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The NHS Injury Cost Recovery Scheme

Picture of a fast moving ambulance - thanks to Ian Taylor on UnsplashSome personal injury claimants who are involved in a particularly nasty accident may require hospital treatment as a result of their injuries, including an ambulance journey to reach the hospital or, in some cases, even an air ambulance. This is often the case for road traffic accident collisions.

When a personal injury claim is successful, the liable individual(s), who should be insured, are legally required to contribute towards the overall cost of any NHS treatment that was carried out on the claimant. This contribution is received under what is known as the NHS Injury Cost Recovery Scheme.

Each time a claim is placed for personal injury compensation, the Compensation Recovery Unit (CRU) - who operate as part of the Department for Work and Pensions - are informed by the involved insurers or instructed legal team.

The CRU forwards the details they receive relating to the claim to the NHS Trust, who then confirm that the treatment details received are correct. Once the CRU are informed that all is accurate they can proceed to calculate what the payable NHS charge will be should the personal injury claim prove successful.

NHS Injury Cost Recovery Tariff for 2021-2022

Annual regulations set a cap each year for the charges that are recoverable under the scheme.

For example, the tariff system that was in place as of April 1st, 2021, only applies to personal injury claims lodged on or following that date.

That tariff system is currently as follows:

  • If a personal injury claimant receives NHS outpatient treatment, the charge is capped at £744.
  • If a personal injury claimant receives NHS inpatient treatment, the charge is capped at £915 per day.
  • The total cap on the amount that can be recovered in relation to a personal injury is £54,682.

The CRU will then issue a certificate to the compensator confirming the NHS charges that are due. The compensator must then pay these charges within 14 days of the claim being settled, or the certificate being issued if it happened to be unavailable at the time the claim was settled.

Who are the NHS charges paid to?

The money that is paid to cover these charges is received by the NHS Trust that provided the treatment to the injured claimant. These funds are invested back into hospitals and the ambulance services so that patient services can continue to benefit in times of an emergency.

It’s important to note that these funds are completely separate to the amount that a claimant receives for damages, and the claimant’s damages is never deducted from the NHS treatment that they received.

However, the NHS is limited by the NHS Charges scheme when seeking to recover costs from insurance firms. Furthermore, the amount that the NHS can recoup is capped below the actual costs that are incurred. Estimations believe that this difference between the amount the insurance industry pays out per patient and the true cost of treating injured claimants is in excess of £400 million each year - many legal industry experts are campaigning in an attempt to see this current cap increased so that the NHS can recover all applicable NHS Charges in legal claims.

Does this also apply to Air Ambulance charges?

Provided the air ambulance service falls within the NHS, then yes, the current capped tariff system will apply. With that said, most Air Ambulance services are not funded by the NHS meaning in these instances they are unable to recover their charges through the NHS Charges scheme.

It can cost an average of £4,600 per patient when an Air Ambulance service attends an accident or incident and transports an injured patient to a nearby hospital. This figure includes the average cost of fuel, critical care team time, plus medication or interventions that need to be carried out at the scene of the accident.

If you’re seeking advice about a personal injury claim don’t hesitate to contact our specialist team of legal experts here at Fonseca Law. You can get in touch by calling 01495 303124, e-mail or simply complete our online contact form and a relevant member of the team will be in touch.