VWF Group 3 claims
45. The assessment of VWF Group 3 claims has caused
particular difficulties between the CSG and Capita-IRISC due to
the difficulty in establishing, to the satisfaction of the contractor,
sufficient evidence of tortious exposure by claimants in this
Group, which included ex-locomotive drivers, transfer point attendants
and those deputies whose work did not include coalface or development
work. Delays occurred with the assessment of the evidence provided
by Group 3 claimants and a backlog of such claims built up. The
CSG attributed these delays to the lack of a mechanism for resolving
disputes over the claims and a lack of uniformity of approach
by the company in dealing with their resolution.[92]
The English Monitoring Group conducted an assessment of the problems
associated with the processing of Group 3 claims, and concluded
that "the timescales within the Handling Agreement [for VWF]
were totally unrealistic." In some cases work records requested
by solicitors had not been provided two years after the initial
request.[93]
46. In order to clear the backlog, the DTI and the
CSG agreed the Occupational Group Procedure (OGP) to enable the
speedy assessment of Group 3 claims. The OGP set out the evidence
that was required to be submitted by the claimant and specific
witnesses in a standardised questionnaire. The CSG told us that
the underlying logic of the OGP was that if a claim was presented
in a form that fulfilled the stated requirements for information
and if the evidence provided was believable and made 'mining sense',
then that claim would be accepted and settled.[94]
The Group criticised the implementation of the OGP by Capita-IRISC
on a number of counts.
47. According to the CSG, the OGP's requirements
have been used by Capita-IRISC as a procedural bar for the processing
of claims on other grounds, and the company has refused to consider
cases in which the evidence submitted does not exactly meet its
interpretation of the OGP's requirements without detailed explanation
as to why those requirements cannot be met. The CSG implied that
the additional bureaucracy required from Capita-IRISC had persuaded
some people to abandon their claim:
"IRISC will not consider claims that do not
meet the requirements of the OGP unless they pass the quality
audit that they devise, and part of the quality audit is checking
that you have got the right number of statements in from appropriate
witnesses. In circumstances where those requirements are not
met they will only consider a claim if a request is made for discretion
which requires the claimant to demonstrate that there are some
exceptional circumstances and to set out in detail the steps that
they have taken to trace the witnesses, so there are other hurdles
that have to be overcome. It is fair to point out that requests
for discretion are largely accepted but it is an additional step
that the claimants have to go through. It is fair to point out
that the DTI have accepted that where claimants are elderly or
in posthumous claims then that satisfies the criteria for 'exceptional',
but nonetheless there is a series of steps that has to be gone
over and at various points along the way people have dropped out
of the process.[95]
48. The Group felt that the iterative process by
which this type of claim is assessed added unnecessary delay to
the settlement of claims. The CSG were also critical of the way
in which the claims adjusters employed by Capita-IRISC to assess
Group 3 claims on the basis of their mining experience operated
in practice. The Group expressed concerns about their application
of 'mining sense'. Another major concern related to the relative
weight that the adjusters gave to different types and different
elements of evidence. The CSG felt that in a number of cases disproportionate
weight was given to documentary evidence which was not relevant
to vibration exposure but which would be contradicted by evidence
from the claimant and his witnesses, who often included mine officials.[96]
Similar concerns were expressed by the English Monitoring Group,
which was also critical of the adequacy of the guidelines within
which the specialist claims adjusters worked.[97]
The Coalfields Communities Campaign provided some specific examples
to support its contention that Capita-IRISC had not implemented
the OGP properly.[98]
49. The CSG and the English Monitoring Group drew
our attention to the difficulty that some claimants had in providing
the necessary statements from qualified witnesses to support their
claim. While the Monitoring Group welcomed the DTI's willingness
to establish a national witness database to assist with this process,
it had been disappointed that the database included only witnesses
identified by claimants, who were denied access to the Department's
own witness database. The Group pointed out that the Department's
witnesses could have been asked for their agreement to the disclosure
of their names and addresses to satisfy the requirements of the
Data Protection Act. Furthermore, the Department has decided
that the national database could not be used retrospectively to
assist those claims which had been denied when claimants could
not provide witness details. This decision had been badly received
in the mining areas.[99]
50. Jeff Wilson defended Capita-IRISC's implementation
of the OGP and suggested that the company was simply following
the procedures agreed between its employers, the DTI, and the
claimants' solicitors:
"Capita's job is to assess the evidence to make
sure the employment criteria are met. It is important that when
information and evidence is submitted in the Occupational Group
Procedure, it follows the form of proper evidence in terms of
claims, questionnaires and witness statements. There will be instances
where we will have to quality check that information and return
it to the solicitors. I understand the concerns regarding the
Group 3 adjusters, but what we have employed are 61 individuals
who have got 1,500 years of mining experience. Ultimately, what
they are trying to assess is the evidence before them. What we
try to do is encourage our adjusters to look for ways to pass
a claim rather than fail it. We should be alive to the fact that
approximately 50% of the claims which they have assessed have
been accepted."[100]
51. The DTI's 'aspirational end date' for the settlement
of all Group 3 claims is September 2005. The CSG were sceptical
about the chances of this aspiration being fulfilled in practice.
