22 October 2014 | Comment | Article by Stephanie Eedy

RTA Low Value Protocol – A practical Note for Claims Handlers/Insurers

The advent of fixed medical fees in RTA soft tissue injury claims is now upon us, where a Claim Notification Form (CNF) has been submitted as of 1 October 2014.

The rationale behind the introduction of the reforms was:

 

  • to control the use and cost of medical reports;
  • to ensure that in most cases only one report is obtained;
  • to ensure the independence of the medical expert and treatment;
  • to ensure that offers to settle are only made after a fixed costs medical report has been disclosed [any offer which is made before such a report is disclosed, a “pre-med offer", will have no adverse costs consequences].

 

The definition of a soft tissue injury claim is one where the significant physical injury is soft tissue in nature and sustained by an occupant of a motor vehicle. It would therefore not apply to any accidents where a pedestrian had suffered a similar soft tissue injury. The definition also applies where there is a minor psychological injury that is secondary to the soft tissue one.

The cost of a report will be £180 + VAT as per CPR 45.19  If a further report is required it can be obtained from experts of the following disciplines, at the specified costs as below:

Consultant Orthopaedic Surgeon £420 (including review of medical records)
Consultant A+E expert £360
GP £180
Physiotherapist £180
Medical Records £30
Addendum report on medical records £50
Part 35 questions £80

In accordance with the reforms objectives, a further report is only warranted where the disclosed first report has recommended a follow up report be obtained (see amended CPR Part 35.4). These fees are payable on submission of the settlement pack with the inclusion of an invoice with the Stage 1 costs. Where a claimant obtains a report outside of the fixed fee scheme, then this cost will not be recoverable.

As to who provides the reports, this will be from a medical expert who has not provided treatment to the claimant, is not associated with any person/party that has provided treatment and does not propose or recommend that they or an associate provide treatment (for the definition of an Associate, refer to Paragraph 1.1 (10A) (B) RTA Pre-Action Protocol).

There were concerns under the old system that medical experts gave diagnoses/prognoses based solely on the claimant’s version of events. In the new procedure, in the event of a conflicting set of circumstances, the expert can have sight of both versions and determine the appropriate diagnosis/prognosis.

Further review of the whiplash claim culture is due, the second tranche of reforms becoming due in January, including the medical expert accreditation scheme. We are hopeful that this will bring a measure of objectivity and improve the quality of the reports.

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