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You are here: BAILII >> Databases >> England and Wales High Court (Senior Courts Costs Office) Decisions >> Sharratt v London Central Bus Co (Accident Group Test Cases Tranche 2) [2003] EWHC 9020 (Costs) (15 May 2003) URL: http://www.bailii.org/ew/cases/EWHC/Costs/2003/9020.html Cite as: [2003] EWHC 9020 (Costs) |
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SUPREME COURTS COST OFFICE
Clifford Inn Fetter Lane London EC4A 1DQ |
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B e f o r e :
____________________
THE ACCIDENT GROUP TEST CASES TRANCHE 2 ISSUES SHARRATT |
Claimant |
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- and - |
|
|
LONDON CENTRAL BUS CO & OTHER CASES |
Defendant |
____________________
(instructed by Messrs Rowe Cohen) for the Claimants
Mr Ian Burnett QC and Mr Benjamin Williams
(instructed by Messrs Carters and Messrs Vizards Wyeth) for the 1st Defendants
Mr Andrew Neish (instructed by Messrs Beachcroft Wansbroughs) for the 2nd Defendants
Hearing dates : 25 March – 1 April 2003
____________________
Crown Copyright ©
Paragraph No. | |
Introduction | 1 |
The Tranche 2 Issues | 5 |
The Tag Contractual Framework | 16 |
Agreements Between TAG and the Insurers | 16 |
Between TAG and LPL- 26 October 1999 | 16 |
LPL's Binding Authority | 22 |
Between TAG and BESSO 5 November 2002 | 23 |
TAG's Binding Authority | 27 |
Between TAG and NIG - 1 July 2001 | 34 |
Agreements Between TAG and the Funders | 36 |
Between AAB (TAG) and Investec Bank (UK) Ltd – 26 November 1999 | 36 |
Between TAG and First National Bank – 3 October 2000 | 39 |
Between TAG and the Bank of Scotland – 15 February 2001 | 43 |
Agreement Between TAG and the Panel Solicitor | 45 |
The Operating Manuals | 49 |
Operating Manual 1 | 51 |
Operating Manual 2 | 65 |
Operating Manual 3 | 67 |
Operating Manual 4 | 68 |
Operating Manual 5 | 69 |
Agreement Between AIL and the Panel Solicitors | 71 |
Agreement Between Investec Bank and the Panel Solicitor | 73 |
Agreement Between Bank of Scotland and the Panel Solicitor | 74 |
Agreement Between the Client and TAG | 75 |
Agreement Between the Client and the Panel Solicitor – The Retainer | 80 |
The Evidence | 81 |
Neil Ross (C/29/659-692) | 84 |
The 2000 Year | 84 |
Lloyds 2001 | 96 |
NIG 2001 | 109 |
The Work Done by AIL and TAG | 113 |
The AIL Fee | 133 |
The Indemnity Principle | 145 |
Justin Coss (C/30/693-705) | 151 |
Daniel Primer (C/31/781) | 161 |
Gordon Blair (D/4/866-871) | 190 |
Stewart McCulloch (C/792-810) | 198 |
Referral Fees | 226 |
AIL Fee | 229 |
Robert Cowley | 234 |
The Live Issues | 253 |
Issue 2 - Is the whole sum payable for insurance by a Claimant under the TAG scheme properly to be regarded as a premium within the meaning of Section 29 Access to Justice Act 1999? If not, how much of the sum payable by the Claimant is such a premium? | 255 |
Issue 3 - Does the sum payable for insurance under the TAG scheme finance services or provide benefits which are collateral or extraneous to such insurance? (For the avoidance of doubt, this is intended to include the "block rating" issue.) To what extent should the cost of collateral or extraneous services or benefits be recoverable? | 255 |
Issue 5 - Is the premium-element of the sum claimed a reasonable and proportionate sum (a) for the benefits actually purchased, and (b) for cases of this character? | 255 |
Issue 6 - Of the "premium" paid by the claimant how much is retained by the underwriter, and how much is paid on to TAG or any other person by way of commission or other payment? | 255 |
The Submissions | 261 |
The 2000 Year (November 1999 to January 2001) | 263 |
Deductions for irrecoverable items | 267 |
Ring Fencing | 268 |
Insurance of the Cost of Funding the Premium and, Insurance of the Claimants' Inability to Recover the Cost of AIL's Services |
269 |
Add Backs | 279 |
Additional Premium | 280 |
Commission | 288 |
Insurance Services | 292 |
2001 Lloyds | 304 |
Deductions for irrecoverable items | 305 |
Add Backs | 307 |
Additional Premium | 307 |
Commissions | 312 |
Insurance Services | 313 |
2001 NIG | 314 |
Deductions for irrecoverable items | 315 |
Add Backs | 318 |
Additional Premium | 318 |
Commissions | 319 |
Insurance Services | 321 |
The Cross Check (Issue 5) | 323 |
2002 and 2003 years | 334 |
Conclusions | 335 |
Issue 2 | 335 |
Issue 3 | 336 |
Issue 5 | 337 |
Issue 6 | 338 |
Issue 10 - Are all or part of the following referral fees: (i) the payment of £310 plus VAT to AIL; (ii) the payment of £385 to Mobile Doctors Ltd; (iii) the payment to Rowe & Cohen of a vetting fee. | 339 |
Issue 11 - If so does the solicitors agreement to pay them breach the Introduction and Referral Code? | 339 |
Issue 13 – Are the payments identified at [10] irrecoverable (in whole or in part) for any other reason? | 339 |
Referral Fees (issues 10 & 11) | 339 |
Other Reasons (issue 13) | 361 |
Conclusions | 374 |
Issue 10 | 374 |
Issue 11 | 378 |
Issue 13 | 379 |
Issue 16 – Does the TAG panel solicitors obligation to reimburse any disbursements which are not recovered from the Defendant breach the indemnity principle? If so what are the consequences? | 380 |
Issue 17 – In some versions of the CFA, it is explicitly provided that the panel solicitor will, in successful cases, limit his fees to those recovered from the paying party. Does this breach the indemnity principle? If so what are the consequences? | 380 |
OM2, 3 and 4 (Issue 16) | 380 |
OM1 (Issue 17) | 387 |
Conclusions | 390 |
Issue 16 | 390 |
Issue 17 | 391 |
Chief Master : Hurst
INTRODUCTION
"Whether under the Accident Group Scheme the Regulation 4 information is given by a "legal representative" within the meaning of Regulations 1 and 4 of the Conditional Fee Agreement Regulations 2002.
If the answer is in the negative what are consequences of that for the Claimants claims for costs?"
"Yes, where the Regulation 4 information is given by a TAG representative on behalf of the "legal representative" within the meaning of Regulations 1 and 4 of the Conditional Fee Agreements Regulations 2000.
If the first question had been answered in the negative then the consequence for the Claimants' claims for costs would have been that they would have been irrecoverable, save for the claim for the premium which is not affected by the fact that the Regulation 4 briefing was not given by the legal representative."
THE TRANCHE 2 ISSUES
"GENERAL ISSUES
A. Premium Issues
1. If the CFA is unenforceable, is the ATE premium recoverable; if so, in what circumstances, and on what basis?
2. Is the whole sum payable for insurance by a claimant under the TAG scheme properly to be regarded as a premium within s 29 Access to Justice Act 1999? If not, how much of the sum payable by the claimant is such a premium?
3. Does the sum payable for insurance under the TAG scheme finance services or provide benefits which are collateral or extraneous to such insurance? (For the avoidance of doubt, this is intended to include the "block rating" issue.) To what extent should the cost of collateral or extraneous services or benefits be recoverable?
4. Was it reasonable of claimants under the TAG scheme to purchase insurance costed on a block rated basis?
5. Is the premium-element of the sum claimed a reasonable and proportionate sum (a) for the benefits actually purchased and (b) for cases of this character?
6. Of the "premium" paid by the claimant, how much is retained by the underwriter, and how much is paid on to TAG or any other person by way of commission or other payment?
7. Is it reasonable for the TAG scheme to be structured so that the whole of the premium is incurred immediately before any letter of claim?
8. What premium would be reasonable in circumstances where liability is admitted before a policy is taken out?
B. Standardised TAB Disbursements
9. What are the financial arrangements between all parties involved in the TAG scheme? Who pays what to whom?
10. Are all or part of the following referral fees:
(a) the payment of £310 + VAT to AIL;
(b) the payment of £385 to Mobile Doctors Limited;
(c) the payment of Rowe & Cohen of a vetting fee?
11. If so does the solicitor's agreement to pay them breach the Introduction and Referral Code?
12. If so, what are the consequences?
13. Are the payments identified at [10] irrecoverable (in whole or part) for any other reason?
C. Consumer Credit
14. Does MDL provide panel solicitors with credit under the Consumer Credit Act 1974?
15. If so, what are the consequences?
D. Indemnity Principle Issues
16. Does the TAG panel solicitor's obligation to reimburse any disbursements which are not recovered from the defendant breach the indemnity principle? If so, what are the consequences?
17. In some versions of the CFA, it is explicitly provided that the panel solicitor will, in successful cases, limit his fees to those recovered from the paying party. Does this breach the indemnity principle? If so, what are the consequences?"
THE TAG CONTRACTUAL FRAMEWORK
Agreements Between TAG and the Insurers
Between TAG and LPL- 26 October 1999
"A … which will provide an indemnity … for AAB clients … in relation to legal work undertaken by solicitors previously approved by AAB … prior to and/or following the issue of legal proceedings … commenced by AAB clients in connection with claims arising out of personal injuries and other ancillary losses sustained by AAB clients …"
There is a subsequent agreement dated 28 September 2000 after AAB had changed its name to TAG (I/43/2261) which is in virtually identical terms.
"E LPL has agreed to engage AAB to undertake certain services … which will enable LPL as underwriters representatives both to introduce and to manage the necessary insurance arrangements in respect of each and every claim which is the subject matter of legal proceedings ("insurance services").
F Investec Bank (UK) Ltd ("Investec") has agreed with LPL an insurance premium funding facility to AAB clients secured by the proceeds of the policy.
G Initially before the insurance is commenced in relation to the legal proceedings, insurance services undertaken by AAB will be provided to underwriters on the basis that they will form part of any insurance contract subsequently entered into between the AAB client and LPL on behalf of Lloyds underwriters and will consequently be deemed to be incorporated into the insurance contract thereby providing Lloyds underwriters with a written proposal and declaration for the purposes of the insurance ("the initial insurance services").
H After the insurance has been effected, additional insurance services will be undertaken by AAB and provided to LPL so as to enable LPL, on behalf of Lloyds underwriters, properly to manage the progress of each insurance contract during the course of the legal proceedings ("the continuing insurance services").
I It is agreed that the consideration paid by LPL on behalf of Lloyds underwriters to AAB for providing insurance services will amount to £480 (or such higher amount as may be agreed between the parties from time to time) for each and every claim ("the premium allocation").
J It is agreed that part of the premium allocation (£100) will be paid by LPL to AAB into a specific bank account maintained by AAB at Investec ("the retention account") on the basis that it will not be available to AAB until the liability of Lloyds underwriters has ceased.
In consideration of the premium allocation, AAB will provide to LPL the insurance services as described below.
The Initial Insurance Services
The initial insurance services to be provided by AAB and its representatives will include:
1. Arranging for the completion of the AAB application form … which will be signed by the AAB client. The AAB representative will emphasise to the AAB client the requirement for full disclosure of all material facts which will enable a proper assessment by LPL, AAB and the vetting solicitor of the insurance risk.
