I'm interested in…

  • Strategy & Procedure
  • Catastrophic Injury
  • Professional Indemnity
  • Motor
  • Fraud
  • Disease
  • Liability
  • Commercial Insurance
  • Costs
  • Local Authority
  • Scotland

Portal Claims: A request for payment is not an invoice

Mr Eddie Blach v Mr Andrew Knight
Nottingham County Court
27th January 2016
Before: DJ MacMillan

A Claimant who failed to provide a triage report, treatment notes or a discharge report, despite the insurer making frequent requests for them, had their claim for treatment dismissed. Whilst the Portal allowed Claimants to provide ‘brief details’ of their claim, that did not mean the Claimant could simply produce a ‘Request for Payment’ and the Judge expected the Claimant to have produced further documents in support of their claim.

In a climate where it is not uncommon for Claimants to refuse a request for disclosure of the type of documents the Judge expected to see here, Strategic Litigation Team Member, Carly Jackson, who acted for the insurer, takes us through this case which will be of interest to insurers finding their request for documentary evidence met with such a refusal.

Background

The Claimant, Mr Blach was a driver involved in a road traffic accident on 9 December 2014. Liability and causation was admitted by the insurer and the Claimant initiated a claim through the Portal on 19 January 2015.

A Stage 2 pack was subsequently presented and the Claimant provided a report from a medical expert, which suggested that the Claimant had sustained an injury to his cervical and lumbar spine. The pack also included a claim for the cost of treatment, loss of earnings and other losses. However, the only losses that were disputed by the Defendant were the claim for treatment and a claim for a pram that was allegedly damaged in the collision.

DWF were instructed by the insurer to defend the Part 8 proceedings on the basis that the Claimant had failed to properly evidence his claim for treatment and had not demonstrated that the treatment was reasonable and necessary.  The case proceeded to a Stage 3 Hearing on 27 January before DJ MacMillan in Nottingham County Court.

Facts

The Claims Notification Form was submitted to the Portal on 19 January 2015. Section C of the form regarding rehabilitation, had been left blank and consequently the insurer sent a letter to the Claimant’s solicitors offering to arrange any treatment that the Claimant might have reasonably needed.

At Stage 2 the Claimant provided a medico-legal report, prepared following a medical examination with his expert on 25 March 2015 (3 months and 16 days post). The report noted that the Claimant began physiotherapy treatment prior to the medical examination and stated that the treatment was ongoing and appropriate. The expert’s opinion was that the Claimant had made a full recovery, eight weeks post accident.

In support of the claim for treatment, the Claimant provided a document described as a “Request for Treatment”. That document detailed the provision of services that were listed as:

  • Initial medical assessment

  • Rehabilitation assessment

  • Treatment

    • 26 January 2015

    • 2 February 2015

    • 9 February 2015

  • Treatment report

In response, the Defendant requested sight of the documents listed in the Request, so as to better enable them to assess the claim. The request was especially valid, given that it appeared from the Request for Payment that the treatment had ceased by the time that the Claimant has been examined by his medical expert, yet the expert had stated the treatment was ongoing and reasonable. Further, the document did not confirm the identity of the physiotherapist or their Health and Care Professions Council registration number. The Defendant made repeated requests for sight of the documentation, which was not forthcoming.

In respect of the claim for the damaged pram, the Claimant provided a copy of a till receipt, that was barely legible and did not specify what type of product had been purchased.

Findings

Sitting in the County Court at Nottingham on 27 January, District Judge MacMillan held that in respect of the claim for treatment:

  • The ‘Request for Payment’ was not an invoice.

  • Whilst the Portal provided for the parties to provide “brief details” of a claim, that did not mean that the Claimant did not have to produce an invoice.

  • The further documents requested by the Defendant should have also been disclosed.

  • The medical expert was plainly not correct in describing the treatment as “ongoing” in March 2015, as treatment had ceased the month before.

  • The Claimant had made a full recovery after 8 weeks; and

  • Consequently, the Judge was at a loss as to how the expert could have formed an opinion that any treatment was necessary

In respect of the pram, the Judge stated that the document that had been provided was not sufficient to support the claim.

The Judge concluded by stating that the Claimant had wholly failed to satisfy the Court in respect of the items in dispute and dismissed the Stage 3 proceedings, going as far as to say that he was not satisfied that the Claimant had either received, or required, the treatment claimed. The Judge awarded the Defendant their costs of the hearing. 

Comment

This is a really good outcome for those dealing with claims for treatment, both in and out of the Portal. Although the Portal provides for only ‘brief details are needed in support of a claim that did not mean that the standard of evidence required was lower.

The Claimant’s representative at the hearing actually had the discharge report in his possession but chose not to ask for leave to introduce it as evidence.

It is also worth remembering that the medical report in this case was obtained before the introduction of the MedCo portal in April 2015. The expert’s failure to pay attention to the chronology of the alleged treatment was significant and one wonders whether things would have been different if the report had been obtained under the MedCo regime.

In the future MedCo may also have a part to play in the rehab claims space, especially if Claimants who lose their entitlement to claim general damages for whiplash are instead to be offered treatment.

Contact

For further information about this case, or about rehab claims strategies, please contact Carly Jackson, by telephone on 01772 554252 or by email at carly.jackson@dwf.law, or Joanne Baker, Claims Management Consultant on, 07804 253272 or by email on joanne.baker@dwf.law

DWF will be addressing adverse and fraudulent behaviours within the treatment supply chain at events, in Leeds on 12 May and in London on 25 May. Please contact jane.hamilton@dwf.law for further information.

By Carly Jackson

This information is intended as a general discussion surrounding the topics covered and is for guidance purposes only. It does not constitute legal advice and should not be regarded as a substitute for taking legal advice. DWF is not responsible for any activity undertaken based on this information.

Top