Bupa recovering costs from a compensation payout, is this right?

marcy990

My other half was knocked off his cycle and hurled into the air last Jan 2020.  He almost died.  He was hospitalized for 8 weeks, initially in an nhs hospital but afterwards his work health insurance with Bupa took over.  He'd suffered multiple fractures in his hips, broken ribs, Over a year later, having suffered back pain from a fractured vertebrae, migraines,  needing counseling, therapy, receiving physiotherapy during his recovery, BUPA are claiming their money from a compensation payout which is being negotiated.  Is this right?  The insurance company for the person who should not have been on the road due to a medical condition, has made a measly offer and BUPA are claiming £12,000 roughly to recover their costs.  Can somebody please explain this way of working please?
 

Aretnap

Sorry to hear that and I hope your husband is continuing to recover.

The compensation payment will (or should) consist of sums for several different things - an amount to compensate for his pain, suffering and disability, another amount to make up for any income he has lost through not being able to work, an amount to pay for damaged property (eg his bike)... and an amount to pay for medical treatment.

In this case the treatment (or some of it) was paid for by BUPA, presumably under an insurance policy, and the terms of his BUPA policy will likely say that if he is entitled to recover treatment costs from another party (eg the driver), they are entitled to claim them on his behalf. It will, or should, just be the portion of the payment that is intended to cover medical bills that they are claiming - not the portion that covers lost income or pain and suffering.

If you think that the offer is generally too low then that's something you would need to discuss with his solicitor. I presume you have a solicitor involved for a claim for injuries this serious? If not, you should. 

dunstonh

 BUPA are claiming their money from a compensation payout which is being negotiated.  Is this right?

Yes. All costs will be attempted to be recovered from the guilty party.    Not just your OH's loss of income and costs he will suffer in future but also any medical costs.   It is not unusual for the NHS and other emergency services to do similar.

The insurance company for the person who should not have been on the road due to a medical condition, has made a measly offer and BUPA are claiming £12,000 roughly to recover their costs.  Can somebody please explain this way of working please?

What does your partner's legal assistance say in respect of the offer and its reasonableness? 

marcy990

dunstonh said:

Yes. All costs will be attempted to be recovered from the guilty party.    Not just your OH's loss of income and costs he will suffer in future but also any medical costs.   It is not unusual for the NHS and other emergency services to do similar.

With respect to this, the medical costs are not being recovered from the guilty party, Bupa are wanting to take it from the compensation payout. This seems totally unreasonable coming out of that. 

What does your partner's legal assistance say in respect of the offer and its reasonableness? 
His solicitor has not been effective.  He first persuaded the other half to go with him as it was an open and shut case with regard to what had happened and he was experienced in these things.  Today, he had forgotten that he was doing this on a no win no fee basis and promptly said that he was to take X  percent from the payout!!  He was soon put back in his box and reminded of this.  He has not added much to the proceedings really.  He did not think that the offer was reasonable at all but cannot come up with any more.  

Aretnap

marcy990 said:With respect to this, the medical costs are not being recovered from the guilty party, Bupa are wanting to take it from the compensation payout. This seems totally unreasonable coming out of that. 

It might seem unreasonable at first, but it's actually the normal process by which BUPA recover their costs from the at fault party. The technical term is "subrogation". BUPA cannot claim their costs directly from the third party, as BUPA were not harmed by the third party. Instead your husband claims his medical bills from the third party, on top of the other things he is claiming for, and these then get paid to BUPA, who provided the medical treatment for which he is claiming.

Sometimes this process is done separately from his own claim for compensation for loss of earnings etc, and the actual victim may have little involvement beyond signing a form allowing BUPA to act on his behalf. If he's not paying too much attention, he might not even realise that it is happening. In this case it sounds like it has been rolled up into his general compensation claim, which may give the impression that it is coming out of his general compensation. But he hasn't lost out; an amount should have been added to his total compensation specifically to cover the medical bills that BUPA are claiming.

He should ask for a breakdown of exactly how the compensation has been calculated. It should be broken down along the lines of:

Pain and suffering £A
Loss of income £B
Damage to property £C
Medical expenses £D
(Maybe some other things, depending on what he's claiming for)
Total £A+B+C+D

£D should match what BUPA are claiming, plus any excesses he's had to pay.

As above if you think £A, £B and £C should be higher then that's an argument worth having, but it's a separate argument to what should happen to £D. 

missile

marcy990 said:

dunstonh said:

Yes. All costs will be attempted to be recovered from the guilty party.    Not just your OH's loss of income and costs he will suffer in future but also any medical costs.   It is not unusual for the NHS and other emergency services to do similar.

With respect to this, the medical costs are not being recovered from the guilty party, Bupa are wanting to take it from the compensation payout. This seems totally unreasonable coming out of that. 

What does your partner's legal assistance say in respect of the offer and its reasonableness? 
His solicitor has not been effective.  He first persuaded the other half to go with him as it was an open and shut case with regard to what had happened and he was experienced in these things.  Today, he had forgotten that he was doing this on a no win no fee basis and promptly said that he was to take X  percent from the payout!!  He was soon put back in his box and reminded of this.  He has not added much to the proceedings really.  He did not think that the offer was reasonable at all but cannot come up with any more.  

No win no fee solicitors are generally opt to settle as quickly as possible and rarely go the extra mile. The other parties insurer will know this and can use it to their advantage.
You might want to consider employing another solicitor, however you will be liable for solicitor No1 fees.
When I had a serious accident, I was keen to settle. My solicitor advised me to wait to see what effect my injuries would have on my future health & employment prospects. You have 3 years to lodge a claim via the court. In my case I gave evidence on day1 of the hearing. Then the other party folded and made a substantially increased 6 figure offer which I was delighted to accept.