2. Arranging for the completion of the credit agreement application form in respect of the premium to be paid for the insurance and arranging for this to be forwarded to Investec for processing.
3. Collating the AAB application form, with such other documents as may be required to substantiate the claim, in order that the documentation can be forwarded to the vetting solicitor for assessment and then to the appointed representative.
4. Obtaining such further information as may be requested by the appointed representative prior to his agreement to commence the legal proceedings.
The Continuing Insurance Services
The continuing insurance services to be provided by AAB and its representatives will include:
1. Obtaining such further information, including a detailed statement of truth, and statements from witnesses and experts, as may be required by the appointed representative.
2. Monitoring the conduct of the appointed representative during the course of the legal proceedings and reporting on same to LPL and Investec whenever it is felt that LPL and Lloyds underwriters ought to be made aware of such conduct in circumstances where due compliance with the Operating Manual agreed between all members of the AAB panel, AAB and LPL and with the terms and conditions of the insurance so far as conducting the legal proceedings with due care and diligence is concerned.
3. In cases where there is a claim under the insurance, attending to a review by a suitably qualified costs draftsman of the appointed representatives disbursements and of the bill of costs of the opponents representatives.
4. Providing and maintaining relevant financial information as may be required by LPL and Investec for the purposes of monitoring the overall insurance result."
"First National Bank Plc ("FNB") has agreed with LPL an insurance premium funding facility ("the loan") to TAG clients secured by the proceeds of the policy."
LPL's Binding Authority
"Section 1
Grant of Binding Authority
The underwriters hereby authorise the coverholder:-
1.1 to bind insurances and amendments thereto for the underwriters accounts;
1.2 to issue the following documents evidencing cover in respect of insurances bound under the agreement:-
1.2.1 certificates of insurance,
1.2.2 endorsements,
1.2.3 such other documents as may be agreed in writing by the underwriters;
1.3 to process claims
in accordance with the terms and conditions contained herein or agreed in writing by the underwriters and endorsed hereon.
Section 2
Persons Authorised to Bind
2.1 The persons authorised to bind and who are responsible for the operation of the agreement are:- Brian Raincock.
2.2 All documents issued in accordance with sub-section 1.2 above shall be signed by one of the individuals named in sub-section 2.1 above.
Section 3
Delegation of Binding Authority
The coverholder shall not delegate any authority granted hereunder to any other person, firm or company without the prior written agreement of the underwriters which shall be endorsed hereon.
…
Section 16
Maximum Limits of Liability/Sums Insured
The coverholder is authorised to bind insurances up to the following limits of liability or sums insured which shall not be exceeded in any circumstances
£25,000 each case.
…
Section 20
Premiums, Deductibles and Excesses
20.1 All premiums for insurances bound under the agreement shall be calculated as follows (incorporating any applicable deductibles and/or excesses as shown in 20.2):- £800 each case, less £480 underwriters contribution costs.
20.2 Deductibles and/or excesses:- not applicable.
Section 21
Gross Income Premium Limit
Unless otherwise agreed by the underwriters in writing and endorsed thereon the total gross premium income attaching hereunder shall not exceed £3 million.
The coverholder shall monitor the total gross premium bound and advise the underwriters immediately when it becomes apparent that the gross premium income will be or is likely to exceed 80% of the above figure.
…
Section 25
Commission
25.1 The coverholder's commission
…
25.2 Contingent or Profit Commission in accordance with the formula as follows: (or as attached hereto) as specified in Appendix 1." (No Appendix is attached.)
Between TAG and BESSO 5 November 2002
"(a) From 1 February 2001 certificates of insurance have been issued on behalf of the underwriters providing insurance under the terms of binding authorities …, TAG have been providing insurance services (as hereinafter defined) as coverholder to underwriters and from the date hereof BESSO shall provide intermediary services (as hereinafter defined) to underwriters and TAG. Underwriters, TAG and BESSO have now agreed to enter into this agreement to set out the terms on which such services are and have been provided.
…
(f) This agreement is supplementary to and should be read in conjunction with binding authority agreements between underwriters and TAG. However, in the event of a conflict between the agreements the terms of this document shall prevail.
(g) Parties to this agreement have agreed that it shall enter into effect on 1 February 2001 notwithstanding that it is executed at a later date.
…
1. TAG's obligations
1.1 TAG will provide the initial insurance services specified in the second schedule and the continuing insurance services specified in the third schedule.
…
2. Underwriters obligations
2.1 In consideration of the provision by TAG of these insurance services underwriters will pay to TAG the premium allocation specified in the fourth schedule which premium allocation shall be paid and refunded as set out in the fourth schedule and profit commission specified in the fifth schedule which profit commission shall be payable as set out in the fifth schedule."
"The initial insurance services
1. The reasonable and responsible marketing and promotion of the TAG conditional fee insurance scheme to potential TAG clients.
2. Advising potential TAG clients, in plain language intelligible to a person with no legal training or experience of litigation, legal procedure or insurance law, of the nature of the insurance services provided by TAG and the nature of the insurance, including:
(a) the fact that although the TAG client may be indemnified by underwriters … the TAG client will be primarily responsible for the costs of the panel solicitor appointed to represent him in the conduct of the proceedings and, if proceedings are commenced in court and are unsuccessful, responsible for the costs of the party against whom such unsuccessful proceedings have been prosecuted;
…
[paragraphs (b) to (h) set out in detail the matters which must be brought to the attention of the TAG client.]
3. Arranging for completion of the TAG application form … which will be signed by the TAG client in the presence of a TAG representative/panel solicitor.
4. Forwarding the TAG application form, together with such other documents as may be required to substantiate the claim in accordance with the Operating Manual.
5. Reviewing the application form and the evidence submitted in support of the claim and considering whether the claim satisfies the insurance vetting criteria set out in Appendix 3.
6. If satisfied that the claim satisfies the insurance vetting criteria … forwarding details of the claim to the vetting solicitors with sufficient information to enable them to forward the claim to the appointed panel solicitor …
7. Upon receipt of agreement from the appointed representative to commence the proceedings under the conditional fee agreement and an undertaking signed by the appointed representative …, and provided ten days have elapsed since the TAG client signed the application form/AIL questionnaire referred to in (3) and (4) above, the certificate of insurance will be issued by TAG on behalf of underwriters and will be sent by TAG to the TAG client.
8. Advising the client that a certificate is not to be issued if the claim does not satisfy the insurance vetting criteria …
The continuing insurance services
1. Receiving underwriting assessment reports from the appointed representative from time to time during the validity of each certificate of insurance including:
(a) reports regarding any Part 36 offer or payment …
(b) reports from the appointed representative if at any time it appears … that the claim no longer satisfies the criteria set out in Appendix 3 …
(c) reports from the appointed representative … that an offer should be made by the TAG client pursuant to Part 36 of the CPR;
(d) reports from the appointed representative if … the total costs of pursuing the claim are … likely to be disproportionately high or at any event to exceed £5,000 or any additional amount of £5,000 over and above any amount previously authorised in writing by underwriters or TAG;
(e) reports from the appointed representative if the appointed representative wishes to incur any unusual disbursements, any disbursement over £500 or any disbursement which may not be recovered from the opponent on an assessment of costs on the standard basis;
(f) reports from the appointed representative immediately prior to the issue of a claim form;
(g) reports from the appointed representative if the TAG client fails to co-operate …
(h) reports from the appointed representative upon the cessation of the proceedings for any reason whatsoever.
2. Generally monitoring the conduct of the appointed representative during the course of the proceedings … considering whether any certificate of insurance should be cancelled …
3. Reporting on the conduct of all proceedings under any certificate of insurance to BESSO whenever it is felt that underwriters ought to be made aware of any matter relating to or affecting the claim or claims of TAG clients provided with an indemnity under the insurance.
4. Without prejudice to the generality of the foregoing, in particular reporting to BESSO:
(a) through a daily activations/change of fact/proceedings issued/trial date/profit costs/Part 36 offers/completed and closed case report in such format as may be agreed by the parties from time to time.
(b) Instances where a court orders the TAG client to make a payment of interim costs prior to the conclusion of the proceedings, such reports to be provided within two working days of the order being made.
…
5. Ensuring that all proceedings are being conducted by the appointed representative in accordance with the terms of the Operating Manuals …
6. In any case where there is a claim under the insurance and TAG deem it necessary to do so, attending to a review by a suitably qualified person of the bill of costs of the opponent following the conclusion of the proceedings.
7. In any case where a claim is resolved with the payment of damages or compensation for the TAG client ensuring that the appointed representative takes all reasonable steps to recover his costs (including disbursements) and the premium paid for the insurance in full in accordance with the terms of the insurance.
8. Maintaining relevant financial and other statistical information …
9. Attending monthly administrative meetings …
10. Providing to underwriters statistical reports …" (I/2551-2557)
"Premium Allocation
The premium shall be £950 plus insurance premium tax at the rate from time to time in force. The premium shall be paid to BESSO.
BESSO shall pay (or shall have paid) to the extent not already paid by Prentis Donegan & Partners Ltd:
(a) for policies issued between 1 February 2001 and 31 December 2001 the sum of £328.50;
(b) for policies issued between 1 January 2002 and 9 May 2002 £360.50.
(c) for policies issued between 10 May 2002 and 23 October 2002 £370.50;
(d) for policies issued on or after 4 October 2002 such other sum as the parties may agree from time to time;
plus all IPT payable on the whole premium to underwriters out of which sum Prentis Donegan & Partners Ltd retained £16.50 for policies issued between 1 February 2001 and 31 December 2001 and £10.50 for policies issued between 1 January 2002 and 23 October 2002 and BESSO shall retain such sum as the parties may agree from time to time for policies issued after 24 October 2002 as brokerage. The balance shall be the "individual claim premium allocation" and shall be paid to TAG as follows:
Individual Claim Premium Allocation
1. The individual claim premium allocation shall be:
(a) for policies issued between 1 February 2001 and 31 December 2002 the sum of £621.50;
(b) for policies issued between 1 January 2002 and 9 May 2002 £589.50;
(c) for policies issued between 1 May 2002 and 23 October 2002 £579.50;
(d) for policies issued on or after 24 October 2002 such other sum as the parties may agree from time to time;
for each certificate of insurance issued.
2. Of the said sum of £621.50, £589.50, £579.50 (as the case may be):
(a) for policies issued between 1 February 2001 and 31 December 2001 the sum of £566.50;
(b) for policies issued between 1 January 2002 and 9 May 2002 £514.50;
(c) for policies issued between 10 May 2002 and 23 October 2002 £464.50;
(d) for policies issued on or after 24 October 2002 such other sum as the parties may agree from time to time
shall be paid (or shall have been paid) by BESSO to TAG not more than one week after the issue of each certificate of insurance.
3. [The balance of premium in respect of each policy to be paid into the appropriate retention account] In the event that any certificate of insurance is cancelled, voided or deemed under its terms to have been avoided ab initio then all premium allocation and brokerage paid in respect of that certificate shall be refunded.
Overall Premium Allocation Refund
In respect of certificates of insurance issued between 1 February 2001 and 31 December 2001 (inclusive) and each 12 month period thereafter, there shall be an overall premium allocation refund if the net premiums received by underwriters after deduction of brokerage and individual claim premium amount to less than 125% of the claims paid under the insurance. The overall premium allocation refund shall be calculated separately for each calculated period. The period between 1 February 2001 and 1 January 2002 shall be the first calculation period. Each subsequent 12 month period shall be a separate calculation period.