The Group pointed out that to meet this end date investigations
would need to be completed in 7,500 cases. To achieve this task
Capita-IRISC would need to significantly increase the rate of
investigation to an average of 825 cases per month—much
higher than had been achieved before.[101]
In reply, the DTI estimated that there would prove to be about
6,600 cases to be cleared by September—5,400 claims which
were ready for investigation but not completed and an estimated
1,200 additional cases that could arise by the deadline for the
submission of supporting evidence of 30 June 2005. The Department
acknowledged the need for increased performance and productivity
but told us that Capita-IRISC had taken a number of steps to achieve
this, including the recruitment of additional investigators. The
DTI remained confident that all outstanding claims would be cleared
by September.[102]
52. It seems to us that a lack of adequate guidance
from the Department to IRISC on how the VWF scheme was to be implemented
caused confusion and created delays in the settlement process,
leading to a backlog of unsettled claims. The Department eventually
responded positively to the problem and developed the Occupational
Group Procedure (OGP) in collaboration with the claimants' representatives.
Unfortunately, it appears that, in some cases, the way in which
Capita-IRISC and the DTI have chosen to implement the OGP has
caused further delay to settlements and created resentment among
claimants. We accept that all compensation claims must be investigated
properly. We are not convinced, however, that the DTI and its
contractors have taken all possible steps to ensure that the OGP
has been implemented in keeping with the spirit with which it
was conceived as opposed to the letter of the agreement itself.
It remains to be seen if the Department's target for the satisfactory
completion of Group 3 settlements will be achieved.
VWF services claims
53. The CSG told us that, although the Handling Agreement
for VWF which was approved by the Court in 1998 covered claims
for the costs of assistance with ordinary tasks which VWF sufferers
could no longer perform, DTI had initially failed to establish
with IRISC a procedure for assessing such claims. Consequently,
IRISC had made no arrangements to assess such claims. In 2001
DTI and the CSG agreed a detailed procedure for the handling and
assessment of these 'services' claims. This 'Services Agreement'
required a claimant to complete a standardised form, which also
required information from those who provided assistance with tasks,
payment for which a claim was made. This approach was intended
to speed up the claims process by limiting the evidence required
to assess claims and providing for the assessment of claims by
reference to agreed tariffs, depending upon the severity of the
claimant's VWF, and after taking into account any separate medical
conditions which would have limited the ability to do the tasks
in any event.[103]
54. Once again, the CSG complained about the implementation
of this Agreement by IRISC, which it accused of conducting overly-detailed
investigations and requiring information which was not relevant
to the claim under investigation, thereby introducing delay into
the procedure.[104]
The CSG called some of the questioning of services claims "inept",[105]
and claimed that Capita-IRISC staff were inadequately trained
for the task.[106]
A deadline for the submission of evidence by claimants has been
imposed by the Court and the CSG was concerned that this would
result in an increase in the rate of claims just before the deadline,
which would in turn slow down the claims handling process.[107]
55. For Capita-IRISC, Jeff Wilson and Kate Roy suggested
that such problems might have been encountered at the first stages
of the implementation of the 'Services Agreement' but that extensive
training and feedback from solicitors had improved the performance
of their staff. The company was also confident that they had arrangements
in place to deal efficiently with the increase in correspondence
to be expected from the imposition of the deadline [108]
The CSG acknowledged that the "mishandling" of claims
by Capita-IRISC had been reduced, but that claimants still experienced
delays in agreeing a settlement of their claim.[109]
56. It seems to us that, once again, the DTI was
slow to ensure that, from the start, its contractor had clear
instructions on how to implement part of the Claims Handling Agreement
for VWF. In this case, too, the Department's good intentions in
trying to produce a streamlined procedure for the settlement of
VWF Services claims has been undermined by the way in which it
has allowed Capita-IRISC to implement that procedure.
92 Q 4 (Maddocks) Back
93
Appendix 8, para 26 Back
94
Ibid Back
95
Q 4 (Maddocks) Back
96
Q 8 Back
97
Appendix 8, paras 37-41 Back
98
Appendix 1, Section 4 Back
99
Appendix 8, para 44 Back
100
Q 98 Back
101
Appendix 6 Back
102
Appendix 3 Back
103
Appendix 5 Back
104
Ibid Back
105
Appendix 7 Back
106
Q 9 Back
107
Appendix 5 Back
108
Qq 101-106 Back
109
Appendix 7 Back
