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Statutory Rules of Northern Ireland


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STATUTORY RULES OF NORTHERN IRELAND


2007 No. 24

HEALTH SERVICES CHARGES

The Recovery of Health Services Charges (Reviews and Appeals) Regulations (Northern Ireland) 2007

  Made 17th January 2007 
  Coming into operation 12th February 2007 

The Department of Health, Social Services and Public Safety, in exercise of the powers conferred on it by Articles 2, 8(1), (2) and (3), 9(7), 10(6) and 19(3) of the Recovery of Health Services Charges (Northern Ireland) Order 2006[1], makes the following Regulations:

Citation, commencement and interpretation
     1. —(1) These Regulations may be cited as the Recovery of Health Services Charges (Reviews and Appeals) Regulations (Northern Ireland) 2007 and shall come into operation on 12th February 2007.

    (2) In these Regulations—

    (3) A reference in these Regulations to a numbered Article is a reference to that Article of the Order.

Review of certificates
     2. —(1) For the purposes of Article 8(1), notification of an order, judgement, minute or document referred to in that Article is to be given to the Department by the compensator sending to it—

    (2) The Department must review a certificate relating to a claim which, after the certificate is issued, becomes a qualifying claim (as defined in Article 5(9)) if, not later than 3 months after the claim becomes a qualifying claim, the report containing the information required by regulation 3(1)(a) (production of report) of the Recovery of Health Services Charges (General) Regulations 2006[5] is sent by the compensator to the Department.

    (3) Subject to paragraph (4), the Department may review a certificate where it is satisfied that—

    (4) An application for a review under Article 8(3) must be in writing on a form approved by the Department[6] and sent to it not later than 3 months after—

Information to be provided on issue of a certificate
     3. —(1) Where the Department issues a certificate to any person, it shall at the same time send the person a notice as to—

Waiver applications and appeals
    
4. —(1) An application under Article 9(4) for a waiver of the requirement in Article 9(2)(b) that payment of the amount specified in the certificate be made before making an appeal ("a waiver application") shall be sent to the Department with particulars of the exceptional financial hardship that would be caused by payment of the amount specified in the certificate.

    (2) A waiver application shall be sent to the Department not later than—

    (3) Where the Department makes a waiver decision[7], the person who made the waiver application shall be—

    (4) An appeal against a waiver decision shall be in writing on a form approved by the Department and unless an application has been granted to extend the time for an appeal against a waiver decision under regulation 7, shall be sent to the Department not later than one month after the date of the waiver decision.

    (5) An appeal against a waiver decision shall contain—

Appeals against certificates
     5. —(1) Any appeal against a certificate shall be in writing on a form approved by the Department and, unless an application has been granted to extend the time for an appeal against a certificate under regulation 7, shall be sent to the Department—

    (2) Where the points raised in an appeal against a certificate have not already been the subject of a review under Article 8 the Department, if it thinks it appropriate to do so, may treat an appeal against a certificate as an application for review under Article 8(3).

    (3) Where the Department decides to treat an appeal against a certificate as an application for review under Article 8(3) it must advise the applicant that it has done so and—

    (4) Any appeal under this regulation shall contain the following particulars—

Appeals — General
    
6. —(1) Where an appeal is not made on the form approved for the time being, but is made in writing and contains all the particulars required under regulations 4(5) or 5(4), as the case may be, the Department may treat that appeal as duly made.

    (2) Where it appears to the Department that an appeal does not contain all the particulars required under regulations 4(5) or 5(4), as the case may be, it may require the person making the appeal to provide such particulars as are not included.

    (3) Where paragraph (2) applies, the Department may extend the time specified by regulations 4(4) or 5(1), as the case may be, for making the appeal by a period of not more than 14 days.

    (4) Where further particulars are required under paragraph (2), they shall be sent to the Department within such a period as it may direct.

    (5) Where a person is required under paragraph (2) to provide further particulars and does not do so within the period of time specified under paragraph (4)—

    (6) The date of an appeal shall be—

Extension of time for appealing
    
7. —(1) The time prescribed by regulations 4 and 5 for the making of an appeal may be extended, even though the time so prescribed may already have expired, on application by the compensator.

