NHS & Air Ambulance Cost Recovery Scheme

Claimants in personal injury claims, such as road traffic accidents or accidents at work often require hospital treatment, or ambulance journeys as a result of their injuries.

When a claim is successful, the person, company or body liable, who are usually insured, are required to contribute towards the cost of any NHS treatment that the claimant has received under the NHS Injury Cost Recovery Scheme.

How does the NHS Injury Cost Recovery Scheme work?

Whenever a claim for personal injury compensation is made, the Compensation Recovery Unit (‘CRU’) (within the Department for Work and Pensions) is informed by insurers and/or their solicitors.

The CRU then sends details of the claim to the treating NHS Trust who will then confirm treatment details. Once the CRU has this information, they are then able to calculate how much will be payable in NHS charges if the claim is successful. Yearly regulations set the cap for the charges recoverable under the scheme.

The tariff system as at the 1^st April 2021 applies only to those injuries sustained on or after that date. They are as follows:

• Where a claimant has been provided with a NHS ambulance service, the charge is £225 for each occasion.
• Where a claimant has received NHS outpatient treatment, the charge is capped at £744.
• Where a claimant has received NHS inpatient treatment, the charge is £915 per day
• The overall cap on the amount that can be recovered in respect of an injury is £54,682.

Once the CRU calculates the amount of NHS charges due, they will issue a certificate to the compensator, to pay the compensation confirming the amount to be paid. The charges must be paid within 14 days of either the claim being settled, or the certificate being issued (if it was unavailable at the time of settling the claim).

Who receives the amount of NHS Charges?

The money is received by the NHS Trust which provided the treatment to the injured party. The idea is that the funds will go back to the hospital/ambulance service and can then be reinvested back into patient services.

The money paid to the NHS trust is entirely separate to a claimant’s claim for damages. The claimant’s damages will not be deducted for the NHS treatment received.

It is however the case that the NHS is limited under the NHS Charges scheme as to the circumstances in which it can seek to recover costs from insurance companies. In addition, the amount which the NHS is allowed to recover is capped at an amount well below the actual costs that are incurred.

It has been estimated that the difference between the amount which the insurance industry is required to pay per patient and the true cost of treating these patients is in excess of £400 million per year.

It is for that reason that Burnetts continues to be part of the Major Trauma Group who are campaigning for the current cap to be increased and to ensure the full recovery of all applicable NHS Charges in legal claims. Particularly at a time when legal changes brought into effect through the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO) and other legislation have meant that Insurance companies have gained huge windfalls.

Does the same apply to Air Ambulance charges?

If the service falls within the NHS, then the statutory tariff system will apply as above. Unfortunately, Air Ambulance services are generally not funded by the NHS and therefore are unable to recover their charges via the scheme.

On average it can cost around £4,600 when an Air Ambulance service attends an incident and transports a patient to hospital. This figure takes into account aircraft fuel, critical care team time, and any medication or interventions carried out at the scene.

How Burnetts can help

If you are a claimant of a personal injury claim and you required NHS treatment, as illustrated above, the NHS Injury Cost Recovery Scheme will apply and the NHS are able to recover their costs.

We have a specialist Serious Injury team which is experienced in supporting patients and their families following serious road traffic collisions and accidents at work. If you required Air Ambulance intervention, we can contact the charity concerned to obtain full details of your care. By looking to include these costs within your claim, we can not only help you and your family, but we can also look to help these amazing charities recover their costs, and ensure that they are able to continue their life-saving work.

As with NHS Charges, any costs that we manage to recover for Air Ambulance services will not be deducted from your damages and will be a separate head of loss.

If the claim is on behalf of a protected party, our Court of Protection team can also be on hand to help with the administration of compensation and navigate the deputyship process.

If you would like to speak to someone within our MNSI team, call us on 0191 300 1833 or email hello@burnetts.co.uk.