Vhi claiming money due from injury claim ????

Milli62

Had an accident in work in 2008 which resulted in me being out of work for over 2.5 years. I was paying Vhi monthly to cover my medical expenses. Vhi covered my hospital treatment of 2 days as outpatient. I signed a form on my first day of treatment in hospital and I stated on form that I was going to be making a personal claim against employer when asked.

At the time I didn't realise the implications of this question. Vhi are now requesting that I pay them €2,500 for the expenses from my personal claim award even though I was paying my monthly premium to cover my hospital treatment.

They have sent several letters requesting payment. At the time I responded to letter stating that my payment from the injuries board was for neglect from my workplace, for the trauma caused by incident and loss of earnings. Nowhere did they make payment for medical expenses.

They have now sent me another letter from debt recovery agency requesting payment.

Am interested to hear people's thoughts on this as afraid of what future implications this may have on my credit rating or should I just disregard letters

Pat Mustard

Milli62 wrote: »

should I just disregard letters

No, you should find out whether you are liable to pay the money. You should bring the letters to your solicitor and you should get legal advice on the matter. If a solicitor acted for you in relation to a personal injury claim in this matter, then you should refer the matter to him/her asap.

You mention an award in respect of personal injuries. You also state that you informed the VHI that you had intended to claim against your employer.

Did you claim for the amount of your treatment, which treatment appears to have been covered by VHI?

goz83

My Dads VHI policy covered medical expenses when I was run over (I was 15 I think). It took 3-4 years for the claim to be settled. The VHI were seeking payment from the awarded monies about a month after the funds were received and spent. The VHI were entitled to seek the money, because it was a claim, where a third party was liable. However, the solicitor had been instructed to pay any outstanding bills before handing a cheque to me. Legal fees were awarded by the court (PIAB did not exist) the firm representing me kindly kept €500 out of the compensation "incase other bills popped up". They had not paid the VHI, which was their duty, as they had agreed to pay all bills before I was paid. They did not get anymore money from me. It had been spent and they knew they messed up. Never heard anything more about it.

Peregrinus

This is how insurance works. If you suffer a loss - say, the cost of medical treatment - and an insurer pays you to cover it, then you are taken to have transferred to them any claim which you may have to be entitled to compensation for the same loss from anyone else. So if you recover the cost of the same medical treatment from someone else, your second recovery belongs to your insurer.

This isn't a special rule for medical treatment; it applies to insurance generally. If an arsonist burns your house down and your insurer pays you for that, any amount you might recover from the arsonist for the loss of your house is due to the insurer.

Cushie Butterfield

Here's a link to the type of form that you probably signed in the hospital :

https://www.vhi.ie/pdf/claims/HospitalDirect.pdf

Scroll down to Page 2 Section 4 small print states that:

''In consideration of Vhi Healthcare discharging my hospital and medical expenses to the extent of my cover limits and in accordance with the Rules of my contract with Vhi Healthcare, I agree to include these expenses as part of my current (or future) claim against a third party(ies). Where I pursue a claim against a third party, either through the Courts or other Tribunals/Boards (and where I have legal representation), I hereby irrevocably authorise the solicitor(s) representing me in making that claim to furnish to Vhi Healthcare an undertaking in the following form: “In consideration of Vhi Healthcare discharging the eligible hospital and medical expenses of my client, I hereby agree to include as part of my client’s claim the monies so paid by Vhi Healthcare (details of which will be supplied to me by Vhi Healthcare) and subject to any court order to thecontrary, to repay to Vhi Healthcare - out of the net proceeds of the settlement that come into our hands - all monies recovered in respect of such expenses paid by Vhi Healthcare.”

