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United Kingdom Statutory Instruments |
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You are here: BAILII >> Databases >> United Kingdom Statutory Instruments >> The Recovery of Health Services Charges (Northern Ireland) Order 2006 No. 1944 (N.I. 13) URL: http://www.bailii.org/uk/legis/num_reg/2006/20061944.html |
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| Made | 19th July 2006 | ||
| Coming into operation in accordance with Article 1(2) and (3) |
| 1. | Title and commencement |
| 2. | Interpretation |
| 3. | Liability to pay health services charges |
| 4. | Applications for certificates of health services charges |
| 5. | Information contained in certificates |
| 6. | Payment of health services charges |
| 7. | Recovery of health services charges |
| 8. | Review of certificates |
| 9. | Appeal against a certificate or a waiver decision |
| 10. | Appeal tribunals |
| 11. | Appeal to Social Security Commissioner |
| 12. | Provision of information |
| 13. | Use of information held by the Department etc. |
| 14. | Payment of health services charges to hospitals or ambulance trusts |
| 15. | Regulations governing lump sums, periodical payments etc. |
| 16. | Liability of insurers |
| 17. | Power to apply this Order to treatment at non-health services hospitals |
| 18. | The Crown |
| 19. | Regulations and orders |
| 20. | Supplementary and consequential provision |
| 21. | Repeals and transitional provisions |
| Schedule 1 | Recovery of health services charges: exempted payments |
| Schedule 2 | Repeals |
(3) Except where any provision of this Order otherwise provides, any word or expression to which a meaning is assigned by Article 2(2) of the 1972 Order has the same meaning in this Order as in that Order.
(2) The person making the compensation payment is liable to pay the relevant health services charges in respect of the treatment or ambulance services to the Department.
(3) "Compensation payment" means a payment, including a payment in money's worth, made—
but does not include a payment mentioned in Schedule 1.
(4) Paragraph (1)(a) applies—
(b) if more than one payment is made, to each payment.
(5) "Injury" does not include any disease.
(6) Nothing in paragraph (5) prevents this Order from applying to—
if the disease in question is attributable to the injury suffered by the injured person (and accordingly that treatment is received or those services are provided as a result of the injury).
(7) "Health services treatment" means any treatment (including any examination of the injured person) other than—
(8) "Relevant health services charges" means the amount specified in a certificate of health services charges—
(9) "Compensation scheme for motor accidents" means any scheme or arrangement under which funds are available for the payment of compensation in respect of motor accidents caused, or alleged to have been caused, by uninsured or unidentified persons.
(10) Regulations may amend Schedule 1 by omitting or modifying any payment for the time being specified in that Schedule.
(11) This Article applies in relation to any injury which occurs on or after the date on which this Article comes into operation.
(12) For the purposes of this Order, it is irrelevant whether a compensation payment is made with or without an admission of liability.
(4) A person may apply under paragraph (1) for a fresh certificate from time to time.
(5) Paragraph (2) does not require the Department to arrange for a fresh certificate to be issued to a person applying under paragraph (4) if, when the application is received, a certificate issued to the applicant in respect of the injured person is still in force; but the Department may arrange for a fresh certificate to be issued so as to have effect on the expiry of the current certificate.
(6) If a certificate expires, the Department may arrange for a fresh certificate to be issued without an application having to be made.
(7) In the circumstances mentioned in paragraph (8), a person who has made a compensation payment in consequence of an injury suffered by an injured person shall apply for a certificate to the Department.
(8) The circumstances are that—
(b) no application for a certificate has been made by him during the prescribed period ending immediately before the day on which the compensation payment is made.
(9) An application for a certificate shall be made in the prescribed manner and, in the case of an application under paragraph (7), within the prescribed period.
(10) On receiving an application under paragraph (7), the Department shall arrange for a certificate to be issued as soon as is reasonably practicable.
Information contained in certificates
5.
—(1) A certificate shall specify the amount for which the person to whom it is issued is liable under Article 3(2).