…
The overall premium allocation refund shall be such amount as will mean that the net premiums received by underwriters after deduction of brokerage and individual claim premium allocation are equal to 125% of the claims paid under the insurance issued during the calculation period, provided that the overall premium allocation refund shall not be more than £238 (for policies issued between 1 February 2001 and 31 December 2001), £250 (for policies issued between 1 January 2002 and 9 May 2002), £240 (for policies issued between 10 May 2002 and 23 October 2002) or such other sum as the parties may agree from time to time (for policies issued on or after 24 October 2002) multiplied by the number of certificates of insurance issued during the calculation period or the relevant part thereof "the maximum overall premium allocation refund".
…" (I/2558-2562)
TAG's Binding Authority
"The net premium will be adjusted to ensure that the cumulative paid loss ratio does not exceed 80% per annual period subject too a maximum net premium of £500 (less brokerage) per certificate issued for the relevant annual period. This will be achieved by rebating the underwriters contribution to costs. Any such adjustment shall be calculated and closed on a monthly basis.
Retention Fund: out of the amount paid as the underwriter's contribution to costs, the coverholder shall pay £55 per certificate.
The above amounts shall be paid into a trust account for the benefit of the underwriters as security for any amount refundable as set out under the adjustment of premium provision above. This retention fund shall form part of the annual review."
25.2 Contingent or Profit Commission in accordance with the formula as follows: (or as attached hereto) as specified in Appendix 1."
"Appendix 1
Profit Commission
The Underwriters agree to pay annually an 25% Profit Commission based on the net ascertained profit from the operations of this Agreement calculated as follows:
…
The first calculation of Profit Commission will be made provisionally 24 months after expiry of the Agreement year and re-calculated every subsequent 12 months until all outstanding losses have been settled."
Between TAG and NIG - 1 July 2001
"Background
(a) TAG markets post event legal expenses schemes to its customers and administers such schemes. The insurer provides post event legal expenses insurance.
(b) The insurer wishes to appoint TAG as its agent for the purposes of marketing post event legal expenses insurance underwritten by the insurer and binding the insurer to and administering such insurances on behalf of the insurer.
…
3. Marketing
TAG will market the insurance(s) as agreed between the parties in writing from time to time. TAG may appoint sub-agents for this purpose but TAG will be liable to the insurer as principal for any acts or omissions of such sub-agents.
4. Binding Authority
4.1 TAG will on behalf of the insurer accept for insurance all customers who are eligible for and request insurance. TAG is authorised by the insurer to –
4.1.1 accept up to 36,000 customers for insurance in any one year;
4.1.2 administer the insurances; and
4.1.3 handle and settle claims up to a limit of £5,000 on the insurers behalf.
…
5. Premium Rates
5.1 The rates of premium applicable to the insurance(s) are as specified in Appendix 1 Part 5 as varied from time to time [premium rates are set at £997.50 including insurance premium tax].
5.2 The insurer may vary any net rates of premium as specified in Appendix 1 Part 5 by such amount as it reasonably considers appropriate taking into account (amongst other things) deteriorating claims experience always provided that the insurer shall give at least 90 days notice to TAG of any such variation.
6. Payment of the Premium Allocation
6.1 In consideration for TAG providing the services the insurer will pay the premium allocation to TAG.
6.2 Each working day the insurer will pay to TAG the premium allocations in respect of all insurance policies for which the insurer has received payment of the premium up to close of business on the previous working day less the insurer retention and if appropriate the funder retention.
…
12. Service Levels
TAG and the insurer will in the performance of their respective obligations comply with the agreed service level specified in the service level agreement [see below].
…
Appendix 1
…
Part 2 premium allocation £650
Part 3 funder retention £100
Part 4 insurer retention £50 [Parts 3 and 4 relate to paragraph 6.2 above]
…
Appendix 2
Service Level Agreement
1. General Terms
1.1 This service level agreement relates to the administration and claims handling services to be provided by TAG in respect of the insurances.
1.2 The services described relate to insurance administration and claims work.
1.3 Times shown as ideal objectives are the normal operating times …
…
2. Services
TAG shall provide the following services in respect of insurance:
2.1 insurance administration, comprising:
2.1.1 policy issue;
2.1.2 policy processing;
2.1.3 claims administration (where relevant);
2.14 creation of claims management reports.
3. New Insurance Fulfilment
3.1 Details of the claim will be taken down by the TAG representative who will make an initial assessment of the claim. If the representative believes that there may be a claim then they will explain the service offered by TAG, including details of the premium for TAG Protect and the funding arrangement. If the claimant is happy to proceed the claim will be sent to TAG Head Office from where it will be passed to AIL for investigation.
3.2 TAG will request AIL to assess the claim by speaking further with the claimant and any witnesses in order to obtain full details of the claim. Once AIL has investigated the claim and believes that there is sufficient information for the vetting solicitor to assess it, TAG will collate the initial assessment, with such other documents as may be required to substantiate the claim and all relevant documentation will be forwarded to the vetting solicitors for the claim to be approved.
3.3 If a claim is approved by the vetting solicitor, it will be referred to such panel solicitor as is agreed between TAG and the vetting solicitor based on the panel solicitor's respective capacities.
3.4 If the claim is accepted by the panel solicitor TAG will contact the claimant and arrange to visit the claimant. The TAG representative visiting the claimant will complete the AIL questionnaire incorporating a statement of truth for signature by the claimant. The TAG representative will also arrange for the claimant to complete any related loan agreement at such meeting.
3.5 TAG will issue evidence of insurance to the claimant, forward the loan agreement, if any, to the funder and advise the insurer that the policy has become active and is "on risk".
3.6 TAG will write to the insured customer setting out the key terms of the arrangement including the key terms of the indemnity offered by TAG Protect and what the insured customer will be liable for on a successful claim and explain that they will have no liability on an unsuccessful claim.
4. Claims Handling
TAG shall:
4.1 Obtain such further information, including a detailed statement of truth and statements from witnesses and experts, as may be required by the panel solicitor.
4.2 Monitor the conduct of the panel solicitor during the course of the legal proceedings and reporting on same to the insurer whenever it its felt that the insurer ought to be made aware of such conduct in circumstances where due compliance with the Operating Manual agreed between all members of the TAG panel, TAG and the insurer and with the terms and conditions of the insurance so far as conducting the legal proceedings with due care and diligence is concerned.
4.3 In cases where there is a claim under the insurance and where in its opinion it is appropriate to do so, attend to a review by a suitably qualified costs draftsman of the appointed representatives disbursements and of the bill of costs of the opponents representatives.
5. Administrative Services
5.1 Staff Matters
5.1.1 TAG will provide a supervised team of trained staff to administer the insurances (including claims) to the standard set out below.
5.1.2 …
5.1.3 …
5.2 Telephones
5.2.1 TAG will provide adequate telephone lines for in-coming customer account enquiries and customer claims enquiries …
5.2.2 …
5.3 Customer Complaints
5.3.1 If a complaint is received by TAG by telephone an attempt to resolve the problem will immediately be made by a member of TAG's staff.
5.3.2 Any unresolved telephone complaint or written complaint received by TAG will be referred to the appropriate Department manager …
[the procedure is set out]
…"
Agreements Between TAG and the Funders
Between AAB (TAG) and Investec Bank (UK) Ltd – 26 November 1999
"Whereas
(a) the Bank has agreed to provide funding for clients of the firm to finance premia due in respect of their Accident Protect legal expenses insurance policy;
(b) the firm [TAG] acts as a provider of claims management services in assisting its clients to obtain compensation for personal injuries claims;
(c) the parties have agreed to enter into this agreement for the purpose of regulating their relationship and establishing the terms on which the Bank will provide its services to the firm's clients."
"1.7 "Credit transaction" means a transaction involving the provision of credit facilities to a client to enable the client to pay for the premium due under a policy."
"2. General Obligations of the Bank
2.1 The Bank shall ensure that at all times when it is providing funding to clients it holds all appropriate licenses … relative to granting credit and administering credit transactions and banking facilities to clients.
2.2 The Bank will use its best endeavours to provide the firm with credit and ancillary documentation for the purpose of credit transactions which conform with all requisite statutory and regulatory requirements so as to be enforceable against the relevant client if duly completed and validly executed.
…
2.6 The Bank will open and maintain an account designated "litigation protection IBA No.2 account" into which it will pay the premium and insurance premium tax advanced to a client under a credit transaction.
2.7 On receipt of valid instructions … from [LPL] acting on behalf of the underwriters of the policy the Bank will, within 48 hours of receipt of such instructions pay to the firm the premium allocation [£480] less the premium retention [£100].
…
3. Warranties and Undertakings by the Firm
3.1 The firm warrants that:
3.1.1 the appointed representative has entered into an agreement with the firm …
3.1.2 the vetting solicitor have entered into an agreement with the firm …
3.1.3 the firm has entered into an agreement with [LPL] …
3.2 The firm hereby undertakes and agrees that it will use its best endeavours to ensure that the parties to the agreements … above meet their duties and obligations under such agreements …
3.3 The firm undertakes and agrees to observe and perform all its duties and obligations in respect of its agreement with [LPL] …
…
4. Credit Transactions
4.1 When introducing a client to the Bank, the firm shall be deemed to warrant to the Bank that:
4.1.1 the client has the benefit of a policy of legal expenses insurance; and
4.1.2 the client has signed an application form … and
4.1.3 the client has signed an AAB service agreement and declaration … and
4.1.4 the claim is a bona fide claim;
4.1.5 the claim has been accepted in writing by an appointed representative and the appointed representative is in receipt of a signed conditional fee agreement pursuant to Section 58(1) of the Courts and Legal Services Act 1990 and a client care letter …
4.2 The firm warrants that it will at all times and for all purposes (including the methods used to make known or available to clients funding under credit transactions) act in a lawful, proper and professional manner …
…"
Between TAG and First National Bank – 3 October 2000
"(a) The Bank has agreed to provide funding for clients of the firm to finance premia due in respect of their Accident Protect legal expenses policy." (2574) (emphasis added)
Whereas under the new Agreement it states:
"(b) The Bank has agreed to provide funding to clients of the company to finance premia due in respect of their Accident Protect legal expenses policy … and disbursements payable by the client to their appointed representative in furtherance of their claim." (emphasis added)
"1.8 "Disbursement" means any indebtedness or expenditure properly incurred and paid for by the appointed representative to a third party on behalf of the client for the purpose of furthering the client's claim."
"2. General obligations of the Bank
2.1 … the Bank shall offer to provide credit transactions to clients of the company … Finance provided by the Bank under such credit transactions may only be used by the client to pay for:
2.1.1 premia due and payable by the client in respect of the policy; or
2.1.2 disbursements due and payable by the client to their appointed representative.
…
3. Warranties and Undertakings by the Company
3.1 The company warrants that:
3.1.1 the appointed representative has entered into an agreement with the company …
3.1.2 the vetting solicitor has entered into an agreement with the company …
3.1.3 the company has entered into an agreement with [LPL] ...
…
4. Credit Transactions
4.1 When introducing a client to the Bank, the company shall be deemed to warrant to the Bank that:
4.1.1 the client has the benefit of a policy of legal expenses insurance; and
4.1.2 the client has signed an application form or a questionnaire (as the case may be) …
4.1.3 the client has signed a TAG service agreement and declaration …
4.1.4 the claim is a bona fide claim;
4.1.5 the claim has been accepted in writing by an appointed representative and the appointed representative is in receipt of a signed [CFA] … and a client care letter …
…"
Between TAG and the Bank of Scotland – 15 February 2001
"(b) The Bank is prepared to enter into a loan agreement with certain claimants for the purpose of financing the cost of claims under TAG's legal expenses insurance cover scheme.
