The MedCo Audit Committee (Committee) have agreed a change to the approach to be adopted when auditing against the rules relating to out of normal office hours support for unrepresented claimant work.
Prior to the Whiplash Reforms in May 2021, the volume of work expected in relation to Unrepresented Claimants was unclear and in the event that numbers were significant, the audit team sought confirmation that robust systems were in place that could manage high volumes of calls out of office hours.
A year on, it has become clear that the number of Unrepresented Claimants using the service is lower than anticipated and feedback received indicates that those claimants pursuing claims outside of office hours is also at a much lower level that might have been expected.
In view of this, the Committee have agreed that when auditing new applications for Unrepresented Claimant work, a more pragmatic approach should be adopted in relation to the rules. For example, a voicemail service out of hours (with next day call backs) would be deemed appropriate. Auditors will not now necessarily look for arrangements such as a dedicated 24 hour out of hours answering service, to ensure that this particular rule is met.
Medical Reporting Organisations (MROs) and Direct Medical Experts (DMEs) that are already approved for Unrepresented Claimant work should be aware of this revised approach. Whilst it will be acceptable for MROs and DMEs to adjust the way they operate in consideration of the above, it remains important that claimants receive a good service in line with the MOJ’s Rules / QC and rationale that are in place for this type of work. These are areas that could be assessed as part of future User audits.
Please note that this revised approach is taken based on the current numbers of selections being made by unrepresented claimants. If numbers increase significantly or feedback is received indicating that required service levels are not being achieved, the Committee will consider reintroducing the requirement for more robust processes in relation to out of hours support.
The rules impacted by this change in approach are listed below;
The MoJ’s Supplementary Qualifying Criteria for MRO’s providing unrepresented claimant reports at 3.3 says:
“Has the resources and structure necessary for operational delivery of the unrepresented claimant service on a consistent and stable basis i.e.:
- a) Ability to operate at times when unrepresented claimants may wish to pursue their claims, which may be outside normal office hours;”
The MoJ’s Additional Rules and Audit Process for Direct Medical Experts undertaking unrepresented claimant at Rule 5 says:
“DMEs must demonstrate they have the resources and structure necessary for operational delivery of the unrepresented claimant service on a consistent and stable basis including the ability to:
- a) be contactable outside normal office hours, as on occasion unrepresented claimants may only be available to pursue their claim at non-standard times; and
- b) operate across multiple channels (phone, email, livechat etc.) to cater for different unrepresented claimants’ communication preferences and needs (e.g. the claimant is vulnerable and/or does not have web access).”
