Procedure for Dealing with Insurance Claims in Respect fo Personal by ramhood17

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Guidance



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

  Adults Division
      Files to update                Area                Residential      Day Care             Other

      Replaces Pages                                                      File Section         Finance
     Equality Impact              Approved by DASS
      Assessment:




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                             PROCEDURE FOR DEALING WITH INSURANCE

                               CLAIMS IN RESPECT OF PERSONAL INJURY

Background

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
litigated.

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
         defence.

5.       The Dept needs to identify a Responsible Investigating Officer re Signing the
         Defence The Statement of Truth
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         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.


Recommendations

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:
1.
2.
3.


FINISH / End document.

Doc. Ref:




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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
                                                                                                            query.
                 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.


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