Where my claim is adjudicated upon by the Injuries Board or the Criminal Injuries Compensation Tribunal and where I do not engage legal representation, I hereby agree to include as part of my claim the monies so paid by Vhi Healthcare (details of which will be supplied to me by Vhi Healthcare) and subject to any order/award to the contrary, to repay to Vhi Healthcare - out of the net proceeds of the settlement that come into our hands - all monies recovered in respect of such expenses paid by Vhi Healthcare. I further authorise Vhi Healthcare to provide the Injuries Board and/or my legal representative with details of all claims paid by Vhi Healthcare relating to my third party case and for the Injuries Board/my legal representative to release to Vhi Healthcare full details of the Injuries Board assessment or other agreed settlement with a third party. In circumstances of an anticipated reduced settlement I agree to contact Vhi Healthcare upon it being made known to me that monies so paid by Vhi Healthcare may not be fully recoverable. When a reduced settlement has been agreed, I will provide Vhi Healthcare with a Certificate from my legal representatives in the format agreed between the Law Society and Vhi Healthcare confirming that the net proceeds recovered is the amount actually recovered. In addition, I agree to provide a Certificate from Counsel (if Counsel was instructed in relation to the settlement/hearing), confirming the veracity of the net proceeds recovered.''

The wording of the document may have changed slightly, but that would have been the general gist.

Pro Hoc Vice

Milli62 wrote: »

Had an accident in work in 2008 which resulted in me being out of work for over 2.5 years. I was paying Vhi monthly to cover my medical expenses. Vhi covered my hospital treatment of 2 days as outpatient. I signed a form on my first day of treatment in hospital and I stated on form that I was going to be making a personal claim against employer when asked.

At the time I didn't realise the implications of this question. Vhi are now requesting that I pay them €2,500 for the expenses from my personal claim award even though I was paying my monthly premium to cover my hospital treatment.

They have sent several letters requesting payment. At the time I responded to letter stating that my payment from the injuries board was for neglect from my workplace, for the trauma caused by incident and loss of earnings. Nowhere did they make payment for medical expenses.

They have now sent me another letter from debt recovery agency requesting payment.

Am interested to hear people's thoughts on this as afraid of what future implications this may have on my credit rating or should I just disregard letters

Did you use a solicitor for your PIAB claim.

Milli62

Thank you all for your replies, I suppose my issues is with the settlement, no medical expenses were taken in to consideration. Everything else was like Doctor's medical reports, prescriptions, and solicitor etc. to which I have all repaid. I of course would in turn have repaid VHI if I received money to do so, but I didn’t. VHI requested that I send in the copy of settlement, which clearly outlined that no medical expenses were included. Solicitor wrote to VHI outlining for their expenses to be included in PIAB claim that it would cost 375e to include report which needed to be paid by them. Solicitor or I did not receive payment.

I'm confused, I dont feel I owe them the bill as my settlement was loss of earning, pain and suffering, However I dont want the hassle.

Any more advice on matter ??

Thanks in advance

kilp10

Funny this should come up now...

Had an accident in 2012. Throughout 2013 had numerous MRIs and on every single form for Aviva I ticked the box 'this is as a result of a claim'. Heard nothing until last week, I sent in some receipts and next thing have a request from them to be included in the claim from 2012. I rang them and asked why were they only contacting me now? And that they were damn lucky because that claim almost got settled over the summer but is now delayed, so they nearly missed out.

If they hadn't contacted me until after the claim was settled and I had ticked all the boxes giving them plenty opportunity to follow it up, then I'd hand it to my solicitor and say 'fight this'. They don't deserve anything for sloppy processes on their side.

Peregrinus

As you can see from the post by Cushie Butterfield, you very likely signed an agreement saying that, if you made an accident claim, you would include the matters covered by VHI in your claim. In the event you didn't include them in your claim, which is why those matters were not included in your award.

You didn't include them because you wanted VHI to pay the cost of including them, but in fact nothing in your agreement with VHI mentions that. Still, the fact that they never replied and pointed out that you had already agreed to include them and should do so without payment may give you some grounds for argument. They should have known, therefore, that their item was not being included in the claim, and they did nothing about it, and can't now turn around when it's too late for you to include it - your claim is settled. So you may have some basis for arguing that they can't recover from you now or, at least, that they need to give you a discount to reflect the fact that their own inaction has contributed to the situation you're in. It really comes down to whether you have the stomach for a fight with them.

