In the first major change to the Rehabilitation Code since the 2015 update, an Addendum drafted by a cross-industry working group has been published with the aim of improving how rehabilitation is delivered for claims within the Online Injury Claims (OIC) portal.
Where the Addendum applies
While the use of the process introduced by the Addendum is voluntary, the stated aim is that "it to be used widely to provide rehabilitation in the majority of OIC claims, whether by represented or unrepresented claimants."
The Addendum also states that it is "intended to be used a [sic] basis for bilateral/trilateral agreements between defendant organisations and rehabilitation providers/claimant organisations", but it does not extend to reports which remain matters for the parties to determine.
The agreed process will only apply where the compensator has made a full admission of liability or where liability is deemed to have been admitted under the OIC process.
In cases where there has been a partial admission of liability, the Addendum provides that the claimant can, if they wish, obtain their own rehabilitation treatment and claim a proportion of the cost in line with the liability split either at the end of the case or as an interim payment.
If there is no agreement on liability or if rehabilitation has begun prior to an admission of liability being received, the Addendum states that the parties can nevertheless agree to follow the process and it states that "Compensators should consider from the outset whether there is a possibility or likelihood of at least a partial admission later in the process so as not to compromise the prospects for rehabilitation."
Rehabilitation for minor psychological injuries will not be handled through the Addendum process, although it acknowledges that claims will arise within the OIC portal where such injuries require rehabilitation.
The process
The 4-stage process introduced by the Addendum will apply where "the claimant representative (if any), the rehabilitation provider and the compensator agree this process will apply (usually by way of a pre-existing overarching agreement)". The detail of how each stage will operate is set out in the Addendum, which can be accessed here. In basic terms, the stages are:
Stage 1
There is to be an initial assessment as to whether the claimant is likely to benefit from rehabilitation. If so, the claim will progress to Stage 2. It should be noted that an initial indication from the claimant that rehabilitation is not required will not prevent them from seeking rehabilitation at a later stage.
Stage 2
A video or telephone consultation will take place with a person (who may or may not be clinically qualified) who will determine the appropriate route for the claimant, which may be:
- No rehabilitation is required.
- Self-help without clinical support.
- Self-help with guidance from clinical staff.
- Remote clinical treatment.
- Face-to-face clinical treatment.
If treatment is recommended, the parties' representatives will be notified and, in accordance with good clinical practice, the number of sessions recommended at the outset will be recorded.
Stage 3
If treatment is recommended, the appropriate treatment pathway identified in Stage 2 will be followed. If face-to-face treatment is recommended there will be an assessment followed by up to six treatment sessions without the need for the further reference to the paying party. If the injury is not resolved after these sessions, the claim drops out of the process.
Stage 4
The invoice for the rehabilitation treatment is to be sent to the compensator only after the treatment is provided with the Addendum setting out the detailed information that must be provided with the invoice.
Rehabilitation standards
The Addendum concludes with a detailed set of rehabilitation standards covering:
- Standards for Business Probity.
- Standards for Clinical Governance.
- Compliance.
- Standards for Conduct and Ethics.
Comment
Properly engaged with, the Addendum introduces a process which, it is hoped, will benefit all parties with claimants receiving the rehabilitation that they require and compensators seeing a positive impact on the quantum of claims.
Should any of our clients wish to discuss the changes introduced by the Addendum they should contact Kevan Smith, Kate Archer or Emma Fuller.
