SOCIAL SECURITY Citation, commencement and interpretation 1 1 These Regulations may be cited as the Social Security (Recovery of Benefits) Regulations (Northern Ireland) 1997 and shall come into operation on 6th October 1997. 2 In these Regulations “ the Order ” means the Social Security (Recovery of Benefits) (Northern Ireland) Order 1997. 3 Any reference in these Regulations to a numbered Article or Schedule is to the Article of, or the Schedule to, the Order bearing that number. 4 The Interpretation Act (Northern Ireland) 1954 shall apply to these Regulations as it applies to a Measure of the Assembly. Exempted trusts and payments 2 1 The following trusts are prescribed for the purposes of paragraph 4 of Schedule 1— a the Macfarlane Trust established on 10th March 1988 partly out of funds provided by the Secretary of State to the Haemophilia Society for the relief of poverty or distress among those suffering from haemophilia; b the Macfarlane (Special Payments) Trust established on 29th January 1990 partly out of funds provided by the Secretary of State for the benefit of certain persons suffering from haemophilia; c the Macfarlane (Special Payments) ( No. 2) Trust established on 3rd May 1991 partly out of funds provided by the Secretary of State for the benefit of certain persons suffering from haemophilia and other beneficiaries; d the Eileen Trust established on 29th March 1993 out of funds provided by the Secretary of State for the benefit of persons eligible for payment in accordance with its provisions. 2 The following payments are prescribed for the purposes of paragraph 8 of Schedule 1— a any payment to the extent that it is made— i in consequence of an action under the Fatal Accidents Act 1976 or the Fatal Accidents (Northern Ireland) Order 1977 , or ii in circumstances where, had an action been brought, it would have been brought under that Act or that Order; b any payment to the extent that it is made in respect of a liability arising by virtue of section 1 of the Damages (Scotland) Act 1976 ; c any payment made under the Vaccine Damage Payments Act 1979 to or in respect of the injured person; d any award of compensation made to or in respect of the injured person under the Criminal Injuries (Compensation) (Northern Ireland) Order 1988 , the Criminal Injuries Compensation Act 1995 or by the Criminal Injuries Compensation Board under the Criminal Injuries Compensation Scheme 1990 or any earlier scheme; e any compensation payment made by British Coal in accordance with the National Coal Board Pneumoconiosis Compensation Scheme set out in the Schedule to an agreement made on 13th September 1974 between the National Coal Board, the National Union of Mine Workers, the National Association of Colliery Overmen Deputies and Shotfirers and the British Association of Colliery Management; f any payment made to the injured person in respect of sensorineural hearing loss where the loss is less than 50 dB in one or both ears; g any contractual amount paid to an employee by an employer of his in respect of a period of incapacity for work; h any payment made under the National Health Service (Scotland) (Injury Benefits) Regulations 1974 , the Health and Personal Social Services (Injury Benefits) Regulations (Northern Ireland) 1975 or the National Health Service (Injury Benefits) Regulations 1995 ; i any payment made by or on behalf of the Secretary of State for the benefit of persons eligible for payment in accordance with the provisions of a scheme established by him on 24th April 1992 or, in Scotland, on 10th April 1992. Information to be provided by the compensator 3 The following information is prescribed for the purposes of Article 25(1)— a the full name and address of the injured person; b either the date of birth or national insurance number of that person, or both; c where the liability arises, or is alleged to arise, in respect of an accident or injury, the date of the accident or injury; d the nature of the accident, injury or disease; and e where the relevant period may include a period prior to 6th April 1994, whether, at the time of the accident or injury or diagnosis of the disease, the person was employed under a contract of service, and, if so, the name and address of his employer at that time and, where applicable, that person’s payroll number. Information to be provided by the injured person 4 The following information is prescribed for the purposes of Article 25(2)— a whether the accident, injury or disease resulted from any action taken by another person, or from any failure of another person to act, and, if so, the full name and address of that other person; b whether the injured person has claimed or may claim a compensation payment, and, if so, the full name and address of the person against whom the claim was or may be made; c the amount of any compensation payment and the date on which it was made; d the listed benefits claimed, and for each benefit the date from which it was first claimed and the amount received in the period beginning with and including that date and ending with the date on which the information is sent; e in the case of a person who has received statutory sick pay during any part of the relevant period falling prior to 6th April 1994, the name and address of any employer who made such payments to him during that period and the dates on which his employment with that employer began and ended; and f any changes in the medical diagnosis relating to any condition arising from the accident, injury or disease. Information to be provided by the employer 5 The following information is prescribed for the purposes of Article 25(5)— a the amount of any statutory sick pay paid to the injured person during any part of the relevant period falling prior to 6th April 1994; b the date on which the liability to pay such statutory sick pay first arose and the rate at which it was payable; c the date on which such liability terminated; and d the cause of incapacity for work during any period of entitlement to statutory sick pay during any part of the relevant period falling prior to 6th April 1994. Provision of information 6 A person required to give information to the Department under regulations 3 to 5 shall do so by sending it to the Department not later than 14 days after— a if he is a person to whom regulation 3 applies, the date on which he receives a claim for compensation from the injured person in respect of the accident, injury or disease; or b if he is a person to whom regulation 4 or 5 applies, the date on which the Department requests the information from him. Application for a certificate of recoverable benefits 7 1 The following particulars are prescribed for the purposes of Article 23(3)( a )— a the full name and address of the injured person; b the date of birth and, where known, the national insurance number of that person; c where the liability arises, or is alleged to arise, in respect of an accident or injury, the date of the accident or injury; d the nature of the accident, injury or disease; and e where the person liable, or alleged to be liable, in respect of the accident, injury or disease, is the employer of the injured person, or has been such an employer, the information prescribed by regulation 5. 