Marcusm

kilp10 wrote: »

Funny this should come up now...

Had an accident in 2012. Throughout 2013 had numerous MRIs and on every single form for Aviva I ticked the box 'this is as a result of a claim'. Heard nothing until last week, I sent in some receipts and next thing have a request from them to be included in the claim from 2012. I rang them and asked why were they only contacting me now? And that they were damn lucky because that claim almost got settled over the summer but is now delayed, so they nearly missed out.

If they hadn't contacted me until after the claim was settled and I had ticked all the boxes giving them plenty opportunity to follow it up, then I'd hand it to my solicitor and say 'fight this'. They don't deserve anything for sloppy processes on their side.

Your argument should be with the solicitor and his/her sloppy processes; this is bog standard and they should have provided for it.

Pro Hoc Vice

Milli62 wrote: »

Thank you all for your replies, I suppose my issues is with the settlement, no medical expenses were taken in to consideration. Everything else was like Doctor's medical reports, prescriptions, and solicitor etc. to which I have all repaid. I of course would in turn have repaid VHI if I received money to do so, but I didn’t. VHI requested that I send in the copy of settlement, which clearly outlined that no medical expenses were included. Solicitor wrote to VHI outlining for their expenses to be included in PIAB claim that it would cost 375e to include report which needed to be paid by them. Solicitor or I did not receive payment.

I'm confused, I dont feel I owe them the bill as my settlement was loss of earning, pain and suffering, However I dont want the hassle.

Any more advice on matter ??

Thanks in advance

I ask again did you use a solicitor for your PIAB claim, without knowing that no one can say what should be your next step.

kilp10

Marcusm wrote: »

Your argument should be with the solicitor and his/her sloppy processes; this is bog standard and they should have provided for it.

True...just after looking at the small print of Aviva. But then, why do the health insurance get you ticking these boxes but yet never following through? When I spoke to them recently, they said they run these reports off at regular intervals and pretty much hinted that it depends on the amounts involved whether they come looking. But I mentioned it once or twice in my dealings with them on the phone over the last two years and ticked the boxes and at no stage did they ever mention that I had to include them in any claim and only sent out the release data forms last week. So I still stand by that they are a little sloppy in their processes as well. Customers will always miss the small print, Solicitor should have included, but there is an onus on the insurance provider to read the forms returned to them as well and not come contacting the customer a few years after they've been well notified.

Milli62

Pro Hoc vice sorry yes my solicitor put in claim with PIAB. The solicitor claimed for everything else I dont know why medical expences wouldnt have been included. I didnt refuse for anything not to be included in claim . I was 24 at the time, hadnt a clue to be fair what was going on just relied on solicitor to do the job.

Milli62

VHI had asked for solicitor to sign undertaking , solicitor voiced under the law society of Ireland or somehing like taht , that undertakings can not be signed due to the unknowst of how much more medical treatment is needed. Solicitor requested VHI to outline exactly how much they were claiming for and to pay the 375 to be uncluded in claim. Id doesnt look like this happened.

Milli62

VHI had asked for solicitor to sign undertaking , solicitor voiced under the law society of Ireland or somehing like that , that undertakings can not be signed due to the unknowst of how much more medical treatment is needed. Solicitor requested VHI to outline exactly how much they were claiming for and to pay the 375 to be included in claim. Solicitor outlind in letter to VHI that they should be well aware how undertakings work.

Pat Mustard

Milli62 wrote: »

VHI had asked for solicitor to sign undertaking , solicitor voiced under the law society of Ireland or somehing like taht , that undertakings can not be signed due to the unknowst of how much more medical treatment is needed. Solicitor requested VHI to outline exactly how much they were claiming for and to pay the 375 to be uncluded in claim. Id doesnt look like this happened.

So are VHI looking for €375 or €2500?

