Dáil Éireann debate -
Tuesday, 13 May 2003

Vol. 566 No. 3

Written Answers. - Private Health Insurance.

Michael Ring

Question:

298 Mr. Ring asked the Minister for Health and Children if his attention has been drawn to the fact that the VHI is putting pressure on its subscribers and solicitors to furnish undertakings that are contrary to public policy and the terms of the VHI policy; and if his attention has not been drawn to such a policy by VHI, the steps he intends to take in relation to the matter. [12590/03]

Michael Ring

Question:

299 Mr. Ring asked the Minister for Health and Children if his attention has been drawn to the fact that VHI has refused to pay medical treatment and maintenance charges to hospitals, doctors, radiologists, pathologists and other medical staff to provide services to persons injured as a result of accidents, contrary to the terms of the insurance policy in place and that subscribers, in the absence of an undertaking by that person who was involved in an accident confirming that all moneys that VHI pay out on the subscribers part be refunded to it, VHI, regardless of whether the subscriber recovers all of the moneys. [12591/03]

Michael Ring

Question:

300 Mr. Ring asked the Minister for Health and Children his views on whether it is proper, just and lawful for a semi-State body such as the VHI, of which he is the sole shareholder, to write to its subscribers to encourage them to take personal injury claims. [12592/03]

Michael Ring

Question:

301 Mr. Ring asked the Minister for Health and Children if his attention has been drawn to the fact that VHI is writing to its subscribers and members inquiring as to whether they intend to take a claim for personal injuries following an accident; and his views on whether such an inquiry is an invitation and encouragement by VHI to its subscribers to take a claim for personal injuries. [12593/03]

Michael Ring

Question:

302 Mr. Ring asked the Minister for Health and Children if his attention has been drawn to the fact that the VHI is writing to its members and subscribers to inquire whether they intend to make a claim for personal injuries following an accident; if his attention has not been drawn to the queries being sent to VHI members, the reason therefor; and if he will make a statement on the matter. [12594/03]

Minister for Health and Children (Mr. Martin)

I propose to take Questions Nos. 298 to 302, inclusive, together.

VHI's private health insurance premiums are primarily determined by the level of claims it is obliged to meet. It represents good commercial and insurance practice for VHI Healthcare, or indeed any other health insurer, to have regard to the possibility of members seeking third party recovery for fees or charges, where such recovery is in order, and a claim against the relevant third party is justified. VHI would be failing in its responsibilities to its members generally were it not to pursue policies that minimise its claims experiences, and consequently the levels of its premiums, where it is reasonable to do so. This is established practice in the area of health insurance, with BUPA (Ireland) having a similar rule regarding the payment of benefits for treatment which was due to the fault of a third party.

Insurance practice in this regard is reflected under the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 which were made in March of that year. These regulations include specific provision in respect of circumstances involving third party recovery relating to healthcare costs incurred by an insured person.

VHI has been contacted concerning the Deputy's questions and has advised that its rules in respect of third party claims are as set out in the rules, terms and conditions of membership. In that context, rule 8 (s) states that it will not pay benefits for expenses which a claimant is entitled to recover from a third party. Furthermore, rule 9 (f) states:

If you (the policy holder) claim benefits for treatment which is needed because a member was injured through the fault of some other person or body, you and the member (if the member is over 18) must complete the relevant section of the claim form. We (VHI Healthcare) will pay the benefits if a policy holder or member completes a written undertaking to:

(i) Include those benefits in any claim being made or to be made against the person who caused the injury: and

(ii) do everything we (VHI Healthcare) ask to recover those benefits and repay them to VHI Healthcare.

Where a claim is received by VHI Healthcare requesting benefit towards expenses which have arisen as a result of an accident, VHI Healthcare will write to the member concerned requesting full details of the accident and whether or not the member intends to pursue a claim against a third party. Where the member indicates that they do not intend to pursue a claim, VHI Healthcare will provide benefit towards the medical costs incurred. If a member indicates that they intend to pursue a claim, VHI Healthcare, in accordance with rule 9 (f), will only provide benefit where an undertaking is received from the member's solicitor.

The member's solicitor undertakes to include the moneys paid out by VHI Healthcare in the claim and, in the absence of a court order to the contrary, to refund these moneys in full to VHI Healthcare where the claim is successful or compromised. Where a case goes to trial, VHI Healthcare will accept the terms as set out in any court order. Where a claim is unsuccessful, VHI Healthcare does not pursue any refund and all undertakings are discharged.

The Deputy refers to the increasing cost of insurance in the context of the number of personal injury claims being taken. It is the need to minimise claims costs in order to minimise premium increases in health insurance, that motivates health insurers to make prudent provision for the legitimate recovery of benefits paid where the costs concerned are later recovered from a third party.