    (2) Any application for an extension of time shall be sent to the Department and shall be determined by a legally qualified panel member except that where the Department is satisfied that the condition in paragraph (3)(b) is satisfied it may also grant the application.

    (3) An applicant must satisfy the person determining the application that—

    (4) For the purposes of paragraph (3) it shall not be considered to be in the interests of justice to grant an application unless the person determining the application is satisfied that—

    (5) In determining whether there are special reasons for granting an application for an extension of time for making an appeal under paragraph (1) the person determining the application shall have regard to the principle that the greater the amount of time that has elapsed between the expiry of the time specified for the making of the appeal and the making of the application for an extension of time, the more cogent should be the special reasons on which the application is based.

    (6) In determining whether facts constitute special reasons for granting an application for an extension of time for making an appeal under paragraph (1), no account shall be taken of the following—

    (7) The person who determines an application for an extension of time for making an appeal shall record a summary of his decision in such written form as has been approved by the President of appeal tribunals appointed under Article 6 of the Social Security (Northern Ireland) Order 1998.

    (8) Where a decision is made under this regulation by a legally qualified panel member he shall notify the applicant and the Department.

    (9) Where a decision is made under this regulation by the Department it shall notify the applicant.

    (10) Any application under paragraph (1) for an extension of time for making an appeal shall contain the following particulars—

    (11) An application under paragraph (1) which has been refused may not be renewed.

    (12) No appeal may be brought later than 1 year after the beginning of the period prescribed in regulations 4(2) or 5(1), as the case may be, or, if more than one such period is relevant, the one beginning later or latest.

General provisions relating to the procedure for appeals
    
8. —(1) Where an appeal is made, the provisions of the Social Security Regulations specified in paragraph (2) shall apply in relation to the appeal as they apply to an appeal to an appeal tribunal under Article 13 of the Social Security (Northern Ireland) Order 1998[8], subject to the modifications to those regulations set out in paragraphs (3) to (7).

    (2) The provisions referred to in paragraph (1) are—

    (3) Any reference in the provisions specified in paragraph (2) to a party to the proceedings shall be construed as referring to—

    (4) Regulation 38 (consideration and determination of appeals and referrals) of the Social Security Regulations shall apply as if the reference to "any provision of these Regulations" were a reference to any provisions of the Social Security Regulations specified in paragraph (2).

    (5) Regulation 46 (appeals which may be struck out) of the Social Security Regulations shall apply as if—

    (6) Regulations 56(1) (correction of accidental errors) and 57(1) (setting aside decisions on certain grounds) of the Social Security Regulations shall apply as if the reference to "a relevant statutory provision" were a reference to Article 10.

    (7) Regulation 58(1) (application for leave to appeal to a Commissioner from an appeal tribunal) of the Social Security Regulations shall apply as if the reference to "Article 15 of the Recovery of Benefits Order or under Article 13 or 14" were a reference to Article 11.

Consolidation of appeals
     9. Where two or more appeals against certificates relate to the same injury, the legally qualified panel member may direct that the appeals be consolidated.



Sealed with the Official Seal of the Department of Health, Social Services and Public Safety on


17th January 2007.

L.S.


Julie Thompson
A senior officer of the Department of Health, Social Services and Public Safety


EXPLANATORY NOTE

(This note is not part of the Regulations)


The Recovery of Health Services Charges (Northern Ireland) Order 2006 provides for a scheme for the recovery of charges in cases where an injured person who receives a compensation payment in respect of his injury has received health services hospital treatment or ambulance services. The charges are specified in certificates issued by the Department for Social Development, and are payable by persons who pay compensation to the injured person.

A person to whom a certificate is issued may appeal against the certificate, provided he pays beforehand the amounts specified in the certificate or the Department waives the requirement to pay. The person may also appeal against the Department's decision whether to waive the requirement to pay ("the waiver decision").