Milli62

2500E , there is no documentation to say that they ever paid the 375 to have there expences to be included, well none that I am aware of.

Pro Hoc Vice

Milli62 wrote: »

2500E , there is no documentation to say that they ever paid the 375 to have there expences to be included, well none that I am aware of.

Hand demand to solicitor and ask him to sort it out.

kennM

I can probably give some feedback here... NOT advice... been through this process and it is a damned nightmare!!!

I was involved in a motorbike accident back in 2010, same story... had VHI, other party liable, civil case, blah... you know the routine.

Anyway into the nitty gritty. Basically VHI's position is that: If the other party is liable for medical costs incurred through an accident or injury that was somebody elses fault then they expect that their medical costs incurred are recouped out of the claim itself. They have some clause in their contract.... deeply unfair IMO but I'll give more insight into this later. (Sorry gonna be a long post, don't say I didn't warn you).

So should I have signed that form in the hospital? This is what I did... so what happens then? VHI will not pay a penny towards your treatment without a signed undertaking that their costs will be recouped in the civil case (From Myself or Solicitor). This is what happened in my situation.... had medical procedure X, Y, Z... filled in VHI claim form, outlined that costs were due to accident & could be recouped etc. (You know the section on the claim form well I'd say). Hospital submitted claim to VHI to be paid, VHI reject the claim on the basis they haven't got a signed undertaking, hospital invoice me directly for monies owed (which was in the tens of thousands of euro, which I don't have), I send this into the solicitor, solicitor writes out to hospital outlining circumstances and with a little persistence they wait for civil case to come to fruition. Repeat last few steps here many many times, i.e. for every medical procedure (of which there were many).

In my case it was just longer and more complicated, so rather than one creditor (VHI) owed tens of thousands I had a list of creditors owed various different amounts. Needless to say, stupid amount of stress and hassle, threatening letters, legal threats etc. over outstanding monies owed.

So should the solicitor sign the undertaking? The Law Society of Ireland are in dispute with VHI over these very undertakings because of the wording and implications. The Law Society of Ireland have recommended to all solicitors that they don't sign them. There are situations where not 100% of medical costs are covered, e.g. in a 50/50 accident but, because of the undertaking, the injured party ends up liable & out of pocket.

So what has been/can be done about it. As advised already, go speak with your solicitor or at least give them a call. I'm aware that a solicitor or the Law Society of Ireland took a case to the Financial Ombudsman with regards to these very undertakings and won. I don't know if this constitutes a landmark ruling or if it was for an individual case.

The process, as you already know, is DEEPLY UNFAIR. If you drive down the road and have an accident that is 100% your fault VHI will pay up no problem. If you're in the unfortunate position that somebody else hits you then you end up with this absolute nightmare ongoing on top of the rest of the pain/suffering/impact on your life/etc.

Probably not the answer you wanted to here but hopefully a little insight and some info is of use to you

d9oiu2wk07blr5

Mary Harney introduced this provision in the Health Insurance Act to ensure that claimants aren't double benefiting from any compensation awards. However, where the claimant doesn't receive any award for their medical expenses, it's the insurance companies who are indeed double benefiting, in terms of getting the insurance premiums and their money back for the costs of treatment. This anomaly in the legislation where PHI companies are the one's who are double benefiting is something that needs to be addressed by the Minister.

Milli62

Kennm thanks so much for your post , I was in contact with injuries board and they sent me out copy of claim . Everything was claimed eg doctors reports , prescriptions etc but no claim was put forward for VHI. So from that my understanding is of two things VHI never paid there E375 to have their bill included in my claim which the solicitor outlined in the letter or for some strange reason solicitor did not include it in claim which I don't know why he would do that considering he put In for everything else. I do feel tho that solicitor maybe didn't clean this up properly and maybe VHI Should have been notified that there claim wasn't included which in turn would have saved me all the hassle.

I'll update this in coming weeks if I sort things for those of you that are interested and thanks again for all the advice