…
2. Provision of Services and Loans
2.1 TAG and the Bank agree with effect from the commencement date to provide the services in accordance with the operational service levels and the Operating Manual on the terms of this agreement.
2.2 The Bank agrees with effect from the commencement date to make the loan available to claimants for the term in accordance with the provisions of Clauses 3.1 and Clause 5.
[Clause 3.1 deals with the duration of the agreement.]
4. Obligations of TAG
4.1 TAG will promote the scheme and provide the services using all due care, skill and diligence in accordance with Best Industry Practice and in accordance with all applicable laws and Codes of Practice.
4.2 TAG will ensure that the services are performed substantially by properly trained, experienced and supervised employees of TAG possessing suitable skills.
4.3 …
4.4 TAG will comply at all times with its obligations under the Operations Manual.
…
5. Obligations of the Bank
…
5.2 The Bank shall pay to TAG for each loan agreement upon which a draw down of funds on behalf of the claimant is made the sum of £13.10 (inclusive of any applicable value added tax) by way of commission monthly in arrears …
…
5.5 The interest rate under the loan is to be set at a margin over the Bank's base lending rate and the bank shall be entitled to vary the amount of such margin upon notice to TAG in writing.
…
5.7 The Bank shall be under no obligation to enter into a loan agreement with any claimant if and to the extent that the aggregate number of loans with outstanding balances at that time exceeds £33,000.
6. Panel Solicitor
6.1 TAG will ensure that each firm of solicitors appointed to TAG's panel of solicitors will enter into the Panel Solicitors Agreement and the solicitors indemnity and undertaking. TAG will provide the Bank from time to time with the name and address of each firm of solicitors approved for the purpose of the scheme."
Agreement Between TAG and the Panel Solicitor
"Whereas:
(a) TAG provides legal expenses insurance to persons ("claimants") who have suffered personal injury where TAG is satisfied that such persons have in their reasonable opinion a better than 50% prospect of success in a claim against a culpable third parties ("opponents") in respect of injuries sustained in an accident where damages for such injuries have a reasonable prospect of exceeding £1,500 ("a bona fide claim").
(b) The appointed representative is a firm of solicitors which specialises in personal injury litigation and who have agreed subject to obtaining claimants instructions to act on claimants behalf in bringing a claim for damages for personal injury against opponents.
It is agreed as follows:
1. Duties of the Appointed Representatives
1.1 In consideration of TAG's undertaking and agreement pursuant to Clause 2 the appointed representative undertakes and agrees with TAG that it will:
(a) observe and perform its obligations set out in the Operating Manual …
(b) observe and perform its obligations set out in the Accident Protect Legal Expenses Insurance Policy ..
(c) observe and perform as obligations hereunder the obligations which are contained in or referred to in Section 5 (step by step procedure), Section 6 (panel solicitors obligations and service standards) and Section 7 (review of files – random selection) …
(d) use the form of client care letter and conditional fee agreement, copies of which are contained or referred to in the Operating Manual …
(e) enter into an agreement with Legal Report Services Limited (the "LRS" agreement) in the agreed form …
(f) enter into an agreement with Rowe & Cohen solicitors … in the agreed form …
(g) enter into an agreement with [AIL] in the agreed form …
(h) observe and perform its obligations set out in its Agreement … with First National Bank Plc or such other funder as TAG may direct …
(i) assess every bona fide claim to ensure that claimants have in their reasonable opinion a better than 50% prospect of success in a claim against an opponent in respect of injury sustained in an accident and that damages for such injuries have a reasonable prospect of exceeding £1,500;
(j) use its best endeavours to recover from opponents all legal costs incurred, disbursements expended together with the amount of the premium, loan interest and any charges the claimant has paid to purchase the policy;
(k) notify the third party and/or the third parties insurers (if applicable) of the existence of the policy and that the claimant's claim will include the costs of paying the premium for the policy;
(l) allow TAG, LPL and/or the funders to have full access to the claimant's file of papers subject to the claimant's authority to do so.
2. Duties of TAG
2.1 TAG will provide such claims management services on behalf of the claimant, the underwriters and underwriters representatives and the appointed representatives, as set out in the Operating Manual …
2.2 TAG will provide the vetting solicitor with details of the appointed representatives eligibility to be a member of the TAG approved panel of solicitors to enable the vetting solicitor to refer bona fide claims to the appointed representative from time to time."
"1. Compliance
…
(b) The assured and the appointed representative shall conduct the proceedings with due care and diligence and shall take all reasonable steps to minimise or avoid the costs and expenses payable under the policy … In conducting the proceedings, compliance by the appointed representative with the terms of the TAG Operating Manual shall be a condition precedent to any liability of the underwriters to make payment under the policy so that, whilst underwriters will be prepared to provide an indemnity to the assured notwithstanding non compliance by the appointed representative with the terms of the TAG Operating Manual, underwriters will be entitled to make a recovery of any payment made in these circumstances from the appointed representative.
2. Arrangements with Funders
…
(b) In addition to making available loan facilities to the insured in respect of the payment of the premium, funders have made arrangements to provide loan facilities to the appointed representatives in respect of own disbursements including counsel's fees to the extent of the investigation costs.
(c) If at the conclusion of the proceedings, an amount of damages and costs is either awarded to the assured by order of the court as a result of the outcome of the proceedings or becomes payable to the assured by the opponent pursuant to a settlement entered into as part of the terms of a compromise, discontinuance or withdrawal of the proceedings, such amount of damages and costs shall first be used to discharge the loan together with related interest made by the funders in respect of the premium and own disbursements including counsel's fees and thereafter the loan together with the related loan interest made by the funders to the appointed representative in order to fund own disbursements including counsel's fees to the extent of the investigation costs.
3. Conditional Fee Agreement
The assured and the appointed representative shall ensure that the [CFA] entered into meets with the requirements [of Section 58 of the CLSA 1990] …"
"EXCLUSIONS
No indemnity under this insurance shall be provided by the underwriters in respect of:
(1) Own disbursements including counsel's fees where these are payable by the opponent …
(2) Proceedings where the assured is … entitled to indemnity under any other insurance …
(3) Proceedings which have been conducted in such a manner that, in the reasonable opinion of the underwriters, their position as insurers has been prejudiced as a result of the delay or other default by the assured or the appointed representative …
(4) Proceedings which are compromised … or discontinued or withdrawn by the assured unless the prior written consent of the underwriters has been obtained …
(5) Proceedings where it is discovered during the course of the proceedings that the opponent is not insured in respect of the outcome of the proceedings except in respect of own disbursements including counsel's fees incurred before discovery and of the premium and loan interest."
The Operating Manuals
- ? OM1 November 1999 to September 2000 (D/40/1049-1136)
- ? OM2 October 2000 to January 2001 (J/2699-2793)
- ? OM3 February 2001 (E/1308-1482)
- ? OM4 February 2001 to November 2001 (F/1484-1593)
- ? OM5 From approximately October 2001 (F/1603-1759)
Operating Manual 1
"The Role of the AAB Claims Manager
The claims manager provides initial insurance services to the client and continuing insurance services once a claim has been accepted by the panel solicitors.
The Initial Insurance Services
The initial insurance services to be provided by AAB and its representatives will include:
1. Arranging for the completion of the AAB application form which will be signed by the AAB client. The AAB representative will emphasise to the AAB client the requirement for full disclosure of all material facts which will enable a proper assessment.
2. Arranging for the completion of the consumer credit agreement application form in respect of the premium to be paid for the insurance and arranging for this to be forwarded to Investec Bank (UK) Ltd for processing.
3. Instructing Accident Investigations Ltd (AIL) to investigate the claim further and provide initial vetting services.
4. Collating the AAB application form, with such other documents as may be required to substantiate the claim, in order that the documentation can be forwarded to the vetting solicitor for assessment who will then refer the case to the panel solicitor who is appointed to conduct the legal proceedings (as defined in the policy).
5. Obtaining such further information as may be requested by the panel solicitor prior to his agreement to commence the legal proceedings.
6. Keeping the client informed of the progress of the case prior to acceptance and the outcome of the investigations.
The Continuing Insurance Services
The continuing insurance services to be provided by AAB and its representatives will include:
1. Advising the client of acceptance of the case and issuing the necessary insurance documentation. Assisting in obtaining such further information, including a detailed statement of truth, statements from witnesses and experts, as may be required by the panel solicitor ("appointed representative").
2. Monitoring the conduct of the appointed representative during the course of the legal proceedings. Reporting on same to LPL. Reporting to LPL whenever it is felt that the underwriters ought to be made aware of such conduct in circumstances where due compliance with the procedures agreed between the panel solicitors, AAB and LPL and their terms and conditions of the insurance so far as conducting the legal proceedings with due care and diligence is concerned.
3. Providing ongoing assistance to the client when requested by them during the course of the legal proceedings.
4. In cases where there is a claim under the policy, attending to a review by a suitably qualified costs consultant of the panel solicitors disbursements and, where appropriate, of the opponents representatives.
5. Providing and maintaining relevant financial information as may be required by LPL for the purposes of monitoring the overall insurance result."
"Step by Step Procedure
1. AAB currently have 25 teams of three who will run a stand in various shopping malls, etc.
2. A member of the public attends at the stand and completes an [AAB] application form which includes a statement of truth.
3. At this point the Consumer Credit Agreement ("CCA") will also be completed. All staff will be fully trained in explaining this and in addition, the literature on the stand and which is to be taken away by the prospective client will fully explain the CCA and what the next procedure will be. This will include details of how AAB will revert back to the client on whether the client has an acceptable claim. The client signs the Consumer Credit Agreement (which is witnessed by the AAB consultant), the application form contains the statement of truth and the AAB Service Agreement and Declaration.
4. The client will be handed a green copy of the CCA which includes explanatory notes on the CCA, a copy of the AAB Service Agreement and Declaration and an Accident Protect Legal Expenses Insurance Policy wording.
5. The application form, the AAB Service Agreement and Declaration and the CCA are then submitted to AAB who allocate a claims manager and a dedicated claims number.
6. The claims manager will undertake an initial vetting of the claim to decide whether or not further investigations are needed. If acceptable acknowledgement letter (1) will be sent. If unacceptable acknowledgment letter (2) will be sent.
7. Acceptable claims are then passed by AAB to AIL with instructions for AIL to investigate the claim. The file will consist of the application form, a signed copy of the CCA and a copy of the AAB Service Agreement and Declaration.
8. …
9. AIL contact the client and complete a questionnaire with more detailed information of the accident, circumstances and losses sustained. AIL return the file to AAB having also provided their recommendations on liability and quantum.
10. AAB then can submit the application form and questionnaire, together with a photocopy of the CCA to the vetting solicitor together with the referral bordereau.
11. The vetting solicitor will vet the case to ensure that it has more than a 50% chance of success and that the personal injury has an apparent value of more than £1,500. If, in their opinion it does, the case is then referred by the vetting solicitor to the panel solicitor as per the referral bordereau.
12. The panel solicitor has 48 hours within which to accept the case subject to receipt of the client's instructions. On acceptance by the panel solicitor, the client care letter must immediately be sent to the client. At this point the case is classified as being retained awaiting instructions. Upon receipt of instructions, including the signed questionnaire, the case is then deemed as accepted. The panel solicitor must send a specific written acceptance letter to AAB by fax which must be signed by an authorised signaturory of the practice and should include details of the client reference and the name of the fee earner.
13. By using the referral bordereau the panel solicitor advised AAB at 48 hours of which claims are acceptable and which are not.
