We provide an update on important issues relating to recoverable benefits and NHS charges: the risks presented by riders to CRU certificates and changes to the appeals process.

As defendants and insurers will be aware, when damages are paid to a claimant following a personal injury claim, benefits paid to the claimant, which are attributable to the injury, can be recovered by the DWP from the compensator. 

The Compensation Recovery Unit (CRU) is charged with recovering these benefits. Similarly, where the NHS provides treatment to an injured claimant, the cost of this treatment is recovered by the CRU from the compensator. 

Rider risk

Difficulties can arise for compensators when the Compensation Recovery Unit (CRU) has not confirmed the identity of a claimant through his national insurance number.

In these circumstances, the CRU may issue a CRU certificate, but with a rider as follows:

"IMPORTANT NOTICE REGARDING THE CERTIFICATE

We have been unable to trace the National Insurance Number based on the information that you provided … it is possible that this Certificate may need to be reviewed to include benefits not yet identified."

This means that the compensator cannot rely on the CRU certificate when settling the claim. The risk is that the CRU may later decide that there are recoverable benefits, which it will seek to reclaim. Where a settlement has already taken place, the opportunity to offset benefits (where appropriate) will have been lost.

Defendants and insurers should ensure they have systems in place to check for this rider on CRU certificates. Where a rider is in place, steps should be taken to have it removed. Whilst it remains in place, there will be significant risks in proceeding to a settlement.

Appeals

Appeals against certificates are an important means by which compensators can recover sums paid to the CRU. By way of illustration, Kennedys’ dedicated sCRUtiny team has recovered over £2.1 million of benefits over the last 10 years, with a success rate of over 95 per cent. 

From 28 October 2013 (benefits) and 7 November 2013 (NHS charges), the Welfare Reform Act 2012 introduces significant changes to the way in which appeals should be made. 

Recoverable benefits:

  • A compensator should draft and send an appeal to the CRU by letter with all relevant evidence and request a Mandatory Reconsideration Notice (MRN). An MRN must be requested within one month of the payment of benefits and damages. The CRU will gather all the information and issue an MRN in duplicate.
  • If the compensator still wishes to appeal, then it should submit the appeal direct to Her Majesty’s Courts & Tribunals Service (HMCTS), using the designated form downloadable from the HMCTS website, with one copy of the MRN and any additional evidence not already submitted. An appeal to HMCTS must be made within one month of the MRN.  
  • The CRU will supply the original paperwork to the HMCTS, once notified of the appeal. HMCTS will then make its decision and, if needed, list an appeal hearing.

NHS charges: 

  • An NHS charges certificate appeal should be made direct to HMCTS, using the designated form downloadable from the HMCTS website. The time limit remains three months from payment of damages.
  • On receipt of the appeal, HMCTS will write to the CRU to request an NHS Decision Notice. It will then notify the compensator of its initial decision. If the compensator is not satisfied, HMCTS will list an appeal hearing.