Life-changing injuries
Insurance and compensation when injured in an accident
People had different financial experiences after life-changing injuries. Some people who were unable to return to work, lived on benefits, payments from insurance companies or compensation claims. Sometimes people had health or life insurance policies, either independently or through work, which became their source of income and paid for medical treatments after injury. Nonetheless, it was important for people to get back to doing something that gave their lives “a purpose” (Adrian). Having this financial security meant they could focus on their rehabilitation and getting on with their lives.
She couldn’t go back to work after her brain injury, but Bridget’s insurance will pay her as if...
She couldn’t go back to work after her brain injury, but Bridget’s insurance will pay her as if...
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Although I had been with my job six months when I had the accident and, therefore, I didn’t have any employment protection, but they had a BUPA scheme so they kept paying me, I think, I’m not sure, for some period of time. I don’t know how many months it was. But, I would say, I was very fortunate. My sister who’s slightly older than me was working for Sun Life Insurance and she had sold me...When I started my job, I didn’t have any employment protection for the first twelve months. Because I was a personnel professional I needed to get it. So, she sold me a permanent health insurance scheme, which was in operation when I had the accident, which meant that I am now paid by my insurance as if I were working until I reach retirement age, less state benefits and I’m very, very grateful for that. Because, you know, if I hadn’t had that it would have been much more difficult. So I can’t remember what the question was.
Adrian wanted to work but as it didn’t make financial sense (because his salary would be deducted...
Adrian wanted to work but as it didn’t make financial sense (because his salary would be deducted...
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Okay, again, working for [investment bank], I’d been working for them for six years. I joined in ‘96 and had my head injury in ‘01. Now through that injury my life’s insured. Through that life insurance I get paid two thirds salary for life. It’s inflation-based, so I get a pay rise every year as well, which is great. But if I worked for money, for the money I would earn – I have also got incapacity benefits, but those two things are my income. If I work for money, whatever I earn, whatever it is – a hundred quid a week a month, a year, whatever – will come off my insurance money. So there’s no point in working for money, which is why working at Headway East London as a volunteer is perfect because I’m not working, I’m not getting paid, I’m actually working and helping out there and also donating money to them, so I’m actually, I don’t have that worry at all. But that’s also, thank God for that, because if I had to work for money, I don’t know if I could do it. Because I think the hours, the stress, knowing the job that I had before, I couldn’t do that job, I know. The worry and the running the team that I did then. I couldn’t do that. But even if it was a smaller job I don’t know if I could do it because of my memory impairment, stamina, because it’s uncertainty.
Having insurance made a difference to those who were injured abroad because it covered the costs of flying them home. However, this was not the case with all policies and some families had to step in and pay the expense.
Nick’s repatriation from Spain was covered by his insurance company. The insurers wanted him to...
Nick’s repatriation from Spain was covered by his insurance company. The insurers wanted him to...
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Well I had private medical insurance that covered repatriation in the event of an emergency. If I hadn’t have had that I think I would have had to have stayed in Spain for treatment, which would have meant being away from my friends and family and being treated by people whose language I couldn’t understand, in a system that I didn’t know anything about. So that would have been a nightmare. But the insurance company made it as difficult as they could because I was in a very unstable health position, so they said that it was better for me to stay where I was, whereas clearly my wife and brother felt very strongly that I should be brought home and treated in the UK. So, I think it was, it was very difficult for them to persuade the insurance company to pay, I think it was about £35,000 to get me brought home in an air ambulance because I couldn’t be brought home on a normal scheduled flight. So I got strapped into a small aeroplane and flown at low level, low altitude, because of my breathing problems, back to the UK.
Wesley’s travel insurance did not cover the cost of flying him home, so his mum had to pay for...
Wesley’s travel insurance did not cover the cost of flying him home, so his mum had to pay for...
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They had all gone, where, I think they all went to the Isle of Wight for a nice four or five day break. I think they’d been there one or two days, or they were somewhere and they got a phone call. I think it was from my sister that or a very good friend of the family that I was in hospital in Turkey in a coma, you know, don’t know if I was going to die or make it and I think they just came back from wherever they were, rushed back here, spoke to certain individuals and tried to get an aeroplane, my Mum and my sister out to Turkey as soon as possible just to be by my side with me. And that was about it I believe, because …
Oh also the insurance wouldn’t pay out for me. So, and I think bills came to around forty, fifty thousand pounds, which, it was just my Mum here, my Mum, myself and my sister and my Mum couldn’t afford that sort of money, so all of my friends and everything, they were all doing fundraising, like male friends getting their legs waxed, their head shaved and they managed to raise together about £20,000. My Scout movement did a lot of fundraising for me. My dance company did a lot of fundraising for me. It was just everyone I knew had to do a lot of fundraising for me. Because they knew it was my Mother alone, my sister at university, so it was all, everyone had to do fundraising for me. But I think they managed to do it in the end, which was good I think.