…
19. Once confirmation of instructions has been received by the panel solicitor from the client, the evidence of insurance will be issued by AAB. This will have the signature of Brian Raincock, managing director LPL, who has the authority to sign on behalf of the underwriters.
20. The original evidence of insurance will be forwarded to the client and a copy will be sent to LPL as well as the panel solicitor.
21. At this point the AAB screen will show the policy as being active. A file will be generated by AAB which will be e-mailed to LPL on a daily basis. This will alert LPL the policy is on risk. The information will be e-mailed to LPL daily and will comprise of batches of new cases and updates on other cases. Investec will also receive this information which initiates the CCA procedure.
22 – 30 [These paragraphs deal with consequential matters and in particular how settled cases, failed cases and Part 36 offers are to be dealt with]."
- i. change of fact
- ii. obtaining reports and authorisation levels
- iii. incurring disbursements
- iv. issuing court proceedings
- v. notification of events, eg Part 36 offers/client refusing to co-operate
- vi. settlement/claims procedures.
"6(ii) Obtaining Reports and Authorisation Levels
(a) Single Disbursements
(1) If a single disbursement exceeding £500 is to be incurred authorisation must be sought from the relevant claims manager. If the single disbursement is less than £500 no authorisation is required.
(2) …
(3) AAB's written authority is required prior to incurring the disbursement.
(b) Profit Costs
…
6(iii) Incurring Disbursements
See above Section 6(ii)(a) for single disbursement authorisation levels.
AAB require panel solicitors to use specific medical agencies. Referrals must be notified to AAB immediately …"
"To give your claim the best opportunity we will require more in-depth information regarding your accident so we will refer your claim to [AIL] to investigate. They will be contacting you in the near future to complete a questionnaire. They will need information about the circumstances of your accident, who you feel was at fault and the reasons why. They will endeavour to collate as much evidence as possible giving your claim the best opportunity of success. It will be of great assistance if you could have any details regarding you accident no matter how unimportant you feel the information is, ready in anticipation of the investigations team call."
"Please undertake all investigation work necessary relating to this claim on behalf of the panel solicitor who will be instructed, if appropriate to handle this claim."
"We understand from [AAB] that you would like us to act on your behalf in accordance with your claim for damages for an injury sustained on the above date.
To enable us to deal with your claim efficiently we would be obliged if you would (1) sign the enclosed copy of this letter and return it to us. Please note that we have enclosed with this letter our Form of Conditional Fee Agreement (Terms and Conditions) ("the Terms and Conditions"). This letter, together with the enclosed terms and conditions, forms the basis of the agreement between us. Please make sure that you understand this letter and the enclosed terms and conditions before signing and returning the letter to us; (2) sign the enclosed Accident Investigation Questionnaire which contains a Statement of Truth … and return it to us."
"If you win the case, you are liable to pay own disbursements, basic costs and a success fee. You may be able to recover our disbursements, basic costs and our success fee from your opponent. If you are not able to recover these fees from your opponent you may be able to recover your disbursements under the policy. For full details, see Conditions 4 and 6 and details of insurance. Please note that if you are unable to recover the basic costs and any success fee from your opponent we will not seek to recover these from you."
"We have taken into account the factors referred to Clause 3(11) above and the fact that you have agreed to purchase the policy and accordingly we have determined to apply a success fee of:
- o 0% of the basic costs
The total of the success fee will not be more than 25% of the damages or settlement you win."
"We will not ask you to pay own disbursements until the conclusion of your case. However, it is anticipated that these will be met by your opponents under the policy as explained above."
"Payments we make on your behalf to others involved in the case. These may be: court fees; expert fees; accident report fees; investigation fees; official search fees; travelling expenses; fees for barristers may also be counted as own disbursements …
You have to pay all own disbursements, whether you win or lose. However, there are three exceptions to this:
- ? if you win, we may be able to recover on your behalf the money for own disbursements from your opponent or, if these are not recoverable from your opponent and they have been reasonably incurred, then, we will make a claim under the policy;
- ? if you lose, then we will make a claim under the policy."
Operating Manual 2
"6(iii) Incurring Disbursements
…
(a) Disbursement Funding
(i) Arrangements have been made with the funders for the client to fund disbursements ("funded disbursements") properly incurred by the panel solicitor on behalf of the client up to a maximum of £1,200.
(ii) Under the facility referred to in (i) above the clients indebtedness to AIL will automatically be paid by the funders (and debited to the client's loan) following acceptance of the claim by the panel solicitor and inception of the client's loan with the funders.
(iii) The panel solicitor may upon written application to TAG enclosing evidence of disbursements incurred, request reimbursement of such further disbursements provided the same exceed in aggregate £150. The panel solicitor must utilise Form TAG SF2 an example of which is contained in Section 8(b).
(b) Repayment of Disbursements to Client in Successful Cases
(i) The panel solicitor undertakes that where they recover any funded disbursement (in whole or in part) they will remit such disbursements to the funders on behalf of the client.
(ii) In circumstances where the panel solicitor fails to recover a funded disbursement, either in whole or in part, the panel solicitor undertakes to remit from their own resources the unrecovered disbursement or proportion thereof to funders in accordance with their obligations hereunder …
TAG stipulate panel solicitors must used authorised medical agencies. Referrals must be notified to TAG immediately …" (J/2727)
At this time the funders were First National Bank Plc.
"(c) Third party challenge to additional liabilities (as defined by Part 43.2(1)(o) CPR) and disbursements.
(i) ….
(ii) …
(iii) The panel solicitor should only incur disbursements which are recoverable from the paying party. It is an express condition of the agreement between TAG and the panel solicitors that any disbursements incurred on behalf of clients are reasonable in amount and the panel [solicitor] has warranted that the same are recoverable from a culpable third party.
(iv) In a case where a claim for costs is made against a culpable third party and the panel solicitor fails to recover a disbursement then the panel solicitor undertakes:
(a) in the case of funded disbursements, to refund to the funders on behalf of the client the disbursement or the proportion thereof which has not been recovered; and
(b) in the case where the disbursement or the proportion thereof is not a funded disbursement not to seek recovery from the client." (J/2730/31)
Operating Manual 3
Operating Manual 4
Operating Manual 5
Agreement Between AIL and the Panel Solicitors
"Whereas:
…
2. AIL undertakes investigatory works on behalf of TAG's approved panel of solicitors ("the solicitors") against payment of a fixed cost of £310 plus VAT … per claim investigated and which is passed to the appointed representative in accordance with the appointed representatives agreement with TAG ("investigated claim").
3. The appointed representative is a firm of solicitors which specialises in personal injury litigation and which is a member of TAG's panel of solicitors.
It is agreed as follows:
1. Duties of AIL
1.1 AIL will on behalf of the appointed representative investigate claims referred to AIL by TAG and, as far as they are able so to do, ascertain:
(a) all necessary information regarding claimants;
(b) all relevant information regarding the circumstances surrounding the claims;
(c) all relevant information regarding the liability of any third party, such third parties details and details of such third parties insurers;
1.2 AIL will also, if considered necessary, obtain:
(a) photographs of the locus in quo or of the claimant's injuries;
(b) witness statements;
(c) detailed statements from the claimants;
(d) locus reports
2. Duties of the Appointed Representative
2.1 The appointed representative hereby appoints AIL as its agents for the purpose of investigating, collating and assessing information regarding claims passed to AIL by TAG and, in particular, to do so prior to the appointed representative commencing to act on behalf of any claimant to enable the appointed representative to consider whether he wishes to act on behalf of such claimant;
2.2 in consideration of AIL observing and performing its obligations under clause 1 hereof and its obligations under this agreement, the appointed representative hereby agrees to pay £310 plus VAT … for undertaking investigatory services in relation to investigated claims in respect of which the appointed representative is retained to act on behalf of a relevant claimant;
2.3 the appointed representative shall make payment to AIL of £310 plus VAT … for undertaking investigatory services in relation to investigated claims in respect of which the appointed representative is retained to act on behalf of the relevant client (which the appointed representative acknowledges is a reasonable sum in relation to AIL's such services).
2.4 The payment shall be made within 14 days of an invoice being raised (as set out in the appointed representatives agreement with TAG).
2.5 For the avoidance of doubt an invoice will be raised 14 days after the appointed representative has confirmed that he has received confirmation of instructions from a claimant in accordance with the appointed representatives agreement with TAG;
2.6 it is hereby acknowledged by the appointed representative that once a claimant has confirmed his or her instructions for the appointed representative to act there will be no refund of the AIL fee under any circumstances.
… " (1474/75)
"Whereas
…
2. AIL undertake investigatory works as instructed by claimants at a fixed cost (the "investigation fee") of £315 plus VAT …
3. The appointed representative is a firm of solicitors which specialised in personal injury litigation and which is a member of TAGs panel of solicitors and has agreed with TAG to comply with the procedures set out in its Operating Manual [OM5].
4. It is envisaged that the said sum of £315 plus VAT … will be funded by a credit transaction. "Credit transaction" means a transaction involving the provision of credit facilities to a claimant to enable the claimant to pay for the premium due under a policy and/or disbursements due by the claimant to his appointed representative or incurred by the claimant including, but not limited to the investigation fee.
5. The appointed representative agrees (and undertakes hereunder, for the benefit of claimants for whom the appointed representative has agreed to act to recover the investigation fee save where the claimants claim for personal injury is unsuccessful.
It is agreed as follows:
1. Duties of AIL
AIL will on behalf of claimants investigating claims referred to AIL by TAG and, as far as they are able to do so ascertain:
[relevant information]
…
2. Duties of Appointed Representative
2.1 Subject to paragraph 2.2 the appointed representative hereby undertakes to recover the investigation fee from a opponents of claimants for whom he acts."
Agreement Between Investec Bank and the Panel Solicitor
"(b) The firm is a member of a panel solicitors of [AAB] for the conduct of personal injury litigation.
(c) The Bank has agreed to enter into funding arrangements with the firm to satisfy certain invoices raised upon the firm by [AIL]
…
2. Definitions
…
7.6 "Invoice" means any invoice issued by AIL upon the firm in respect of claim investigatory services and being in the sum of £310 plus VAT.
…
4. The Facility
The Bank agrees to provide the firm with a facility up to the maximum limit set out in the schedule … for the settlement of invoices in accordance with this agreement.
5. Utilisation
5.1 Utilisation of the facility shall be conducted as follows: when AIL raise an invoice, subject to clause 5.2 below, the Bank shall settle the same on behalf of the firm and shall debit the account of the firm and the bank in the sum of £310 plus VAT for each invoice.
5.2 The Bank shall be under no obligation to settle any invoice but shall notify the firm if it does not do so. Without prejudice to the generality of the foregoing the Bank shall be under no obligation to settle any invoice where the debit balance on the account referred to at clause 5.1 exceeds the facility limit set out in the schedule (or where such settlement would cause the limit to be exceeded).
6. Repayment
Subject to clause 8 the firm shall repay the Bank £310 plus VAT in respect of each invoice paid by the Bank under clause 5.1 on the date falling 12 months from the date of the invoice or if earlier upon receipt of funds in respect of the settlement of a particular claim for which that invoice relates."
Agreement Between Bank of Scotland and the Panel Solicitor
"Whereas …
(c) the Bank has entered into credit agreements with clients (as defined below) to fund personal injury litigation, insurance policy premia and disbursements;
now it is agreed as follows:
1. Definitions
…
1.3 "Disbursement" means any indebtedness or expenditure properly incurred and paid for by the firm to a third party on behalf the client for the purpose of furthering the client's action.
