Private Medical Care and
Interim payments – what you should get and why
Jill
Greenfield
This was first published in the
Spinal Injury Association magazine
With the concerns regarding funding
for spinal cord injury centres, funding for medical care where
someone has a personal injury claim is of critical concern. A
personal injury claim, if successful, should provide financial
support for an individual, allowing them to access all the care and
medical support needed, for life.
Not everyone has a claim that can be
pursued successfully of course. But, it is to everyone’s benefit
that, if someone is able to get funds from an insurer to pay for
care and treatment, these funds are provided quickly. That way, NHS
funds and resources are not being diverted from those who do not
have personal injury claims.
This is not simply about recovering
money spent but is to ensure that a comprehensive rehabilitation
plan is put in place whilst the injured person is still in hospital
and, that this is then followed through when the individual returns
home. If you do have a claim, where liability is not in dispute,
you should obtain an interim payment at an early stage after the
injury and a case manager should be appointed to ensure that your
care and medical needs are met.
I recently attended a medical
conference dealing specifically with spinal cord injury where one
of the speakers referred to lawyers not being involved during the
early stage of a patient’s recovery. The reason being that it was
not always clear at this stage that there was a case for
compensation. That can sometimes be the situation but, generally,
my experience is different. The intervention and involvement of the
solicitor, as soon as possible after the accident, can help to put
in place the foundations for future rehabilitation and private
medical care.
I recently acted for someone who was
very severely injured in a road traffic accident. When I first saw
this client I was told by the NHS clinical team that they were
about to transfer the patient to an orthopaedic ward in a general
hospital. They felt that this individual had been medically
stabilised and the stay in the specialist ward was no longer
necessary. This was clearly inappropriate given the nature of the
injuries.
I was instructed just a few weeks
after the accident. It was clear to me that liability would not be
in dispute. On that basis, I pressed the defendant insurers for
money for rehabilitation and, within a week of being instructed, a
case manager was appointed, an immediate-needs assessment done and
plans for my client to be transferred to a specialist centre were
made. Upon my client’s return home a specialist 24-hour care
package and rehabilitation programme were put in place.
Sometimes , a defendant may state
that liability has not yet been admitted and therefore, on that
basis, they are not prepared to pay for rehabilitation. If there is
an l issue over liability then that can be a real sticking point
and it may be that a trial, concentrating on liability, will be
necessary to determine this before funding can be made
available.
However, there are cases where
liability is not formally admitted because, for example, a criminal
prosecution against a defendant driver is yet to go ahead or simply
because the police have yet to complete their investigations. This
does not always mean that there will not be an interim payment
forthcoming or a rehabilitation programme put in place.
I recently took over another case
where the claimant had been told by his previous lawyers that he
ought not to expect a significant interim payment until later in
the case. The inference was that because there was a police
investigation and liability was not admitted, my client would have
to wait. He’d had no income for six months and a full
rehabilitation package was not in place. He was reliant upon what
was available to him via the local authority, which did not fully
meet his needs.
I met with him and his family. It was
clear to me that this particular individual, a passenger in a
vehicle, was in no way to blame for this accident. Whilst the
defence had some issues with their own insured, (the driver) it was
clear that this was of no concern to my client and that the defence
should be providing my client with an interim payment and be paying
for rehabilitation. We took over conduct of this case and, within a
short time frame (a couple of weeks) we obtained both an interim
payment and rehabilitation paid for by the insurers. There was
absolutely no reason for this injured person to be waiting for
financial support, medical care and help.
This is the way that litigation
should be progressed where possible. Insurers will not offer an
interim payment. It has to be requested. In cases where the
individual has suffered such severe injuries, interim payments
ought to be made available by insurers at an early stage.
When assessing any case,
consideration will be given to the cost of care for the rest of the
person’s life, loss of income and pension and other loss and
expenses consequent to the accident. It is important that factored
into this is the cost of private medical treatment. This may be
refresher physiotherapy, urological maintenance, fertility
treatment or a contingency fund for more serious instances when an
inpatient stay at hospital is required. If you have a personal
injury claim, where liability is not in dispute, then there is no
reason why you should not be able to access such funds and they
should properly form part of your claim.
The situation can be more difficult
where liability is in dispute. However, it ought to be possible to
pursue the claim to a trial on liability. The nature and complexity
of the claim will determine how long it takes to get to a trial on
liability. If it is successful, the fact that you have been having
care on the NHS, should not prevent you from seeking that care
privately in future.