Private Medical Care and Interim payments – what you should get and why
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.