…
2. Acknowledgment
The firm acknowledges that the Bank will provide funding to clients of a kind referred to in recital (c) above and, notwithstanding any rights the Bank may have against clients or any security it may hold in respect of the same, is entitled to rely on the proceeds of actions or payments under policies to obtain repayment of such advanced to clients under its credit agreements. The firm acknowledges that the terms of the policies contain certain exclusions of liability on the part of the insurance company to make payment.
3. Duty of Care
…
The firm also acknowledges that it will conform and comply with the terms of all its obligations and instructions under any arrangement or agreement with TAG that agreement has annexed to it OM3."
Agreement Between the Client and TAG
"1. That the information in this form is true to the best of my knowledge, information and belief and I request that [AAB] deal with this matter on my behalf.
2. I understand that the information in this form may be used as a basis for court proceedings and for an application for a legal expenses insurance policy.
3. I have carefully read and understood the AAB service agreement and declaration enclosed with this form."
"This information form is designed to ensure that you understand the proposals [AAB] are providing under this arrangement and is also intended as a guide for future reference.
Your signature below confirms that you have carefully read and understand the form and that you have retained a copy.
Please keep the form safe for future reference.
I understand that:
(1) If my application is accepted by AAB and evidence of insurance is issued, that AAB will assist me with my claim;
(2) …
(3) AAB will undertake whatever action is necessary to ascertain whether or not I have a claim that in their opinion has a reasonable prospect of success;
(4) …
(5) if AAB do not accept my application and do not issue evidence of insurance, the loan agreement with Investec Bank (UK) Ltd which I have signed will be cancelled automatically;
(6) if my claim is successful my appointed solicitor will attempt to recover the amount of premium, loan interest and any charges I have paid to purchase the insurance policy from my opponent in addition to my compensation;
(7) if my claim is successful but my appointed solicitor fails to recover all or any part of the balance outstanding on my loan, then the money I receive for my compensation will first be used to discharge my obligations under the loan. If the compensation I receive is less than the balance outstanding on my loan, then my liability to repay such outstanding balance will be indemnified, in so far as provided by, and subject to, the terms of the Accident Protect legal expenses policy ("the policy");
(8) if my claim is successful, the policy, subject to compliance with its terms and conditions, provides for deficiency of damages cover which will guarantee a minimum sum of £500 damages being retained by myself after the deduction of any obligation under the loan and/or the policy provided my damages exceed this amount;
(9) if my claim is not successful I will be indemnified, … against my liability to pay my own disbursements and counsel's fees …, my opponent's legal costs and the outstanding balance on the loan made available to me to purchase the policy.
Declaration
I agree that if AAB accepts this claim:
(1) I will pay the premium of £840 [including IPT] for the policy;
(2) as I will borrow the money to pay the premium from Investec Bank UK Ltd I hereby irrecoverably and unconditionally authorise any solicitor appointed to act on my behalf to [deal with the money as provided by the funding agreement]."
"I understand and agree that:
…
4. I would like and hereby instruct [AIL] to investigate and obtain further information surrounding the circumstances of my accident. I understand that the cost of the investigation will be a fixed fee of £364.25 and that such fee will form part of my claim.
5. In the event that evidence of insurance is not issued then TAG will not seek to enforce liability to pay the premium and Accident Investigations Limited will not require me to pay their fee.
…" (D/35/928)
"This document is designed to ensure that you understand the proposals [TAG] are providing under this arrangement and is also intended as a guide for future reference.
Your signature below confirms that you have carefully read and understood the form and that you have retained a copy.
Please keep the form safe for future reference.
I understand that
…
5. If TAG accept my application I understand that they will (and I hereby confirm that I have instructed them so to do):
(a) recommend a solicitor to act on my behalf;
(b) arrange for my claim to be investigated by [AIL] for a fixed fee (the "investigation fee") of £376 (inclusive of VAT) to provide sufficient information to enable my solicitor to present a claim to my opponent and arrange for my claim to be funded by a suitable bank or other financial institution ("the funder").
6. If my claim is successful the solicitor recommended by TAG to act on my behalf will attempt to recover from my opponent (in addition to my compensation) the premium I have paid to purchase the TAG project legal expenses insurance policy, any disbursements that have been incurred on my behalf and the investigation fee from my opponent. I understand that I will still have to pay the loan interest, which will be deducted from my compensation.
7. If my case is successful but the solicitor recommended to act on my behalf fails to recover all or any part of the balance outstanding on my loan, then the money I receive from my compensation will first be used to discharge my obligations under the loan. If the compensation I receive is less than the balance outstanding on my loan, then my liability to repay such outstanding balance will be indemnified, in so far as provided by, and subject to, the terms of my legal expenses insurance ("the policy").
8. If my case is successful, the policy, subject to compliance with its terms and conditions, provides "deficiency of damages" cover which means that I will receive a minimum of £500 after the deduction of monies due under the loan provided my damages originally exceeded this amount.
9. If my case is not successful I will be indemnified … against my liability to pay my own disbursements and counsel's fees (as defined in the policy), my opponents legal costs and the outstanding balance on the loan made available to me to purchase the policy and disbursements (if applicable).
10. This policy contains and embodies the entire agreement between the claimant and TAG no variation or waiver of the terms of this agreement is valid unless in writing signed by a duly authorised employee of the Accident Group Limited.
Declaration
I agree that I will be bound by and will comply with the terms and conditions of the policy. I agree that I will pay the premium of £997.50 (including insurance premium tax) for the policy, a copy of which is available upon request. In the event that a certificate of insurance is not issued solely on the grounds of liability and/or quantum (meaning the amount of the case) then TAG will not seek to enforce my liability to pay the premium.
If TAG accepts this case, I further understand and agree that:
1. If I borrow the money to pay the premium and disbursements (if applicable) from the funder I hereby irrevocably and unconditionally authorise any solicitor recommended to me by TAG to act on my behalf to:
(a) pay any monies received by me as a result of the legal action being pursued by me and insured under the policy (save where monies are received in respect of a prior obligation to pay credit hire or repair charges) to the funder and that the funder will then deduct and keep the amount outstanding under my loan agreement with them and deal with any balance (and interest on that balance) according to my instructions.
(b) The loan includes the premium, investigation fee of £376 (inclusive of VAT), interest, and any other expenses incurred by my solicitor on my behalf; …
…
I have carefully read and understood this document before signing it. By signing, I agreeing to be bound by its terms." (D/35/928 FF)
The declaration is signed by the client and dated.
Agreement Between the Client and the Panel Solicitor – The Retainer
THE EVIDENCE
Neil Ross (C/29/659-692)
The 2000 Year
"Cover/Debit Note
This is being specially produced and will be with you shortly. What we have will not provide the information that you require.
Policy Document
The final version has now been agreed by underwriters and has therefore been "scratched off" and is ready for use.
Premium Allocation
You expressed an unwillingness to accept that the additional £10 imposed by underwriters to extend the cover to include "positive deficiency of damages up to £500" [ring fencing] should be shared between us.
I have been back to underwriters who are adamant that this should stand, a view point with which I cannot disagree. You also expressed a view on what you called "our commission" and described it as "more than enough". I am sorry but I do not accept this – our share of the total premium is relatively modest when viewed in the totality and in particular our intellectual contribution.
We must insist therefore that the additional £10 demanded (quite understandably) by underwriters is divided equally between us.
I intend to process the current business on this basis accepting that it may need a meeting to achieve final resolution. Having said that I have an outstanding issue with Gary over Investec's £20 fee and maybe we should resolve both matters at the same time. This will not happen before the New Year, however, and I suggest that we arrange to meet then."
"…
1.3 to process claims
in accordance with the terms and conditions contained herein or agreed in writing by the underwriters and endorsed hereon."
"The only issue which I am undecided on is with regard to the level of commission we are receiving and which has to be detailed to the other side if proceedings are issued. I realise most of our costs is for providing post and pre insurance services on behalf of the underwriters but I recall there being a small element of commission. What are your views here? A commission could be challenged."
No response was received from Mr Raincock
Lloyds 2001
"Interest: conditional fee insurance scheme
Limit: £50,000 each case
Policy wording: to be drafted by Berrymans including deficiency in costs limit £500 each case [ring fencing] – wording as previously provided.
Claims: Coverholder to have settlement authority of up to £5,000 each claim.
Premium income limit: £20 million based on 60,000 policies
Premium: £345 (including PDP brokerage of £18) with swing adjustment on 125% paid loss load up to a maximum £550.
In lieu of LOC underwriters to have charge on £100 per case upon release from retention fund. (Terms to be agreed.)
Profit commission: 25% to TAG
…"
" "Premium" - £950 each case plus IPT of £47.50 each case less £621.50 each case underwriters contributions to costs.
The net premium will be adjusted to ensure that cumulative paid loss ratio does not exceed 80% per annual period subject to a maximum net premium of £550 per certificate issued for the relevant annual period. This will be achieved by rebating underwriters contributions to costs. Any such adjustment shall be calculated and closed on a monthly basis.
Retention fund: out of the amount paid as underwriters contributions to costs, the coverholder shall pay £55 per certificate.
The above amounts shall be paid into a trust account for the benefit of underwriters as security for any amount refundable as set out under the adjustment of premium provision contained herein. This retention fund shall form part of the annual review."
NIG 2001
The Work Done by AIL and TAG
"We were trying to develop a system whereby different areas of business – there was time recording put against the different aspects of the scheme so with regard to AIL you can see upwards of 10 or so different activities and Accident Advice Bureau activities."
"That is more a deficiency of this time recording system which has had a lot of failings with regard to being inputted correctly and being correctly written in the first place, programming errors, wrong usage, under usage and so on."
He then confirmed that the individual who had put in the information had automatically applied AIL against that area of work where it should not have been.
"I think to be honest about this description there was no claims manager as such and this step by step procedure is quickly amended when Operating Manual 2 comes out. The reality was that the claim would come into the office and would receive a very high level vetting of what I would describe as an inputting stage, inputting that claim onto the system and then would be passed to AIL to carry out the investigation."
"The investigator contacts the claimant, usually by telephone and completes a detailed questionnaire which contains a statement of truth specifically designed to the category of claim (road traffic, employers liability or public liability). The investigator will determine whether or not or one of his colleagues should meet with the claimant to obtain further information or take photographs."
"… by virtue of the type of individual who are clients, they tended to quite often be more comfortable contacting us for an update on the progress of their claim or if they had received a communication from the solicitor that they did not understand or whether they felt the case was not progressing quickly enough. There were many occasions when we would deal with customer enquiries after acceptance."
"We are not saying that under the insurance services the actual investigation is being done. That is completely separate. That is Accident Investigations Ltd. It is important for the underwriters and the insurers that the process, if you like, of an investigation in terms of gathering information, is done. It is that service that we are being paid for, ensuring that a full investigation is being carried out and information is being collated and then vetted, rather than the actual investigation, the actual information gathering, which is done by Accident Investigations."
"It does not accurately reflect what is meant by the statement "obtaining such further information including a detailed statement of truth, and statements from witnesses and experts as may be required by the appointed representative. That is not in my view reference to the actual investigation work by AIL."
He denied that TAG was charging underwriters for exactly the same work as was being charged to the panel solicitors.
The AIL Fee
"… the investigation services were a necessary function of the scheme and … the scheme did not simply refer the panel solicitor to a name and address of a client but to enable the client's claim to be considered properly and the investigation fee was charged but paid by the client, an intention really on behalf of the claimant as opposed to a claimant going directly to a solicitor and spending some time giving detailed information regarding the circumstances of an accident which I am not sure would happen before [or] after a retainer but that was always the intention as opposed to it being a claim by the solicitor for the referral of the case."
