7. The Law - NHS Charges
7.1 The law on the NHS Charges scheme in GB is contained in:
For incidents occurring on or before 28/01/2007
- Road Traffic (NHS Charges) Act 1999 which refers to The Road Traffic Act 1988
- The Road Traffic (NHS Charges) (Reviews and Appeals) Regulations 1999 [S.I. 1999 No. 786]
- The Road Traffic (NHS Charges) (Reviews and Appeals) (Scotland) Regulations 1999 [S.I. 1999 No. 1843 (S.111)]
- The Road Traffic (NHS Charges) Regulations 1999 [S.I. 1999 No. 785] as amended by SSI 2001 No. 466, SSI 2002 No. 56 and 528 SSI 2004 No. 076 and SSI 2005 No. 123
For incidents occuring on or after 29/01/2007
- The Health and Social Care (Community Health and Standards) Act 2003, Part 3 supported by The Personal Injuries (NHS Charges) (General) and Road Traffic NHS Charges) (Amendment) Regulations [S.I. 2006 No. 3388] and The Personal Injuries (NHS Charges) (Reviews and Appeals) and Road Traffic (NHS Charges) (Reviews and Appeals) (Amendment) Regulations 2006 [S.I. 2006 No. 3398]
- The Health and Social Care (Community Health and Standards) Act 2003 (Commencement) (No.11) Order 2006 No. 3397
- The Personal Injuries (NHS Charges) (General) (Scotland) Regulations [S.S.I. 2006 No. 592]
- The Personal Injuries (NHS Charges) (Reviews and Appeals) Scotland [Regulations S.S.I. 2006 No. 593]
- The Personal Injuries (NHS Charges) (Amounts) Scotland [Regulations S.S.I. 2006 No. 588]
- The Personal Injuries (NHS Charges) (Amounts) Regulations 2007. [S.I. 2007 No. 115]
- The Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2008 S.I. No. 252 and in Scotland S.S.I. No. 96
- The Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2009 S.I. No. 316 and in Scotland S.S.I. No. 193
- The Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2010 S.I. No. 189 and in Scotland S.S.I. No. 42
- The Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2011 S.I. No. 520 and in Scotland S.S.I. No. 71
- The Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2012 S.I. No. 387 and in Scotland S.S.I. No. 76
Recovery of NHS charges is subject to two separate schemes, governed by separate legislation. The guidance below relates to cases where the incident occurred on or after 29 January 2007, however it will also largely apply to accidents that occurred prior to 29 January 2007. Specific information relating to accidents (RTA cases only) that occurred prior to 29 January 2007 can be found at section 8.8.
7.2 Personal Injury cases occurring on or after 29 January 2007
For personal injury compensation claims with a date of incident on or after 29 January 2007 Part 3 of The Health and Social Care (Community Health and Standards) Act 2003 applies (“The 2003 Act”). A person is liable to pay the NHS charges if they make a compensation payment in consequence of any injury suffered where the injured person has:
- received NHS treatment at an NHS hospital, and or
- been provided with NHS ambulance services
In this instance the injury may be:
- physical
- psychological
In Section 150 (3) of The 2003 Act, a compensation payment is defined as a payment, made:
- by, or on behalf of, a person who is, or is alleged to be, liable to any extent in respect of the injury, or
- in pursuit of a compensation scheme for motor accidents.
The definition of ‘compensation payment’ covers any payment made, even where liability is denied or payment is made in respect of costs only. The definition also includes payments made in money’s worth, which would include, for example:
- gift vouchers
- providing physiotherapy
These would constitute a compensation payment.
Although disease cases are generally not included in the recovery scheme, Section 150 (5) and (6) of The 2003 Act does allow recovery in disease cases where the disease in question is directly attributable to an injury suffered by the claimant.
The 2003 Act applies to almost all compensators. The provisions under the 2003 Act are not restricted to payments made as a result of being an authorised insurer (as applicable to incidents occurring prior to 29 January 2007). The person making the payment in the compensation claim will be liable to pay the NHS Charges. This includes the general public, as well as businesses and other organisations.
The 2003 Act applies to cases involving foreign nationals, foreign compensators and for incidents and injuries sustained abroad, where NHS treatment and or ambulance services were provided to the injured person on their return to England, Scotland or Wales.
7.3 The recovery process
When completing the CRU1 form to notify CRU of a claim for compensation ensure that, where appropriate, it contains the name and address of the hospital where treatment was provided as a result of the incident. This is a requirement of Section 160 of The 2003 Act and is subject to compliance checking.
For incidents that happened before 29 January 2007 you should only notify CRU of NHS hospital details where the incident involved the use of a motor vehicle on a road. This could include cases registered as Employer or Public liability.
When CRU receive the hospital details they will immediately begin their enquiries with the relevant trust to establish the treatment that was provided. Where CRU are not given enough information for the trust to trace the relevant treatment CRU will need to make further enquiries with the:
- compensator,
- injured person’s representative, or
- the injured person directly.
These enquiries can be lengthy and the NHS Certificate cannot be issued until they are complete. It is therefore essential that accurate information be provided to CRU at the outset.
CRU will not issue the Certificate of NHS Charges until the compensator requests it and enquiries are complete, unless the NHS enquiries are complete when a CRU Certificate is issued. When issued, the Certificate of NHS Charges will usually be valid from the date of the incident until a final compensation payment is made.
The compensator must pay the amount shown on the Certificate of NHS Charges to CRU within 14 days of:
- making a compensation payment(interim or final), or
- the issue of the Certificate of NHS Charges, if that is after the date of the compensation payment.
CRU will repay the NHS charges directly to the responsible NHS body and or ambulance service that provided treatment/ambulance services, within forty days of receipt.
