The Compensation Recovery Unit (CRU), on behalf of the Department for Work and Pensions, currently administers the NHS Injury Cost Recovery (ICR) Scheme. This scheme allows for the recovery of National Health Service (NHS) costs incurred as a result of NHS treatment which has been made necessary by the fault of a third party who subsequently agrees to or is ordered to pay compensation.
In short, defendants to a successful personal injury claim are liable to meet the NHS costs of associated NHS treatment, in addition to the injured person’s claim for damages and legal costs. Unlike social security benefits, which may be paid to the injured party, NHS charges cannot be recouped against any head of compensation.
The scheme ensures NHS and ambulance trusts, are not left out of pocket when providing treatment to injured claimants in England and Wales. The money recovered under the scheme goes back directly to the NHS entity for reinvestment in patient services.
The Injury Cost Recovery scheme (ICR) allows for the recovery of pre-determined fixed sums. These ‘NHS charges’ are calculated on a simple average cost tariff system to allow the efficient and cost-effective recovery of monies while also keeping running costs down to maximise the benefits for NHS services. The tariffs are broken down as follows:
The ICR annual tariff table is available on the gov.uk website.
The payments are subject to an overall maximum charge for any one individual.
All claims for personal injury must be registered with the Compensation Recovery Unit (CRU). The CRU liaises with NHS Trusts to confirm details of the injured person’s treatment and thereafter they calculate how much will be payable in NHS charges. The defendant is then issued with an ‘NHS charges certificate’ confirming the applicable charges.
Defendants are required to pay CRU the charges identified on the NHS charges certificate within 14 days of a compensation payment (interim or final), or within 14 days of receiving the certificate if the claim has already been settled. The CRU then forwards the funds recovered to the NHS Trust that treated the injured person.
The at fault party may challenge the NHS charges certificate where there is evidence to show that the treatment was not caused by the injury that has given rise to the compensation claim.
The Personal Injuries (NHS Charges) (Amounts) (Amendment) (No. 2) Regulations introduced updated tariffs for NHS charges which came into effect on 1 October 2024.
The latest tariff sees an increase across ambulance journey costs, inpatient and outpatient charges, with a new tariff added for accident dates occurring on or after 1 October 2024. For an injured person to now attend A&E as an outpatient post-1 October 2024, the tariff charge is fixed at £848. This is an increase of 2.79% on the previous 1 April 2024 tariff.
The tariffs are expected to be updated again from 1 April 2025.
The advantage of the tariff system is that the compensator can anticipate from an early stage what charges they will likely be expected to pay at the end of the claim if it is successful. This means the compensator can be provided with clear advice and thus hold accurate reserves to cover the overall expected cost of a claim. Furthermore, the tariff system relates the recoverable cost to the date on which the NHS treatment was provided, adding another layer of certainty.
The increasing tariff is reflective of the increasing costs faced by the NHS in providing care. The impact on compensators should be minimal as reserves will be earning investment interest, such that claims cost inflation should be equalised. The costs of an individual claim post-1 October 2024 will only increase by around £23 for an injured person’s outpatient attendance compared with the previous 1 April 2024 – 3 September 2024 period. The increase will, however, be most noticeable in higher value claims where the injured person required lengthier in-patient stays. The maximum recovery of NHS charges has increased from £60,610 to £62,272.
Becky Phillips - Legal Apprentice
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