Just what the doctor ordered - factoring in emergency treatment costs in claims by foreign nationals

Posted: 10/06/2016

Insurers who handle road traffic accident claims will be only too familiar with their obligation to meet emergency treatment fees for claimants taken to hospital for injuries sustained in accidents, but the liability may be far more significant in relation to claims made by foreign nationals.

While emergency treatment (and GP treatment) remains free for everyone in England, all other health care is only free to those who fall outside the National Health Service (Charges to Overseas Visitors) Regulations which came into force last year. Free health care is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK. The test to be applied is whether the patient is “ordinarily resident” in England (or is an EU or Swiss national who presents a valid European Health Insurance Card (EHIC), where arrangements exist for the NHS to recover its charges from the EU state concerned).

Victims of certain crimes of violence (defined as torture, FGM, domestic violence and sexual violence) are exempt from charging. Other than very limited exceptions (set out in detailed guidance to the regulations), non-EU foreign accident victims requiring medical treatment beyond emergency treatment are generally subject to be charged for the treatment, pursuant to the 2015 Regulations, at 150% of the standard NHS tariff charge.

So beware if you are representing a foreign claimant and fail to include the charges or if you are an insurer facing a personal injury claim by a foreign claimant.

How do we ascertain the costs payable? Each NHS trust will now have an Overseas Visitor Manager (OVM) whose role is to ensure that the regulations are being implemented. The OVM will usually be in the trust’s finance department. We recommend that representatives of foreign claimants make contact with all trusts where their client has been treated so that what can sometimes be very substantial amounts are not missed. Failure to do so, could see a claim being compromised and the patient receiving a bill for the treatment. Insurers need to factor these costs into their reserve calculations.

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