(2) The amount to be specified is to be that set out in, or determined in accordance with, regulations, reduced if applicable in accordance with paragraph (3) or regulations under paragraph (10).
(3) If a certificate relates to a claim made by or on behalf of an injured person—
(e) in the case of which the parties to any resulting action before a court in Scotland have executed a joint minute which specifies—
(f) in respect of which a document has been made under any provision of the law of a country other than Northern Ireland, England and Wales or Scotland—
and in the case of sub-paragraph (e) may make such provision by modifying this Order.
(6) Any reference in paragraph (5)(a) or (b) to any amount specified in a certificate is to the amount which would be so specified apart from paragraph (3) or regulations under paragraph (10).
(7) Regulations under paragraph (2) which provide for cases mentioned in paragraph (5)(e) may (among other things) provide in the case of each compensator for—
(8) Regulations under paragraph (2) which provide for cases mentioned in paragraph (5)(f) may (among other things) provide in the case of any compensator for the matters mentioned in sub-paragraphs (b) and (c) of paragraph (7).
(9) For the purposes of paragraph (10), a claim made by or on behalf of an injured person is a qualifying claim if—
(10) Regulations may make provision as to the circumstances in which the amount specified in a certificate relating to a qualifying claim is to be that which would be so specified apart from the regulations, reduced by the same proportion as the reduction of damages.
(11) A person to whom a certificate is issued is entitled to such particulars of the manner in which any amount specified in the certificate has been determined as may be prescribed, if he applies to the Department for those particulars.
(12) Regulations under paragraph (2) may be made so as to apply to any certificate issued after the time the regulations come into operation, other than one relating to a compensation payment made before that time.
(2) The Department may—
and, in either case, issue him with a demand that payment of any amount due under Article 3(2) be made immediately.
(3) The Department may recover the amount for which a demand for payment is made under paragraph (2) from the person who made the compensation payment.
(4) Any amount recoverable shall, if the county court so orders, be enforceable as if it were payable under an order of that court.
(5) A document which states that it is a record of the amount recoverable under paragraph (3) is conclusive evidence that the amount is so recoverable if it is signed by a person authorised to do so by the Department.
(6) For the purposes of paragraph (5), a document purporting to be signed by a person authorised to do so by the Department is to be treated as so signed unless the contrary is proved.
(e) in the case of which, after the certificate is issued, the parties to any resulting action before a court in Scotland execute a joint minute which specifies—
(f) in respect of which, after the certificate is issued, a document is made under any provision of the law of a country other than Northern Ireland, England and Wales or Scotland—
and notification of the order, judgment, minute or document has been given to the Department in the prescribed manner.
(2) Regulations may make provision as to the circumstances in which the Department shall review a certificate relating to a claim which, after the certificate is issued, becomes a qualifying claim (as defined in Article 5(9)).
(3)The Department may review a certificate issued by it—
(4) On a review under this Article, the Department may—
(5) The Department may not vary a certificate so as to increase the amount, or the aggregate amount, specified unless it appears to the Department that the variation is required as a result of the Department having been supplied with incorrect or insufficient information by the person to whom the certificate is issued.
Appeal against a certificate or a waiver decision
9.
—(1) An appeal against a certificate may be made by the person to whom the certificate was issued on one or more of the following grounds—
(c) that the payment on the basis of which the certificate was issued is not a compensation payment.
(2) No appeal may be made until—
(3) For the purposes of paragraph (2)(a), if an award of damages in respect of a claim has been made under—
(orders for provisional damages in personal injury cases), the claim is to be treated as having been finally disposed of.
(4) The Department may, on an application by the person to whom the certificate was issued, waive the requirement in paragraph (2)(b) that payment of the amount specified in the certificate be made before making an appeal.
(5) The Department may only grant a waiver if it appears to it that payment of the amount specified in the certificate would cause exceptional financial hardship.
