Motor Accidents (Lifetime Care and Support) Act 2006
61The LCS Act was passed in 2006 to create, and give effect to, a Scheme which provided for the reasonable lifetime care and support needs of catastrophically injured people, to be met by the LCS Authority, provided that the injuries arose out of a motor vehicle accident.
62This Act contains no statement of purpose, nor a list of the objects to be achieved by the legislation.
63Attendant care services are defined in s 3(1) in this way, namely, services
"...that aim to provide assistance to people with everyday tasks, and includes (for example) personal assistance, nursing, home maintenance and domestic services."
64This definition of attendant care services incorporates all of the services which have traditionally been compensated by awards of damages, including those instances where services are provided gratuitously to fulfil needs created by injuries and disabilities which were "tortiously" sustained in a motor vehicle accident.
65It is the existence of the need for these services, and the gratuitous fulfilment of that need, which is covered by the principles in G v K .
66Section 5 is a provision which provides some limited assistance in the interpretation of the LCS Act. It reads:
"Words and expressions used (but not defined) in this Act have the same meanings as in the Motor Accidents Compensation Act 1999. "
67It is appropriate to note, and make some observations about, the other provisions which are relevant to the present issues:
" 6 Scheme participants' treatment and care needs to be paid for by Authority
(1) The Authority is to pay the reasonable expenses incurred by or on behalf of a person while a participant in the Scheme in providing for such of the treatment and care needs of the participant as relate to the motor accident injury in respect of which the person is a participant and as are reasonable and necessary in the circumstances.
(2) For the purposes of this Act, the treatment and care needs of a participant are the participant's needs for or in connection with any of the following:
(a) medical treatment (including pharmaceuticals),
(b) dental treatment,
(c) rehabilitation,
(d) ambulance transportation,
(e) respite care,
(f) attendant care services,
(g) domestic assistance,
(h) aids and appliances,
(i) artificial members, eyes and teeth,
(j) education and vocational training,
(k) home and transport modification,
(l) workplace and educational facility modifications,
(m) such other kinds of treatment, care, support or services as may be prescribed by the regulations.
(3) As an alternative to paying the expenses for which it is liable under this section as and when they are incurred, the Authority may pay those expenses by the payment to the participant of an amount to cover those expenses over a fixed period pursuant to an agreement between the Authority and the participant for the payment of those expenses by the participant.
(4) The LTCS Guidelines may make provision for or with respect to determining which treatment and care needs of a participant in the Scheme are reasonable and necessary in the circumstances.
7 Eligibility for participation in the Scheme
...
(3) A person is not eligible to be a participant in the Scheme in relation to an injury if the person has been awarded damages, pursuant to a final judgment entered by a court or a binding settlement, for future economic loss in respect of the treatment and care needs of the participant that relate to the injury."
68It is appropriate to notice that s 7(3) denies eligibility to participate in the LCS Scheme, but only to a person who has received damages, by way of a court order or settlement, for future economic loss. That is, economic loss calculated as arising after the date of judgment or settlement (as the case may be). There is no mention of damages for past attendant care needs as a ground for lack of eligibility for the LCS Scheme.
69Section 9 deals with participation in the LCS Scheme in this way:
"9 Acceptance as a participant
(1) A person becomes a participant in the Scheme if the Authority is satisfied that the person is eligible to be a participant and accepts the person in writing as a participant in the Scheme, either as a lifetime participant or an interim participant (according to the person's eligibility).
(2) If the Authority is satisfied that a person is eligible to be a participant and that application for the person's acceptance as a participant has been duly made, the Authority must accept the person as a lifetime participant or an interim participant (according to the person's eligibility).
(3) A person accepted as an interim participant must be accepted as a lifetime participant if the Authority becomes satisfied during the person's interim participation in the Scheme that the person is eligible for lifetime participation in the Scheme.
(4) A person accepted as a lifetime participant in the Scheme remains a participant for life."