2 For the purposes of the Order an application for a certificate of recoverable benefits is to be treated as received on the date on which it is received by the Department. Payments into court 8 1 Subject to the following provisions of this regulation, where a party to an action makes a payment into court which, had it been paid directly to another party to the action (“the relevant party”), would have constituted a compensation payment— a the making of that payment shall be treated for the purposes of the Order as the making of a compensation payment; b a current certificate of recoverable benefits shall be lodged with the payment; and c where the payment is calculated under Article 10, the compensator shall give the information specified in Article 11(1) to the relevant party instead of to the person to whom the payment is made, and in this paragraph “a current certificate of recoverable benefits” means a certificate that is in force in accordance with Article 6(4). 2 The liability under Article 8(1) to pay an amount equal to the total amount of the recoverable benefits shall not arise until the person making the payment into court has been notified that the whole or any part of the payment into court has been paid out of court to or for the relevant party. 3 Where a payment into court in satisfaction of his claim is accepted by the relevant party in the initial period, then as respects the compensator in question, the relevant period shall be taken to have ended, if it has not done so already, on the date on which the payment into court (or if there were two or more such payments, the last of them) was made. 4 Where, after the expiry of the initial period, the payment into court is accepted in satisfaction of the relevant party’s claim by consent between the parties, the relevant period shall end, if it has not done so already, on the date on which the application to the court for the payment is made. 5 Where, after the expiry of the initial period, payment out of court is made wholly or partly to or for the relevant party in accordance with an order of the court and in satisfaction of his claim, the relevant period shall end, if it has not done so already, on the date of that order. 6 In paragraphs (3) to (5) “the initial period” means the period of 21 days after the receipt by the relevant party of notice of the payment into court having been made. 7 Where a payment into court is paid out wholly to or for the party who made the payment (otherwise than to or for the relevant party) the making of the payment into court shall cease to be regarded as the making of a compensation payment. Reduction of compensation: complex cases 9 1 This regulation applies where— a a compensation payment in the form of a lump sum (“the earlier payment”) has been made to or in respect of the injured person; and b subsequently another such payment (“the later payment”) is made to or in respect of the same injured person in consequence of the same accident, injury or disease. 2 In determining the liability under Article 8(1) arising in connection with the making of the later payment, the amount referred to in that paragraph shall be reduced by any amount paid in satisfaction of that liability as it arose in connection with the earlier payment. 3 Where— a a payment made in satisfaction of the liability under Article 8(1) arising in connection with the earlier payment is not reflected in the certificate of recoverable benefits in force at the time of the later payment; and b in consequence, the aggregate of payments made in satisfaction of the liability exceeds what it would have been had that payment been so reflected, the Department shall pay the compensator who made the later payment an amount equal to the excess. 4 Where— a a compensator receives a payment under paragraph (3); and b the amount of the compensation payment made by him was calculated under Article 10, then the compensation payment shall be recalculated under that Article, and the compensator shall pay the amount of the increase (if any) to the person to whom the compensation payment was made. 5 Where both the earlier payment and the later payment are made by the same compensator, he may— a aggregate the gross amounts of the payments made by him; b calculate what would have been the reduction made under Article 10(3) if that aggregate amount had been paid at the date of the later payment on the basis that— i so much of the aggregate amount as is attributable to any head of compensation listed in column (1) of Schedule 2 shall be taken to be the part of the gross amount which is attributable to that head, and ii the amount of any recoverable benefits shown against any head in column (2) of that Schedule shall be taken to be the amount determined in accordance with the most recent certificate of recoverable benefits; c deduct from that reduction calculated under sub-paragraph ( b ) the amount of the reduction under Article 10(3) from the earlier payment; and d deduct from the latest gross payment the net reduction calculated under sub-paragraph ( c ), and accordingly the later payment may be nil. 6 Where the Department is making a refund under paragraph (3), it shall send to the compensator (with the refund) and to the person to whom the compensation payment was made a statement showing— a the total amount that has already been paid by that compensator to the Department; b the amount that ought to have been paid by that compensator; and c the amount to be repaid to that compensator by the Department. 7 Where the reduction of a compensation payment is recalculated by virtue of paragraph (4) or (5), the compensator shall give notice of the recalculation to the injured person. Structured settlements 10 1 This regulation applies where— a in final settlement of an injured person’s claim, an agreement is entered into— i for the making of periodical payments (whether of an income or capital nature), or ii for the making of such payments and lump sum payments; and b apart from the provisions of this regulation, those payments would fall to be treated for the purposes of the Order as compensation payments. 