Some people with brain injury found that their insurance didn't cover anything other than their physical rehabilitation and care. They fought with their insurers to change this and were successful.
Ed explained to his insurers that they should pay for the help he needed to fix his brain just...
Ed explained to his insurers that they should pay for the help he needed to fix his brain just...
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One thing I would like to add though, is part and parcel of my, my rehabilitation and care involves, you know, these neuropsychology sessions. They are very useful. They are very valuable. My insurance company had a slightly different view of them. And in fact actually turned round and said, “No, we’re not going to pay for that aspect. Because we don’t, in our policy guidelines and documentation we don’t do that.” And I had, I was almost in tears on the phone after a couple of discussions I had with them, and I actually got, I turned round and said, “Well if I’d broken my leg, or my pelvis or whatever, in the accident, you’d pay for as much physiotherapy as was required to get me well again, wouldn’t you?” The answer, “Yes.” I said, “But I haven’t done that, I’ve broken my head.”
Unfortunately for us, brain controls everything else. I’ve got a broken brain. I need some help to fix it. It’s exactly the same. Neuropyschology is not different than physiotherapy. It’s just a different part of the body. And it was only when the lady I was speaking to went and referred it further up the chain and started speaking to more sort of medical practitioners, that Aviva have actually changed their policy documentation, so that when people have had these sorts of accidents, they will provide this sort of care. What they were trying to prevent and prior guard themselves against, as in all insurance companies do because it’s, it’s a risk business, is, if someone’s had a stroke, they don’t want to end up footing the bill for this sort of care forever and a day. The idea is that I’m not going to be having this forever and a day. However, what I want to prevent is getting some sort of mental illness on the back of it, which invariably I would have, if we weren’t doing these sort of sessions. So, that in itself, yeah, I have made a little difference. That’s good. Yes, ideally no one else would have this sort of injury, but if they do, and if they’re covered by that insurance company, and they’re recommended to go down this sort of line, hopefully, it means that they won’t have to go through what I had to go through to explain it and articulate it, and argue the point.
After a life-changing injury, people may be entitled to make a compensation claim against other parties (e.g. car insurance companies) or, where there is no one else to blame, against the government. Some people were unaware that they may be able to claim for compensation.
The Criminal Injuries Compensation Authority (CICA) is a government organisation that provides compensation for people who have sustained physical or mental injuries as the result of violent crime. Compensation claims can take a long time to process, and can be time consuming, stressful and frustrating for people with life-changing injuries, especially as they worry whether the claim will be successful. One couple described the compensation case as worse than the accident.
Lawyers can present a case for the injured person’s initial treatment and rehabilitation to be paid for by activating the Rehabilitation Code. Under the Rehabilitation Code insurance companies are obliged to pay for early rehabilitation and treatment if it will improve the injured person’s present or future wellbeing, and early intervention usually leads to better recovery for people with life-changing injuries. Insurance companies do not have to admit liability and cases do not have to be completed for the Rehabilitation Code to take effect.
Some people were better placed than others to make compensation claims because of the type or extent of injury, or their background. One man was a trained accountant and became very interested in the area of compensation and injury. Another man talked about taking control of his life and making sure fees and costs were fair. Sometimes parents made the claim on behalf of their children.
In order to claim compensation, people needed the help of lawyers. People felt that there were good and bad lawyers. They said the good ones will be experienced, able to guide you through the process, and will fight to ensure your compensation reflects your injury and the implications it will have on your future health and wellbeing.
It is important to get the right lawyer working on his case, so Bill sacked one and got another...
It is important to get the right lawyer working on his case, so Bill sacked one and got another...
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So you’ve got your lawyer. I like to think of him like in football, you’ve got Premier League lawyers and you’ve got division four lawyers. If you had an amputation or you’re paraplegic or you’ve got some other catastrophic injury. What do you want? Division Four or Premier League? Personally, I’d like the Premier League. I sacked one, one lawyer that was in Division Four. I realised the problem quite quickly. So I managed to get the Premier League lawyer and I would advise everyone to research who they employ.
How do you do about employing a lawyer?
You don’t.
How does it happen?
