Is Illness a Disease?

Not just a philosophical question but one of some significance in the context of NHS charges. Overseas accidents have historically been exempt from recovery of hospital charges, although this all changed for accidents from January 2007 onwards. Treatment is charged on a daily tariff basis, which for 2007 to 2010 accidents, ranges from £505 to £585 in respect outpatient care and £620 to £719 for admissions, subject to a cap of £37,100 to £42,999. This can therefore add up to a significant additional cost to the tour operator or its insurers.

The relevant legislation is found in Part 3 of the Health and Social Care (Community Health and Standards) Act 2003. Section 150 provides that where “a person makes a compensation payment to another person in consequence of any injury”, that person is liable to pay the relevant NHS charges. Section 150(5) however confirms that “injury does not include any disease”. This is of no help in slipping and tripping cases, but what about gastric illness? Our view is that gastric illness is plainly a disease. Just like any other illness, the body’s proper functioning is disrupted by viral, parasitic or bacterial infection producing gastrointestinal symptoms which resolve (albeit with ongoing symptoms on occasions) once the infection is no longer operative.

After consulting the Department of Health, the CRU have agreed with this analysis and have reduced NHS charges accordingly. Clients may therefore wish to consider requesting reviews of existing NHS certificates in illness cases or appealing those that have already been paid. In the latter case, the appeal must be made within 3 months of payment, subject to an extension of up to 1 year from payment in “special circumstances”.

For further information please contact Robin Adams at mb LAW at robin.adams@mb-law.co.uk

Please note this information is for general guidance only and is not intended to be a substitute for specific legal advice.