1.5.4 Insurance Claims and Ex Gratia Payments

1. Background

The County Council does have insurance cover for instances where a liability exists. For a legal liability to exist the claimant must prove that Lincolnshire County Council acted negligently, in other words that it was in breach of a duty of care towards the claimant.

If a claim is made where there is no breach of duty of care, then settlement can be made ex-gratia without the benefit of insurance cover and must be met from the Directorate's own budget.

The exception to this is in respect of claims by foster carers for loss or damage to their personal property (excluding motor cars) and for personal assault, where insurance cover exists and claims can be made without having to prove that the Council was in breach of a duty of care. In these cases where insurance cover applies it is important that details of the incident are passed to the Financial Administration Section at Central Office within ONE MONTH of the damage occurring. No payments should be made to the claimant without the insurer's authority.

Claims from members of the public - these generally result from damage to vehicles (and possibly property) by children/young people who are looked after by the local authority.

Foster Carers - these can cover damage to property, personal accidents, public liability in their role as carer and legal costs arising from a wrongful complaint of a child.

2. Process

Small deliberate damage claims (members of the public)

A full report of the circumstances of how the claim arose should be completed and submitted to the Team Manager/Unit Manager prior to submission to the relevant Head of Service for recommendation.

The claim must then be passed to the Financial Administration Section at Central Office for processing.

The report must indicate:

• What the claim is for;
• How the claim arose with as much detail as is available;
• Who caused the damage;
• Age and original cost of the damaged article with receipt if available;
• A written estimate of the cost of replacement;
• Details of any insurance held by the claimant that would cover the damage.

The Financial Administration Section will refer all cases to the Insurance Officer for consideration. In certain circumstances the claim may be referred to the Legal Division for advice. Where insurance cover for the damage exists it may be necessary for the damage to be examined.

The Financial Administration Section will, on receipt of the Insurance Officer's approval, arrange payment of a claim on a 'without prejudice/no legal liability' basis.

Claims for deliberate and accidental damage to a foster carer's home and contents by a child looked after by the local authority

On notification of the incident the child's Social Worker will request the foster carer to complete form SS2/13. The Social Worker should inspect any damage that has occurred and complete a report supporting the claim with an indication of its reasonableness. All documentation should be forwarded to the Head of Service for recommendation and passed to the Financial Administration Section at Central Office for processing.

The Administration will forward the claim to the Insurance Officer for approval.

The insurance policy for this type of damage carries a £100 excess on each claim. Each incident is classed as a separate claim therefore each incident should be reported and claimed for as it occurs.

On receipt of the Insurance Officer's approval the Financial Administration Section will contact the Service Manager for approval to pay the £100 excess which will be met from the Area budget.

The Financial Administration Section will arrange payment of the claim (the insurance figure plus the excess) through the Foster Payment Scheme where appropriate.

Claims arising from physical abuse by a foster child or by another person in connection with the fostering

Where a foster carer is attacked by a child looked after by the local authority or by another person in connection with the fostering and suffers serious permanent injury, a benefit may be payable by the insurers.

On receiving notification of the incident, the Fostering Officer will visit and ascertain the extent of the injuries sustained. The insurers will require medical evidence to be produced. A report of the incident must be completed detailing the sequence of events and the injuries sustained. The report should be forwarded to the Head of Service for recommendation and passed to the Financial Administration Section at Central Office for processing.

On receipt of the claim the Financial Administration Section will forward a copy to the Insurance Officer for referral to the insurers.

The Insurance Section will notify the Financial Administration Section of the Directorate of the progress of the claim.

If the claim is accepted the Insurance Section will arrange payment direct.