How does it happen? You, if you’re lucky then you might belong to a union or a trade organisation like I was and find yourself that the trade organisation has already sorted it out. And that they will refer you on. They will get a referral fee and you know, you become a client and all that sort of thing, but your part of the client, but they are the bigger client because they’ve got lots of members.
You might have an insurance policy for legal aid cover attached to a motor policy, a motor cycle policy, motor car policy, something like that. Or you might just have to go for a ‘no win no fee’, a conditional fee arrangement. You might be better going off that route, and actually trying to get a conditional fee arrangement with the Premium League lawyer, because they will know how to handle it. The fees will be greater but that’s not your problem, that’s their problem. And that will all be explained if you do it.
Bill says you should question the experts working on your case. They need to do their best for...
Bill says you should question the experts working on your case. They need to do their best for...
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We were talking about experts and how experts think that they’re experts. And I’m telling people they shouldn’t accept what their experts are saying; they should question absolutely everything. When you’re fighting a civil case in the courts, the first task you have to do is hold your own people to account. Because if your own people aren’t actually doing the thing that they’re being paid to do, i.e. report on your needs.
And the thing they do, these experts, and the insurance company they will get you to a point where you are at your best and then they’ll stop. What do I mean by that? Okay let’s say that my amputation took place when I was 15, because of some accident I had then. They will get you to the point of when you’re 20, and you’re fit and healthy and you’re doing whatever and then that’s where they’ll put their compensation claim to.
In my case my accident happened at 45. It takes four or five years to get to the point of settlement. So I’m in middle age and the health problems of a middle aged individual starts to come about. You might start to have heart problems, you might have overweight, you might find yourself with diabetes. The point I’m trying to make here is that if you develop an illness that you might have actually have developed in any event, but then find yourself at a disadvantage in that illness because of your disability you might need care that, that you might not have necessarily have had if you hadn’t had the catastrophic injury.
So you’ve got to look to the point of your life i.e. old age where you actually need nursing care that you might not necessarily because of your injury and they want to forget that bit, because that’s a very expensive bit for them, you know, it’s and if your own lawyers don’t look at that they’re not doing you a service either. And by the way there are lots of lawyers that have no idea what they’re doing, they call the barrister in and try and rely on the, on the barristers.
Claims usually involve being assessed by health and rehabilitation professionals appointed by the insurance company. This can involve extensive tests; Bryan had a day of neuropsychology tests arranged by his insurance company. These assessments can continue over time as it is not always apparent how extensive injuries are, or will continue to be, particularly in the case of brain injury. People recognised a tension between the insurance companies wanting to limit payments and being awarded sufficient money to live on. Recovery was also hindered by the claims process when health professionals did not want to treat people because they felt they had a “vested interest” (Bill) in not getting better. As well as these assessments, people were sometimes put under surveillance by insurance companies. This was a very stressful experience for Bill and Catherine.
Bill describes how he felt when he found out he was being watched by his insurance company.
Bill describes how he felt when he found out he was being watched by his insurance company.
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I was, my intention at that point wasn’t to kill myself. It was to go into the underworld, you know, I was very au fait with how vagrants lived. I shouldn’t call them vagrants, homeless people. But I knew that their lifestyle, you know, they didn’t have any identity and that was what I was intending to do, but it was very difficult, you know, just doing it on crutches, very difficult.
And so I changed my plan when this guy stopped me at a Station, it turned out that he was going past [place name]. And I just was on the platform and the train literally came in as I got on the platform and I had this thought that I could end it all. And it would have been very easy, all I had to do was go in front and then that would have been the end. And I was a coward. I know I was a coward because I know it takes huge courage to go that extra step to do the action that kills you. You know, I wasn’t thinking right. I know that. I’ve got experience of that, you know, subsequent that people don’t make good decisions when they’re depressed and suffering mental illness, and you’ve got to understand why I’d got to that point as well, because all that stress had actually been leading up to it.
It wasn’t the event that actually tipped me. What tipped me was the surveillance, a surveillance video that had been disclosed to us a few weeks previous, prior to an application at the High Court to try and get money out of the insurance company. And unbeknown to us, they’d been following us, following me, in our old home before we moved here. It was disclosed after we moved to this particular house that all the surveillance had taken place in the other house. And the reason the surveillance had been put in was because they couldn’t understand how we managed to buy the kind of home that we’re in, which is wheelchair friendly. The fact is that they said that I was entitled to move, but they didn’t want me to move locally. They wanted me to move to some place where property prices were dead cheap. But of course our family life was here. So when they, when they learnt that we actually moved house or in the process of moving house, on the conveyance, they put all these, these surveillances in and in turns out six cars, possibly up to twelve people on six days. It must have cost them an absolutely fortune. I just cannot understand why an insurance company would do that, other than to put pressure on you and to find something that they can negotiate down the final compensation package.
