Procedure For Dealing With Insurance Claims In
Respect Of Personal Injury
Sefton Health & Social Care Directorate
Version Number 1.2 Date of Issue Feb 2006
Authority for issue Peter Pattenden – Head of Adult Services Review Date: January 2007
Drive Document(s) Directorate Policy Committee Item Statute
Files to update Area Residential Day Care Other
Replaces Pages File Section Finance
Equality Impact Approved by DASS
PROCEDURE FOR DEALING WITH INSURANCE
CLAIMS IN RESPECT OF PERSONAL INJURY
On the 26th April 1999, the Civil Procedures Rules ('the Rules') governing the conduct of all
Civil Litigation comes into effect. These Rules will require a significant change in the way in
which claims are investigated, both before and after litigation has commenced.
The Woolf Report has laid down a set of pre-action Protocols, the object of which is to
speed up the litigation process, make it simpler and cheaper, and lead to fewer cases being
At present the Protocol which affects us concerns Personal injury Claims against the
Council. Any breaches of the Protocol will be viewed by the Courts as the Council being
unreasonable and penalties will be awarded against us.
Effect on this Department
Currently, insurance matters are co-ordinated through the Finance Section, Merton House.
It is essential therefore, in order to fulfil this function that all staff are aware of what is
required and ensure that the principles and deadlines are adhered to:
1. Staff must be able to recognise what constitutes a claim as opposed to a complaint.
There are many trigger words such as negligence, compensation, fault, failure of
statutory duty, money, damages, reimbursement. If any of these words are present
in a letter received by a manager, the letter should be forwarded to the Claims and
Administration Section, Finance Dept. 4th Floor Merton House.
2. The Claims and Admin Section, must acknowledge letters of claim within 21 days of
receipt in the Council. Claims must therefore be passed to that team, not the Legal
Dept as soon as they are received
3. All Reports must he prepared/co-ordinated and sent to the Insurance Section, within
1 Month. Any subsequent queries must be answered within 7 working days. Priority
must be given to injury claims.
The imposition of this deadline is necessary in order to comply with the Protocol
which gives the Council's insurers a maximum of 3 months to investigate, form a
view, and advise the claimant of the decision regarding liability.
If liability is agreed, the claim will then be settled. If however, liability is denied, there
is a chance that the claimant will issue proceedings against the Council.
The Department will be advised of the decision on liability, after the 3-month stage.
4. On receipt of a legal summons/writ, Departments must send the original document
immediately to the Insurance Section as the Council has only 14 days to file a
5. The Dept needs to identify a Responsible Investigating Officer re Signing the
Defence The Statement of Truth
Under the Rules, the defence must provide their version of events and explain why
they feel that they are not liable. This must be verified by a statement of truth.
This is a new requirement and requires that the Responsible Officer (R0) reports that
all checks, records, and documentation used in defending the claim are true and
accurate to the best of their knowledge. They must then sign: - 'The Defendant
believes that the facts stated in this defence are true’. Anyone who signs this without
the honest belief in the truth of the defence is guilty of contempt of court.
Finance Dept suggest that the Service Director is the Responsible Officer. We need
to notify the Finance Dept of our nominated Officer and 2 alternative names to cover
leave etc. I would suggest the Deputy Director and one or all of the AD's, depending
on the case. I would also recommend that before the 'Defence' is passed to the
Responsible Officer, the appropriate 4th Tier Manager completes a standard memo
confirming accuracy and truth of the facts presented, which will be given to the RO
enabling them to sign the statement.
6. There will be a strict deadline for disclosure of documents. We must make a
reasonable search for documents and must even disclose documents, which
could harm our defence. A disclosure statement will accompany the documents,
which again must be signed by the Service Director.
7. Once the defence has been filed, the court will allocate the claim into one of three
tracks Small Claims Track - claims <£5,000 & date of bearing given at outset,
Fast Track - claims up to £15,000, trial within 30 weeks
Multi Track - claims in excess of £15,000 or more complex claims. Officers may be
called upon to attend a case conference before a judge.
All staff to be made aware of the Protocol and the need to respond to requests for
information on claims as a matter of priority.
SMT to nominate Responsible Officer and Deputies and agree procedure for signing'
The Statement of Truth'
Other relevant documents:
FINISH / End document.
Procedure For Dealing With Insurance Claims In respect Of Personal Injury
Manager Receives Claim
Forwards original to Claims & Forwards copy to Resource
Admin Section Merton House /Area Managers
who acknowledge claim
within 21 days
Claims & Admin Section forward claim to Insurers
Claims & Admin Section request report/info from Dept.Co-ordinator
Departments Co-ordinator to meet with Resource/Area Manager
to decide who should provide information
Co-ordinator request information from various sources e.g. Personnel, One Month to prepare/
Unit Manager etc. Co-ordinate initial
report. Seven days to
Information received by co-ordinator who forwards it to Claims & Admin Section reply to any subsequent
Claims & Admin Section forwards information to insurers
Insures review facts and admit or deny liability and inform Claims & Admin Section
Claims & Admin Section informs Department of decision
If yes If no
Co-ordinator advises Resource/Area
Manager and gives copy of all
documents forwarded to the Claims &
Admin Section. Resource/Area
Manager to complete standard memo
confirming accuracy/truth of facts
presented and return it to Co-ordinator.
Claim is settled out
of court by insurers
Claimant could issue proceedings against the Authority.
Should manager receive court proceedings these should
be forwarded immediately to the Claims & Admin Section
Merton House. Claims & Admin Section appoint outside
Solicitors to act on behalf of Sefton
Insurance has 14 days to file Defence. During this
time the Statement of Truth and Disclosures will be
forward by them to Departments Co-ordinator who Twenty-four hours
will then pass signed standard memo confirming from receipt to sign
accuracy and truth of facts presented together with Statement of Truth
Statement and obtain signature of Responsible
Investigating Officer and return to Insurance Section
within 24 hrs of receipt.
Court will allocate claim into one of three tracks small
claims, fast or multi track
If multi track. Officers may be required to attend a Case
Conference before a Judge.
Any additional information requested by the appointed solicitors including witness
statements will be put in writing and forwarded to the Departmental Co-ordinator for
action. Upon completion of enquiries a decision will then be made on liability and
the claim may be settled out of court. If not the case will run to trial and witnesses
will be required to attend. Departmental Co-ordinators are dept informed.
NB THIS DOES NOT COVER THEFT OR MOTOR VEHICLE UNLESS THERE IS AN ELEMENT OF PERSONAL INJURY.