"2. AIL undertake investigatory work as instructed by claimants at a fixed cost … of £315 plus VAT …
…
5. The appointed representative agrees (and undertakes hereunder) for the benefit of claimants for whom the appointed representative has agreed to act to recover the investigation fee (save where the claimant's claim for personal injuries is unsuccessful)."
"1.1 AIL will on behalf of claimants investigate claims referred to AIL by TAG and as far as they are able to do so ascertain: [relevant information]"
"2.1 Subject to paragraph 2.2 the appointed representative hereby undertakes to recover the investigation fee from opponents of claimants for whom he acts;
2.2 the appointed representative shall not be required to recover the investigation fee from opponents of claimants in cases where the claimant's case has been unsuccessful …" (F/1813)
"The intention of the scheme had always been that this was a disbursement incurred on behalf of the claimant, paid by the solicitor on behalf of the claimant and in November 2000 it was decided that the payment of that would move from the panel solicitor to the claimant. It is correct to say that the paperwork with regard to that probably took another 12 months to catch up."
The Indemnity Principle
Justin Coss (C/30/693-705)
Daniel Primer (C/31/781)
"the arithmetic therefore was done on the assumption that the figures could and would be readjusted as and when more information became available and claims were being experienced." (C/31/783 para 6)
"Prior to the February 2001 renewal I had formed the opinion that the risk premium retained by underwriters was significantly unrealistic and insufficient to either pay for claims or generate any profit. I was also interested in formalising the underwriter's partnership with TAG by creating a "swing premium" mechanism whereby the underwriters would receive by way of refund from TAG an additional premium allocation to the extent justified by underwriting performance. For the 2001 underwriting it was agreed that there would be an initial premium allocation to underwriters of £328.50 per policy including £16.50 brokerage to the Lloyds broker. Up to an additional £238 per policy making a total of £566.50 would be payable to the underwriters to the extent necessary to cap the underwriters loss ratio at 80% …"
"Loss Experience Adjustment: In addition to the premium specified, coverholder shall pay to underwriters an amount equal to £150 times the number of certificates declared hereto. For underwriters accounting purposes, the loss experience adjustment shall receive a separate reference and shall be paid in accordance with an endorsement to be agreed between underwriters and BESSO." (723)
"that was still attached to the 2000 year of account and in Lloyds parlance the Catlin underwriters, the names for the 2000 year, are the people who took benefit of that payment." (transcript day 3, page 7, line 14)
"we had some very broad assumptions, we expected a percentage of cases to fail, 4% to 6% that sort of range, we made some assumptions as to what the average claims cost would be and wanted to have a cushion about that so that there would be some profit in it for us." (day 3, page 20, line 8)
Underwriters were hoping to achieve at least a 20% to 25% profit margin.
"No cases will be assigned to the bottom 20% of coverholders solicitors panel "league table" as at 31 October 2002, without underwriters prior written consent."
"That meant that as the scheme was maturing we were getting more data and were able to apply – if you look at the first slip there is a lot more underwriting discipline that is reflected. What that particular paragraph is about is that TAG maintains statistics … what sort of success rates they have and by looking at that league table you can see there is a number of solicitors whose performance is not very good and we said as underwriters we are not happy to have those solicitors continuing to handle cases because they are giving us bad results."
"We received £2.7 million during the 2000 year which reflected our percentage of all business written, plus the additional £3 million or thereabouts, as reflected in this contract. So our total premium for TAG for the 2000 year, all of which is called risk premium, whatever, our premium, our accounted premium, is £5.7 million, and that is the amount that we use in all of our accounting, recording and reserving."
Gordon Blair (D/4/866-871)
"• expenses of claims allocation teams
• expenses of post acceptance disbursement funding team
• expenses relating to collection and dispatch of files to external vetting solicitors including IT costs, support and staff costs, etc
• 25% of the cost of panel liaison consultants, this element being referable to "process chasing" in relation to solicitors
• other miscellaneous expenses not connected to the provision of insurance services."
"The cost of initial and continuing insurance services per case handled by TAG has been calculated at £310.33. This calculated is based upon an equal distribution of the AE cost across the number of accepted cases handled by TAG in the relevant period. This does not include allowance for void cases which are cases abandoned by the client. These cases involve a substantial proportion of initial and insurance services but are subsequently abandoned beyond acceptance. The percentage of cases which fail in this way amount to 13%. If the cost of initial and continuing insurance services is spread across the remainder of the accepted cases handled during the period, the total AE cost per case for insurance services amounts to £356 per case."
"I gave instructions to the finance team to undertake an exercise, but the actual split of that exercise was in conjunction with the executives in the TAG business who understood what the contractual position was."
Stewart McCulloch (C/792-810)
"To provision of enquiry agents services,
quantity 1,
value £310.
To our charges in connection with liaising with claimant, obtaining information as to the date of the incident, obtaining full details, including name, address, date of birth, national insurance number and occupation of the claimant including address, department, telephone and facsimile numbers.
Obtaining full details of the relevant third party, including name, address and telephone number together with appropriate insurance details.
Providing you with information to progress the case including obtaining details of the accident, the nature and extent of the injury, details as to the hospital and general practitioner who attended, details as to the extent and nature of treatment received.
Further obtaining preliminary details as to financial losses of the claimant including loss of salary, prescription charges, travelling expenses and other losses, together with other relevant information to assist you in pursuing the claim."
"VAT rates 17½%, goods total £310 deliver to T Ashbourne. [The last word is misprint for Ashmore.]"
"on the face of it, yes, but the reality of it is that the disbursement here was discharged by the client directly out of his or her loan account …
I am not an expert in banking law, but I believe it was the client's obligation to authorise payment of the invoice and it was paid out on account which was nominated to the client's name, yes. It might physically have been paid by First National."
"We shall attempt to recover the premium from your opponent if you win your case but the court may disallow it in whole or in part. In such circumstances the loan you have taken out to pay for the policy premium, disbursements (if applicable) and any interest and charges due and payable by you in respect of your loan will be deducted from your damages (compensation)."
He confirmed that the money did not pass through his firm but went straight from First National to AIL. He confirmed that the contract for the provision of AIL's investigation services was not between the client and AIL but between his firm and AIL.
"Payment of that invoice was made by the client directly out of his or her loan account to AIL. My firm played no part in arranging for that payment to be made and indeed it can be seen from the [CFA] signed in each case that the client was aware that the investigation fee would be incurred. My firm has not made any payment to AIL in these cases."
"… It was paid by FNB to the order of my client."
Referral Fees
"… It was my view that working on the basis of a 0% success fee or no success fee … would maximise the client's chances of recovering the premium in full. That has been borne out by what I have been able to achieve in my own practice over the last 2 or 3 years and because of that that meant to me that it was more likely that clients interests were not going to [be] prejudiced under this type of [CFA]; and so that fits, that is a very close fit with my outlook in terms of delivering client's service and what happens to the client, whether I am responsible for him or not. That is the reason why primarily I was prepared to accept the situation of a 0% success rate."
AIL Fee
Robert Cowley
(i) return of TAG premium;
(ii) AIL fee;
(iii) other disbursements;
(iv) loan interest on premium/AIL fee/disbursements;
(v) third party (ie, defendants) costs/disbursements;
(vi) TAG "win-positive deficiency in damages" loading.
"The [BWD] report assumes that the average cost of a claim depends upon the length of the time the claim takes to settle; it sets out the assumed average cost of each component of the claim for different delays to settlement [M/3363] and the assumed proportions of claims which are settled within those periods … these enable me to derive an overall average cost for each component of the claim. Multiplying the average claims cost by the claim frequency gives the estimated "burning cost", or expected claim cost per policy."
"(a) insurance premium against the risk of meeting the premium on losing cases is recoverable;
(b) premium against the risk of meeting own sides disbursements is recoverable, except in respect of the fees paid to AIL;
(c) premium against the risk of meeting the defendant's costs is recoverable;
(d) premium against the risk of meeting the loan interest, whether relating to the loan for premium or the loan if different for disbursements, is not recoverable;
(e) premium against the risk of the [ringfencing] clause operating is not recoverable."
Applying these legal assumptions gives a burning cost of £420 and a discounted burning cost in respect of recoverable items of £388. The burning cost itself depends on the level of the premium charged by TAG since the policy covers both repayment of the loan (ie, the premium itself) and the interest cost of funding the loan at 15.9% APR. Reducing the premium reduces the expected claim cost under the policy and vice versa.
"I have used period 4 as an example. The only difference between the terms of insurance in period 3 (activation months February 2001 to February 2002) and in period 4 is the level of the AIL fee as I have assumed that this element of the premium is not recoverable, this would make no difference to my figure in table RHSC3. The burning costs for periods 3 and 4, associated with the net premium of £327 and the legal assumptions at paragraph 13, are set out in table RHSC4."
"Where explicit assumptions were made around levels of brokerage and commission and expenses that might be implicit within the premium calculation."
"… because the insurance policy pays for the premium when a claim is made, as the premium goes up by £150 it goes up by the amount of the insurance services, so does the claim costs in the policy by an amount and therefore the increase in the premium is … it is a circular sort of thing."
He confirmed that his formula was to get round the circularity.
"The particular feature of this policy is that in the event of a claim the policy pays its own premium, so the return of the premium comprises a substantial component of the claims costs. So. as the premium is increased, so the claim costs under the policy increases and so the premium must again increase to maintain a given level of profitability so there is a circular element. That means that the effect on the ultimate premium of a given increase in insurance service charge, for instance – there is a gearing up effect in terms of the impact and the overall premium charged."
THE LIVE ISSUES
Issue 2 - Is the whole sum payable for insurance by a Claimant under the TAG scheme properly to be regarded as a premium within the meaning of Section 29 Access to Justice Act 1999? If not, how much of the sum payable by the Claimant is such a premium?
Issue 3 - Does the sum payable for insurance under the TAG scheme finance services or provide benefits which are collateral or extraneous to such insurance? (For the avoidance of doubt, this is intended to include the "block rating" issue.) To what extent should the cost of collateral or extraneous services or benefits be recoverable?
Issue 5 - Is the premium-element of the sum claimed a reasonable and proportionate sum (a) for the benefits actually purchased, and (b) for cases of this character?
Issue 6 - Of the "premium" paid by the claimant how much is retained by the underwriter, and how much is paid on to TAG or any other person by way of commission or other payment?
"44.4(1) Where the court is to assess the amount of costs (whether by summary or detailed assessment) it will assess those costs –
(a) on the standard basis … but the court will not … allow costs which have been unreasonably incurred or are unreasonable in amount.
(2) Whether the amount of costs is to be assessed on the standard basis the court will –
(a) only allow costs which are proportionate to the matters in issue; and
(b) resolve any doubt which it may have as to whether costs were reasonably incurred or reasonable and proportionate in amount in favour of the paying party."
"Premium defined. The premium is the consideration required of the assured in return for which the insurer undertakes his obligation under the contract of insurance (Lewis Ltd v Norwich Union Fire Insurance Co [1916] AC 509, 519)."
"87. In my judgment, in this quite exceptional case, it was inevitable that the Master should adopt this [deconstruction] approach in order to identify what should truly be treated as the premium. As this court explained in Callery v Gray (No.2) at paras 11-12:
"It was common ground, and rightly so, that the court, when considering whether to award an insurance premium by way of costs, has to consider whether the premium is reasonable. It was also common ground that, in so far as the court finds that the premium is not reasonable, it can and should reduce it. There was debate as to the appropriate approach to the application of the test of what is reasonable.