(6) An appeal against a decision of the Department on an application under paragraph (4) (referred to in this Article and Articles 10 and 11 as a "waiver decision") may be made by the person to whom the certificate was issued.
(7) Regulations may make provision—
Appeal tribunals
10.
—(1) The Department shall refer to an appeal tribunal an appeal against—
(2) In determining an appeal against a certificate, the tribunal shall take into account any decision of a court relating to the same, or any similar, issue arising in connection with the injury in question.
(3) On an appeal against a certificate, the tribunal may—
(4) When the Department has received the decision of the tribunal on an appeal against a certificate, the Department shall in accordance with that decision—
(5) On an appeal against a waiver decision, the tribunal may—
(6) Regulations under Article 9 may (among other things) provide for the non-disclosure of medical advice or medical evidence given or submitted following a reference under paragraph (1).
(7) Regulations may apply any provision contained in the 1998 Order in relation to appeals under this Article to an appeal tribunal, but subject to such modifications as may be prescribed by the regulations.
(8) In this Article and Article 11 "appeal tribunal" means an appeal tribunal constituted under Chapter 1 of Part II of the 1998 Order.
Appeal to Social Security Commissioner
11.
—(1) An appeal may be made to a Commissioner against any decision of an appeal tribunal under Article 10 on the ground that the decision was erroneous in point of law.
(2) An appeal under this Article may be made by—
(3) If an appeal is made under this Article, paragraphs (7) to (13) of Article 15 of the 1998 Order apply to the appeal as they apply to an appeal under that Article (reading references to a tribunal as references to an appeal tribunal constituted as mentioned in Article 10(8)).
(4) In a case in which paragraph (7) or (8)(b) of Article 15 of the 1998 Order applies by virtue of paragraph (3) to an appeal against a decision of an appeal tribunal under paragraph (3) of Article 10, paragraphs (2) to (4) of that Article apply as they apply to an appeal determined on a reference under paragraph (1)(a) of that Article.
(5) In a case in which paragraph (7) or (8)(b) of Article 15 of the 1998 Order applies by virtue of paragraph (3) to an appeal against a decision of an appeal tribunal under paragraph (5) of Article 10, the appeal tribunal may—
(6) In a case in which paragraph (8)(a) of Article 15 of the 1998 Order applies by virtue of paragraph (3) to an appeal against a decision of an appeal tribunal under paragraph (3) of Article 10, paragraph (4) of that Article applies as if the references to the decision of the tribunal on an appeal against a certificate were references to the decision of the Commissioner on an appeal under this Article.
(7) In this Article "Commissioner" has the same meaning as in section 167(1) of the Social Security Administration (Northern Ireland) Act 1992 (c. 8).
(2) A person who is required to give information under this Article shall do so—
(3) Regulations under this Article may, in particular, require the provision of information about any health services treatment which an injured person has received at a health services hospital and any health services ambulance services provided to the injured person.
(4) In this Article—
Use of information held by the Department etc.
13.
—(1) Paragraph (2) applies to information which is held—
for the purposes of, or for any purpose connected with, the exercise of functions under the Social Security (Recovery of Benefits) (Northern Ireland) Order 1997 (NI 12).
(2) The information may—
(3) Paragraph (4) applies to information which is held—
for the purposes of, or for any purpose connected with, the exercise of functions under this Order.
(4) The information may—
Payment of health services charges to hospitals or ambulance trusts
14.
—(1) If the Department receives a payment of relevant health services charges under Article 3(2)—
(2) Paragraph (1) does not apply to any amount received by the Department under Article 3(2) which it is required to repay in accordance with regulations under Article 5(2).
(3) Regulations under this Article may—
(4) Any amounts received under this Article by the responsible bodies of the health services hospitals concerned shall be used for the purposes of providing goods and services for the benefit of patients receiving health services treatment at those hospitals.
(5) Any amounts received under this Article by the relevant ambulance trusts concerned shall be used for the purposes of health services ambulance services.