70I note that the effect of this section is that if a person, by reason of the extent of their injury (which by its nature is permanent and unlikely to improve) and it being caused wholly or partly by a motor vehicle accident, is eligible to participate in the LCS Scheme then:
(a)the LCS Authority must accept the person into the LCS Scheme either as an interim or lifetime participant; and
(b)the person, once a lifetime participant, remains a participant for life.
Whilst the LCS Authority has a limited discretionary decision as to whether it is satisfied that a person is "eligible", once that determination is made the inclusion of a person into the scheme is mandatory and not the subject of a further discretion.
71The provisions which affect the assessment by the LCS Authority of the needs of a participant are these:
"23 Assessment of treatment and care needs of participants
(1) The Authority is to make an assessment of the treatment and care needs of a participant in the Scheme.
(2) The assessment is an assessment of the participant's treatment and care needs that are reasonable and necessary in the circumstances, and as relate to the motor accident injury in respect of which the person is a participant in the Scheme.
(3) An assessment of treatment and care needs is to be made in accordance with the LTCS Guidelines.
(4) The Authority is to certify in writing as to its assessment of the treatment and care needs of the participant including its reasons for any finding on which the assessment is based, and is to give a copy of the certificate to the participant.
26 Effect of assessment
(1) The Authority's assessment of the treatment and care needs of a participant is final and binding for the purposes of this Act and any proceedings under this Act.
...
28 LTCS Guidelines
(1) The LTCS Guidelines may make provision for or with respect to the assessment of the treatment and care needs of a participant in the Scheme."
72Some features of these provisions which make provision for the administration of the LCS Scheme, should be here noted.
73Section 6 requires the LCS Authority to pay expenses incurred in providing, inter alia, for attendant care needs.
74Section 23 provides for a preceding and essential step to be taken, namely, the making of an assessment of the treatment and care needs of a participant. This section does not deal with costs or expenses. It simply deals with an assessment of needs.
75I note that there is no provision which specifically obliges the LCS Authority to provide or pay for all of the assessed needs of a participant. It seems to be assumed by the Act, that the LCS authority will provide for all the assessed needs of a participant. This is a significant lacuna in the legislation which seems, at least in part, to have given rise to the current dispute. Nor does the LCS Act articulate any objects or purposes, the equivalent of those in s 5(a) and s 5(e) of the MAC Act.
76Although s 54 was not referred to by any of the parties, it seems to be relevant to the consideration of how it was envisaged that the Scheme would work. It is unnecessary to set out the section verbatim. It provides that the LCS Authority is entitled to recover from a motor vehicle tortfeasor, or if insured, the CTP insurer, the present value of the Authority's treatment and care liabilities in respect of the motor vehicle accident. That present value is defined as including the Authority's past expenses and the present value of the amounts which:
"...the Authority estimates will become payable...in the future...in respect of the treatment and care needs."
77There is no identified exclusion from the recovery. The section envisages that the present value of all of the future treatment and care needs of an individual will be recovered where a motor vehicle tortfeasor is identified.
78The section also makes provision for a limited recovery if the identified motor vehicle tortfeasor is only partially liable, either because of the negligence of another person, or because of the contributory negligence of the injured plaintiff.
79The consequence of s 54 is that the position of the CTP insurer is no different, in principle, from that which exists under the MAC Act, or else where an injured plaintiff is accepted as a participant in the LCS Scheme. That is because the motor vehicle insurer will have to pay a sum of money that fully compensates for the injuries and disabilities suffered, and all of the treatment and care needs which are properly to be provided.
80There will be a difference in terms of to whom the money will be paid, namely either to the injured plaintiff directly, or else to the LCS Authority. Another difference which may be monetarily significant, is that the sum to be paid by the insurer to the LCS Authority is determined by the Authority's estimates and not a sum fixed by the Court in accordance with common law principles, as amended by the MAC Act.
81It is unclear from the terms of s 54, whether the CTP insurer is entitled to have the Authority's estimates of G v K damages calculated in accordance with s 128 of the MAC Act. That is an issue which it is unnecessary for me to resolve.