During the claims process, people were able to get interim payments. This meant they got part of their compensation payment in advance. Usually people are assessed to see if they are capable of understanding the process and handling their compensation. If not, someone else can be appointed to take help with their finances. This is usually someone who is not related to them.
Barrie was put under Court of Protection once his case was settled out of court. A deputy was...
Barrie was put under Court of Protection once his case was settled out of court. A deputy was...
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No, the case, it went on for four years. It was basically settled out of Court, because the other side didn’t have a case. It was the Royal Court of Justice, so it would have been like a… it was a high money thing you know, basically lost income, lost, care, money, you know, future money, blah, blah, blah. And it was settled out of Court after four years. But it takes forever; it goes on and on and on and on, you know, that’s the thing. And it was a stress because, you don’t actually know when it was going to last, and if it would last if and it didn’t have any structure to it. Whether it would be successful. Whether it would be only like interim payments. How it would work at all really. And they didn’t really know. You know, they have to have like crime scenery reconstruction, they had like witness statements, they had medical reports, blah, blah, blah, and psychological reports. I did loads and loads of psychological stuff. Loads of it. And that went on as I said for four years. And then it was settled out of Court and that was finished, and then after that, I was put in Court of Protection, which was a nightmare.
And they put you in a situation where they’re saying after brain injury you won’t be able to do this, won’t be able to do that.
Yeah.
And theoretically you should have a financial assessment assessing your capabilities. But I didn’t have any of that. It was basically based on well you can’t do this, can’t do that. So I had a deputy put in place, who actually looks after your...You know what a deputy is...? I’ve lost you.
No sorry I didn’t hear what you said.
A deputy.
A deputy put in place.
What it is basically someone is supposed to be handling your affairs for you. So, in other words if you actually want something done you ask them. And they ask the investment company or my mortgage company or whatever and it gets done that way.
A deputy is basically someone...for example, it was a large settlement I got basically. And the money’s invested in a company, and for me to get money from that company, I have to go through the deputy and then ask them, who then charge me for the privilege of me asking him to ask them. It was mental. And I was in this about a year and then I got myself out of it, because I got a medical record saying I was more capable. I was perfectly capable of handling stuff. You know what I mean?
Right.
So I was signed off by the Court. So it’s gone. Because it was costing me, well it cost me £7,000.
For what?
The deputy. It was a nightmare. Because it was things like, I was basically asking them to ask the other people, and then they were charging me. You email them, then they were charging you for reading the email; you phone them and they charge you for their answering the phone; you text them and they… anything like that. It was a nightmare. This was going to be there for...I was given no structure for it. I was given no restrictions for it. I was given nothing. This bloke, the deputy could have been there for life. And it would cost you, what £70,000, £100,000, who knows?
People who received compensation and who were seen as capable of managing their finances were not given any advice about how to handle the sometimes large amounts of money they received. They felt there were people who would try to take advantage of them. However, for others a guaranteed income meant they could be more generous with their money.
Adrian was able to help his friend out. He feels he can be more generous because his income is...
Adrian was able to help his friend out. He feels he can be more generous because his income is...
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And that’s why I’m the way I am, because something in, I will do anything for friends or family.
For example, about two or three years ago, my friend I met in rehab in [place], called [name] lives in [place] and we also met up with him Wednesday or Thursday and he’ll come down to me or I come to him. He drives and I drive. One Wednesday he said to me, “Oh I’d love to come over Adrian, but I can’t, I’m a bit short on my cash.” I said, “Oh do you have enough petrol to get here?” “Yes.” “Get here [name]. I will fill up your car with petrol. It’s the least thing that a friend can do.” “Yeah, but…” “No, no, just please do it.” The cost of twenty or thirty quid to see a friend, you can’t put a price on it. Thirty quid’s nothing for, to see that person to make sure they have a good evening. I want to see him anyway. I don’t see why that should be a reason. So where I’ve become much more generous, thinking, I’m sure I would have done that before my injury but I don’t know. But now definitely, money’s...Because of benefits and insurance money guaranteed no matter what, it doesn’t make me, lax, lackadaisical and also carefree. I’m still, being an accountant I’m still careful, but I’m also much more generous. I think it’s not a worry. I’ve got a guaranteed income anyway. And in the, in the environment as it is now, that worry isn’t mine.
Whilst the sums of money involved could appear large, people talked about having to be careful as the money needed to last. There could also be further health complications from the injury as people got older.
Last reviewed October 2015.
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