The regulations make provision—


Notes:

[1] S.I. 2006/1944 (N.I. 13) Article 2 is cited for the definition of "prescribed".back

[2] S.I. 1998/1506 (N.I. 10)back

[3] 1992 c. 8back

[4] S.R.1999 No. 162; the relevant amending instruments are S.R. 1999 Nos. 242 and 408, S.R. 2000 No. 215, S.R. 2001 No. 23, S.R. 2002 No. 189 and S.R. 2005 No. 46back

[5] S.R. 2006 No. 536back

[6] Any form approved by the Department and referred to in these Regulations is obtainable from the Compensation Recovery Unit, Magnet House, 81-93 York Street, Belfast BT15 1SS.back

[7] See Article 9(6) of the Order for the meaning of waiver decisionback

[8] S.I. 1998/1506 (N.I. 10).back

[9] S.R. 1999 No. 162. Paragraphs (2), (3) and (6) to (8) were amended by S.R. 2000 No. 215, paragraphs (2), (5) and (7) were amended by S.R. 1999 No. 242 and paragraphs (2), (5) and (9) were amended by S.R. 2004 No. 516.back

[10] S.R. 1999 No. 162. Provision heading and paragraphs (1) to (4) were amended by S.R. 2004 No. 516.back

[11] S.R. 1999 No. 162. Paragraphs (1) and (2) were amended by S.R. 2000 No. 215.back

[12] S.R. 1999 No. 162. Paragraphs (1) and (4) were amended by S.R. 2004 No. 516.back

[13] S.R. 1999 No. 162. Paragraphs (1) and (2) were amended by S.R. 2002 No. 189 and paragraph (2) was amended by S.R. 2004 No. 516.back

[14] S.R. 1999 No. 162. Paragraphs (6), (9), (10) and (13) were amended by S.R. 2002 No. 189 and paragraph (7) was amended by S.R. 2002 No. 189 and S.R. 2005 No. 46.back

[15] S.R. 1999 No. 162. Paragraph (5) was revoked by S.R. 2002 No. 189.back

[16] S.R. 1999 No. 162. Paragraph (3) was amended by S.R. 1999 No. 215 and S.R. 2005 No. 46, paragraph (4) was amended by S.R. 2000 No. 215, S.R. 2002 No. 189 and S.R. 2005 No. 46 and paragraph (4A) was inserted by S.R. 2005 No. 46.back

[17] S.R. 1999 No. 162. Paragraph (1) was amended by S.R. 2000 No. 215 and S.R. 2005 No. 46, paragraphs (6), (10), (11) and (12) were amended by S.R. 2002 No. 189 and paragraph (12A) was amended by S.R. 2002 No. 189 and S.R. 2005 No. 46.back

[18] S.R. 1999 No. 162. Paragraphs (2) to (4) were amended by S.R. 2005 No. 46.back

[19] S.R. 1999 No. 162. Paragraph (1) was amended by S.R. 2000 No. 215 and S.R. 2005 No. 46 and paragraph (2) was amended by S.R. 2005 No. 46.back

[20] S.R. 1999 No. 162. Paragraphs (2), (3) and (6) to (12) were amended by S.R. 2002 No. 189 and paragraph (4A) was inserted by S.R. 2005 No. 46.back

[21] S.R. 1999 No. 162. Paragraph (1) was amended by S.R. 2002 No. 189 and S.R. 2005 No. 46, paragraph (1A) was inserted by S.R. 2005 No. 46, paragraph (3) was revoked by S.R. 2002 No. 189, paragraph (4) was amended by S.R. 2002 No. 189, paragraph (5) was amended by S.R. 2005 No. 46 and paragraph (6) was amended by S.R. 2002 No. 189.back

[22] S.R. 1999 No. 162. Paragraphs 2(1) and (2) were amended by S.R. 2005 No. 46 and paragraph (3) was amended by S.R. 2002 No. 189.back



ISBN 978 0 337 96811 2


 © Crown copyright 2007

Prepared 22 January 2007


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