2 Where this regulation applies, the provisions of the Order and these Regulations shall apply with the following modifications— a the compensator in question shall be taken to have made a single compensation payment on the date of settlement; b the relevant period, in the case of the compensator in question, shall be taken to end, if it has not done so already, on that date; c payments under the agreement referred to in paragraph (1)( a ) shall be taken not to be compensation payments; and d paragraphs (5) and (7) of regulation 11 shall not apply. 3 Where any further payment falls to be made to or in respect of the injured person otherwise than under the agreement in question, paragraph (2) shall be disregarded for the purpose of determining the end of the relevant period in relation to that further payment. 4 In any case where— a the person making the periodical payments (“the secondary party”) does so in pursuance of arrangements entered into with another (“the primary party”) (as in a case where the primary party purchases an annuity for the injured person from the secondary party); and b apart from those arrangements, the primary party would have been regarded as the compensator, then for the purposes of the Order, the primary party shall be regarded as the compensator and the secondary party shall not be so regarded. 5 In this regulation “the date of settlement” means— a if the agreement referred to in paragraph (1)( a ) is approved by a court, the date on which that approval is given; and b in any other case, the date on which the agreement is entered into. Adjustments 11 1 Where the conditions specified in Article 16(1) and (2) are satisfied, the Department shall pay to the compensator the difference between the amount that has been paid and the amount that ought to have been paid. 2 Where the conditions specified in Article 16(1) and (3) are satisfied, the compensator shall pay to the Department the difference between the total amounts paid and the amount that ought to have been paid. 3 Where the Department is making a refund under paragraph (1), or demanding payment of a further amount under paragraph (2), it shall send to the compensator (with the refund or demand) and to the person to whom the compensation payment was made a statement showing— a the total amount that has already been paid to the Department; b the amount that ought to have been paid; and c the difference between those amounts, and whether a repayment by the Department or a further payment to it is required. 4 This paragraph applies where— a the amount of the compensation payment made by the compensator was calculated under Article 10; and b the Department has made a payment under paragraph (1). 5 Where paragraph (4) applies, the amount of the compensation payment shall be recalculated under Article 10 to take account of the fresh certificate of recoverable benefits and the compensator shall pay the amount of the increase (if any) to the person to whom the compensation payment was made. 6 This paragraph applies where— a the amount of the compensation payment made by the compensator was calculated under Article 10; b the compensator has made a payment under paragraph (2); and c the fresh certificate of recoverable benefits issued after the review or appeal was required as a result of the injured person or other person to whom the compensation payment was made supplying to the compensator information knowing it to be incorrect or insufficient with the intent of enhancing the compensation payment calculated under Article 10, and the compensator supplying that information to the Department without knowing it to be incorrect or insufficient. 7 Where paragraph (6) applies, the compensator may recalculate the compensation payment under Article 10 to take account of the fresh certificate of recoverable benefits and may require the repayment to him by the person to whom he made the compensation payment of the difference (if any) between the payment made and the payment as so recalculated. Transitional provisions 12 1 In relation to a compensation payment to which, by virtue of Article 4, the Order applies and subject to paragraph (2), a certificate of total benefit issued under Part IV of the Administration Act shall be treated on or after 6th October 1997 (“the commencement date”) as a certificate of recoverable benefits issued under the Order and the amount of total benefit treated as that of recoverable benefits. 2 Paragraph (1) shall not apply to a certificate of total benefit which specifies an amount in respect of disability living allowance but does not specify whether that amount was, or is likely to be, paid wholly by way of the care component or the mobility component or (if not wholly one of them) does not specify the relevant amount for each component. 3 Any appeal under section 94 of the Administration Act made on or after the commencement date shall be referred to and determined by a medical appeal tribunal notwithstanding that it would otherwise have been referred by the Department to a social security appeal tribunal. 4 Paragraph (5) applies where— a an amount has been paid to the Department under section 78(1)( b ) of the Administration Act; b liability arises on or after the commencement date to make a payment under Article 8(1); and c the compensation payments which give rise to the liability to make both payments are to or in respect of the same injured person in consequence of the same accident, injury or disease. 5 Where this paragraph applies, the liability under Article 8 shall be reduced by the payment (or aggregate of the payments, if more than one) described in paragraph (4)( a ). 6 Where— a a payment into court has been made on a date prior to the commencement date but the initial period, as defined in section 89(6) of the Administration Act, in relation to that payment, expires on or after the commencement date; and b the payment into court is accepted by the other party to the action in the initial period, that payment into court shall be treated as a compensation payment to which the Administration Act, and not the Order, applies. 7 Where a payment into court has been made prior to the commencement date, remains in court on that day and paragraph (6) does not apply, that payment into court shall be treated as a payment to which the Order applies, but regulation 8(1)( b ) and ( c ) shall not apply. Sealed with the Official Seal of the Department of Health and Social Services for Northern Ireland on John O'Neill Assistant Secretary 23rd September 1997.