(6) In this Article—
(c) for cases in which the compensation payment to which Article 3(2) applies is an interim payment of damages which a court orders to be repaid.
(2) Regulations made by virtue of paragraph (1)(a) may (among other things) provide—
(3) Regulations may make provision modifying the application of this Order in relation to cases in which a payment into court is made and, in particular, may provide—
Liability of insurers
16.
—(1) If a compensation payment is made in a case where—
the policy is also to be treated as covering any liability of that person under Article 3(2).
(2) Liability imposed on the insurer by paragraph (1) cannot be excluded or restricted.
(3) For that purpose excluding or restricting liability includes—
(4) Regulations may in prescribed cases limit the amount of the liability imposed on the insurer by paragraph (1).
(5) This Article applies in relation to policies of insurance issued before (as well as those issued after) the date on which it comes into operation.
(6) References in this Article to policies of insurance and their issue include references to contracts of insurance and their making.
Power to apply this Order to treatment at non-health services hospitals
17.
—(1) Regulations may make provision for this Order to apply, with such modifications as may be prescribed, if—
(subject to paragraph (2)).
(2) Paragraph (1)(b) does not apply where the person to or in respect of whom the payment is made receives, or is taken to a hospital for, treatment which would be provided as mentioned in sub-paragraph (a) or (c) of Article 3(7) if it were provided at a health services hospital.
(3) In paragraph (1), "health services arrangement" means an arrangement or agreement between—
(4) In this Article "qualifying hospital" means a hospital which is not a health services hospital.
The Crown
18.
This Order binds the Crown to the full extent authorised or permitted by the constitutional laws of Northern Ireland.
Regulations and orders
19.
—(1) Regulations under Article 3(10) or the first regulations under Article 5(2) may not be made unless a draft has been laid before and approved by resolution of the Assembly.
(2) Any other regulations or orders made by the Department of Health, Social Services and Public Safety under this Order (except an order under Article 1) shall be subject to negative resolution.
(3) Regulations or orders under this Order may make—
Supplementary and consequential provision
20.
—(1) The Department of Health, Social Services and Public Safety may by order make—
as it considers necessary or expedient for the purposes of, in consequence of, or for giving full effect to, any provision of this Order.
(2) The provision which may be made under paragraph (1) includes provision amending or repealing any statutory provision, instrument or document.
Repeals and transitional provisions
21.
—(1) The statutory provisions mentioned in Schedule 2 are repealed to the extent specified in the second column of that Schedule.
(2) The repeal by this Order of Part II of the Health and Personal Social Services Act (Northern Ireland) 2001 (c. 3) does not affect the operation of that Part in relation to any injury which occurs before the date on which this Article comes into operation.
A.K. Galloway
Clerk of the Privy Council
2.
Any payment made in the exercise of a discretion out of property held subject to a trust in a case where no more than 50 per cent by value of the capital contributed to the trust was directly or indirectly provided by persons who are, or are alleged to be, liable in respect of—
3.
Any payment made out of property held for the purposes of a prescribed trust.
4.
—(1) Any payment made to the injured person by an insurer under the terms of any contract of insurance entered into between the injured person and the insurer before the occurrence of the injury in question.
(2) In sub-paragraph (1), "insurer" means—
(3) Sub-paragraph (2) shall be read with—
5.
Any payment which apart from this paragraph would be made by—
6.
Any payment to the extent that it is made—
7.
Any payment to the extent that it is made in respect of a liability arising by virtue of section 1 of the Damages (Scotland) Act 1976 (c. 13).
8.
Any payment of a prescribed description, either generally or in such circumstances as may be prescribed.
| Short Title | Extent of repeal |
| The Road Traffic (Northern Ireland) Order 1981 (NI 1). |
In Article 101(2)—
(b) in sub-paragraph (b), the words from "or under section 23" to "traffic casualties)". |
| The Health and Personal Social Services Act (Northern Ireland) 2001 (c. 3). | Part II. |
