlcial. s.lcjron_a - nccpbnr$ DUII Il you are injurecl as at result o['an accidcnt whilst oif cluty, inclucling road traffic accidents, please complete Claims Form LS3 as above anrl return it via your l,ocal Branch Official. si{g TroN_s -_g.bimin& J\rJ U-liIUS-.eWgN!3 At{UIlArrAqK s CHltMlI If y<tur injuries are as result o1'tt climinal ilss;trh, yoll mllst notify the Policc imrnedizrtely anri r;onrplete Claims Form [-S7 obtainablr: via youl L,ocal Branch O1flcial. Yci ri's sincerr:ly {,cgiil Scrviccs Departrncnt

3 Form LS 3 U Th e co m m u nicati on s u ni on NOT TO BE USED WHEN REPORTING OFFENCES TO BE CONSIDERED UNDER THE DRIVERS PROTECTION SCHEME / ROAD TRAFFIC ACT PROSECUTION CWU Ref: Branch: COMPI.ETE AS MUCH OF THIS FORM AS YOU CAN AND SIGN IT ON THE BACK PART 1: PERSONAL DETAILS - PLEASE COMPLETE EVERY SECTION Surname Address First Names Telephone No. Membership No. National lns. No. Postcode Date of Birth Employer: D BT tr RM Q Parcel Force E Counters tl Quadrant Q Other (specify) Were you D On Duty tr Off Duty PayrollNo'/ElNNo./oUCCode...'..,...'.'.'. ls the claim made on behalf of a Dependant?... f so; please complete this section: Dependant's surname Relation to Member First Nlames National lns. No. Ernployer's Nlame Date r:f Birth... f'}art 2: IISJURIES AND MEDICAL'I'Rf1"4l'nfi gilit Flave you fully recovered?... lf Yes, how iorrg clid recovery take?.'\re you nor,,/ carrying out your pre-accident clutics'? lf the injrrries are riisible, e.g. cuts, oruise ;,::c;arring; etc. pleerse tilr<c sonie photograph::. Fhotos attached tlyes l-l No l-i'ib follow

4 Name and address of injured person's General Praciitioner together with name and address of Hospital and Consultant if attended and outpatient No.... Date commenced sick leave and resumption of duty if known Has the accident been registered with the Department for Work and Pensions Yes D No fl Address of Department for Work and Pensions PART 3: THE ACCIDENT Date of accident Time of accident... AM/PM Where did the accident happen? Please provide full details of exactly how the accident happened; who do you think was to blame and why? What steps could your employer have taken to prevent the accident? Have any of these steps been introduced since the accident? lf the accident was caused by defective tools or equipment please give full details of the item and defect. The more information you give, the quicker your claim will be dealt with. lf there is not enough space here, please continue on a separate piece of paper and attach it securely to this form. Name and address of person/party considered responsible for accident. Were there any witnesses to the accident? Yes [l I'lo l.l \rvitnesses name'i and addresses... ;rk;asr: milkc sure 1.he slatemeni is signecl and da, i.er-i i:y ilrr; wiir:r:s::. {itatcrncirts rti;rchecl? Yes tl itjo l.l li Yi.:S, rt)v iltilitv

5 Fufther details (a) AGGIDENTS AT YOUR WORKPLACE ONLY Generally speaking, your claim is more likely to succeed if other people have had similar accidents before but your employer has done little or nothing to improve safety. lt does not matter whether anyone else has been injured. Please, therefore make enquiries of the people you work with to see if anyone else has had similar problems while performing their duties. lf so, please ask them to write down what happened to them, when it happened and whether they reporled it to their supervisor. Please make sure each statement is signed and dated by the person making it and, then, attach it to this form. Statements attached? Yes tr No D lf Yes, how many (b) RoAD TRAFFTC ACCTDENTS ONLY Was the accident reported to the police? Yes tr No tr lf Yes, how many Police Officer's name/number Police Station Were you driving: employer's vehicle D private vehicle E bicycle tr pedestrian Q Your vehicle registration no Your insurers (not brokers)... Your policy no.... Type of policy Fully comprehensive D Third party, fire, theft D Has your vehicle been repaired? Yes I No Q lf your vehicle has not been repaired please provide photos of the damage. Photographs attached? Yes tr No B To follow tr Please give address where the vehicle can be inspected Are storage charges being incurred Yes O No D Othcr,lrirler's narne and address Othcr rjriver's registration nrrmber Olhcr ciiivcr's insurance detail.s, including policy no.... Dicl lhe oihcr driver say anything to you about ihe accident? lf '/ES, urhai clici hclshe say?

6 (c) DOG BITE CASES ONLY Have you reported the attack io the Police? lf not, please do so immediately. This may help your case and also prevent other people being injured. Name and address of Owner of Dog Police Officer's name/number Police Station Do you know whether anyone else has been attacked? lf so, please provide details (d) DEFECTTVE PAVFMENT OI{LY lf you have not already done so, please take photographs of the defective pavement or other hazard that caused your accident. Please do this even if the defect has been repaired. Please measure exactly the height of the trip/ depth of pothole. Photographs and sketch plan attached Yes E No tr PART 4: YOUR SPECIAL ATTENTION IS DRAWN TO TTIIS CLAUSE, WHICH MUST BE SIGNED. I-EGAL COSTS I acknowledge that the Union will be responsible for any and all legal fees connected with the investigation and prosecution of rly case. However, I also acknowledge that I will be responsible for any and all legal fees connected with the investigation and prosecution of my case if: a) take the case out of the hands of the Union solicitors or, b) My Union membership (or that of the person on whom I am dependent) lapses or, c) I doliborateiy and fraudulenlly deceive the Union irr any rnaicrial lrarticular I acknowledge thai any such liability would only arise upon the occllrrence oi'one or more of the abo,re wrilten circrrmstanccs. tletails of the arrang;oments concerning legal costs ar; posied on the CWU website. I clcclarc llr;ii i have r'3acj lhe L$18 lettcr and to the best of my belief iiie informai:ioir given in this form is true. I deslre ihai riry casc be t:rl<en up hy th,; Union and its Soilcitors, whom I retain to act for me. l-j,;\ta ;r+l<) I'r:t:'llClrl AC r' ili,)ij I r,iride,'rs;i.rtrrci i.irai. in orc.ler i.o l,rlrr:;ue rrry claim the Union and its nornii'ateci Solicitors r,rrill have access ic pr.;rsonll (Ji]ri.l:,lrci s;cnsititrr; l.lersoni:. dala as defined in Seciions I and 2 or'ihr; t-i:ta Prctection Act i998. iircrci;y girrc rrry i.);(pi'css coitsoni lo i.lrc processing of ihat data by tht; C$/tJ anrl its norninated Solicitors Sr; fiii as il i:; nccessary for i.he.:onduct of my claim. \'bur :;i1.,1r-.ail!r:)...,;ir-;litr,ii t,irtr-;irtl'i sigitait,r-rr..!)arti;d lj.ricci