It is important in this context to draw a distinction between two separate matters. The first is the nature of the benefits to which the litigant is contractually entitled in exchange for the payment of the premium. This falls to be determined from the terms of the contract under which the premium is paid. Section 29 permits the recovery of a premium where this is payment for insurance against the risk of liability for costs. If payment of a so called premium buys a collateral entitlement to other benefit it is, to say the least, arguable that the premium cannot, to that extent, be recovered under Section 29. Thus the court has to consider the terms of the contract under which the premium is paid to see whether it is simply a contract of insurance against liability for costs or whether it is something other than, or additional to, that."
88. It was not, in my judgment, the intention of Parliament when it enacted Section 29 of the 1999 Act to overload the recoverable premium by adding to the costs customarily embraced by such a premium, the costs which a company like MLSS had to incur if insurers were to accept the risk at all. I would look equally askance at the recoverability, in similar circumstances, of a premium for a fire policy which included the cost the insured had to incur in installing and maintaining a sprinkler system as a condition of his insurance cover, or a premium for a household insurance policy which included the cost of installing and maintaining a burglar alarm.
89. The obligation which the insurer undertook under his contract of insurance with the claimant was to provide an indemnity in the event that the Claimant's compensation claim was dismissed or was discontinued. It was not an obligation to provide the "continuing insurance services" described in the 26 August agreement. The claimant would be provided with the services in any event, whether or not the claim was unsuccessful. If, and in so far as the work done by a claims manager represented an appropriate disbursement for work a solicitor would otherwise have to perform himself, then the cost of that work would be properly recoverable as part of the solicitor's bill."
The Submissions
"44. … I would observe that for the purposes of Section 29, it is the premium as between the claimant and the provider of the policy which is in issue. In my judgment the premium is not necessarily limited to payments paid on inception of cover, but could include any further amounts paid by or on behalf of the insured, pursuant to terms agreed with the insurer. The premium could also include sums paid to the benefit of the insurer. We are told that the insurer has, in effect, out sourced claims administration. The cost of this is borne by Claims Direct on behalf of underwriters. Any part of the sum paid by the insured which is devoted to this purpose may be capable of forming part of the premium."
The 2000 Year (November 1999 to January 2001)
Deductions for irrecoverable items
i. ring fencing;
ii. nsurance of the cost of funding the premium;
iii. insurance of the claimant's inability to recover the cost of AIL's services, if this is held to be a referral fee.
Ring Fencing
Insurance of the Cost of Funding the Premium and, Insurance of the Claimants' Inability to Recover the Cost of AIL's Services
"[Presenting] such figures requiring non expert analysis, ie by persons who are not accountants, is misconceived as a means of assisting the court in a particular case. Assessing costs is not an exact science; neither is accountancy. Treating the latter as if it were so that the results of an accountancy exercise can be used as a basis for the former, seems to me to achieve the worst of both worlds. The [Costs Judges] general knowledge and experience of local conditions and circumstances remains the only firm basis for reliable and consistent [assessment]."
Add Backs
Additional Premium
Commission
Insurance Services
i. arranging for the completion of the TAG application form;
ii. arranging for the completion of the credit agreement form;
iii. collating and forwarding the application form and supporting documents to TAG for onward transmission to the panel solicitor;
vi. monitoring the conduct of the panel solicitor and reporting on that to LPL and/or funders; and
v. providing and maintaining relevant financial information to LPL and/or funders.
vi. Attending to a review by a suitably qualified costs draftsman of the appointed representatives' disbursements and the bill of costs of the opponent's representatives in cases where there is a claim under the insurance.
"In my judgment it is clear that the Master attached too much weight to the figures quoted in the prospectus about which Mr Doona was quite rigorously cross examined. The difference between the minimum fee of £395 which a panel solicitor had to pay a claims manager and the sum of £425 quoted in the prospectus as a direct cost suggests a net outlay of £30 by MLSS on each claim, but I do not consider this figure casts any particularly useful light on anything the Master had to decide. It is clear that MLSS incurred significant expense in performing the "insurance services" required of them under the 26 August agreement. The central issue under question 2 is whether the Master was entitled to lift the veil and to be influenced by what was actually being provided in return for the premium allocation paid to MLSS …"
2001 Lloyds
deductions for irrecoverable items
Add Backs
Additional Premium
Commissions
Insurance Services
2001 NIG
Deductions for irrecoverable items
Add Backs
Additional Premium
Commissions
Insurance Services
Policy Year |
Payable by Claimant (including (IPT) |
Claimants' Case if Insurance Services Worth £100 |
Claimants' Case if Insurance Services Worth £30 |
Defendants' Case |
Mr Cowley's Cross Check (see below) |
2000 Lloyds |
840 | 515 | 441 | 330 | 488 |
2001 Lloyds |
997.50 | 605 | 532 | 441 | 480 |
2001 NIG |
997.50 | 575 | 502 | 403 | 424 |
The Cross Check (Issue 5)
"In deciding whether the costs of insurance cover is reasonable, relevant factors to be taken into account include:
(1) where the insurance cover is not purchased in support of a conditional fee agreement with a success fee, how its cost compares with the likely costs of funding the case with a conditional fee agreement with a success fee and supporting insurance cover;"
2002 and 2003 years
Conclusions
Issue 2 - Is the whole sum payable for insurance by a Claimant under the TAG scheme properly to be regarded as a premium within the meaning of Section 29 Access to Justice Act 1999? If not, how much of the sum payable by the Claimant is such a premium?
Issue 3 - Does the sum payable for insurance under the TAG scheme finance services or provide benefits which are collateral or extraneous to such insurance? (For the avoidance of doubt, this is intended to include the "block rating" issue.) To what extent should the cost of collateral or extraneous services or benefits be recoverable?
Issue 5 - Is the premium-element of the sum claimed a reasonable and proportionate sum (a) for the benefits actually purchased, and (b) for cases of this character?
Issue 6 - Of the "premium" paid by the claimant how much is retained by the underwriter, and how much is paid on to TAG or any other person by way of commission or other payment?
Issue 10 - Are all or part of the following referral fees: (i) the payment of £310 plus VAT to AIL; (ii) the payment of £385 to Mobile Doctors Ltd; (iii) the payment to Rowe & Cohen of a vetting fee.
Issue 11 - If so does the solicitors agreement to pay them breach the Introduction and Referral Code?
Issue 13 – Are the payments identified at [10] irrecoverable (in whole or in part) for any other reason?
Referral Fees (issues 10 & 11)
"(3) Solicitors must not reward introducers by the payment of commission or otherwise …"
"I understand and agree that …
(9) [AIL] will investigate and obtain further information surrounding the circumstances of my accident. I understand that the costs of the investigation will form part of my claim."
"[AIL] will investigate and obtain further information surrounding the circumstances of my accident. I understand the cost of the investigation will form part of my claim."
"If TAG accepts this claim I further understand and agree that … the loan includes the premium investigation fee of £364.25 (inclusive of VAT) interest and any other expenses incurred by my solicitor on my behalf."
Other Reasons (issue 13)
"investigate the case on behalf of the client/appointed representative"
and later that:
"the client's indebtedness to AIL will automatically be paid by the funders (and debited to the client's loan) following acceptance of the case by the appointed representative."
"5. The appointed representative agrees (and undertakes hereunder), for the benefit of the claimants for whom the appointed representative has agreed to act, to recover the investigation fee …"
"… for the client to fund disbursements … properly incurred by the panel solicitor on behalf of the client …"
"81 Other questions arise when one considers the nature of the MLSS invoice. In my judgment the invoice, which is sent as soon as the panel solicitor has accepted the case, can refer only to future work, ie to work done after the solicitor has been retained. In order for a disbursement to be recoverable it must have been made by the solicitor on the client's behalf or be an out of pocket expense of the client personally (see Re: Remnant [1849] 11 Beav 603 at 611; Re: Buckwell & Berkeley [1902] 2 Ch 596 CA and Brown v Barber [1913] 2 KB 533). In the Claims Direct Test Cases no client has ever been called upon to pay the MLSS fee. Indeed the client does not even know of the existence of MLSS.
82. Solicitors can only pay disbursements as agent for a client if they are authorised to do so by the client. Prior to the acceptance of the case by the solicitor there is no client and therefore no authority. It is quite clear therefore that any recoverable element of the £395 plus VAT could only be in respect of work undertaken by the claims manager after the case has been accepted. It may well be that, once the case has been accepted, the claims manager carries out work, on the instructions of the solicitor, for which it is appropriate to make a charge, the cost of which may be recoverable as a disbursement. On the evidence before me, applying the above principles, none of the cases contain details of work which would bring the amount properly chargeable near to the figure of £395 plus VAT."
CONCLUSIONS
Issue 10 - Are all or part of the following referral fees: (i) the payment of £310 plus VAT to AIL; (ii) the payment of £385 to Mobile Doctors Ltd; (iii) the payment to Rowe & Cohen of a vetting fee.
"2.1 … the bank shall offer to provide credit transactions to clients of the company … finance provided by the bank … may only be used by the client to pay for:
…
2.1.2 disbursements due and payable by the client to their appointed representative."
Issue 11 - If so does the solicitors agreement to pay them breach the introduction and referral code?
Issue 13 – Are the payments identified at [10] irrecoverable (in whole or in part) for any other reason?
Issue 16 – Does the TAG panel solicitors obligation to reimburse any disbursements which are not recovered from the Defendant breach the indemnity principle? If so what are the consequences?
Issue 17 – In some versions of the CFA, it is explicitly provided that the panel solicitor will, in successful cases, limit his fees to those recovered from the paying party. Does this breach the indemnity principle? If so what are the consequences?
OM2, 3 and 4 (Issue 16)
"I confirm that the client understands this disbursement will be added to their loan for the premium (and any other disbursements already incurred if applicable).
I understand that in the event of a successful case if this disbursement is not recovered it will be repaid to the client by ourselves."
"What happens if you win.
If you win:
- ? You are then liable to pay all our basic charges, our disbursements and success fee …
- ? Normally you will be entitled to recover part or all of our basic charges, our disbursements and success fee from your opponent.
- ? If you and your opponent cannot agree the amount, the court will decide how much you can recover. If the amount agreed or allowed by the court does not cover all our basis charges and our disbursements then you pay the difference …"
"(2) For the purpose of this Section and Section 58A-
(a) a conditional fee agreement is an agreement with a person providing advocacy or litigation services which provides for his fees and expenses, or any part of them, to be payable only in specified circumstances …"
"(3) In Parts 44 to 48 costs are recoverable where –
(a) advocacy or litigation services are provided to a party under a conditional fee agreement (within the meaning of Section 58 of the Courts and Legal Services Act 1990); and
(b) the client is only liable to pay his legal representatives fees and expenses to the extent that those costs are –
(i) received from another person; or
(ii) ordered or agreed to be paid to the client."
OM1 (Issue 17)
"(d) Paying us
If you win the case, you are liable to pay own disbursements, basic costs and a success fee. You may be able to recover our disbursements, basic costs and our success fee from your opponent. If you are not able to recover these from your opponent you may be able to recover your disbursement under the policy … please note that if you are unable to recover the basic costs and any success fee from your opponent we will not seek to recover these from you."
CONCLUSIONS
Issue 16 – Does the TAG panel solicitors obligation to reimburse any disbursements which are not recovered from the Defendant breach the indemnity principle? If so what are the consequences?
Issue 17 – In some versions of the CFA, it is explicitly provided that the panel solicitor will, in successful cases, limit his fees to those recovered from the paying party. Does this breach the indemnity principle? If so what are the consequences?
PTH\44\Accident Group Tranche 2