Download - the Motor Insurers' Bureau

MIDIS enquiry case no________MIB Ref:___________________Your ref____________________MOTOR INSURERS’ BUREAU(A company Limited By Guarantee, Registered in England - No. 412787)Linford Wood House, 6-12 Capital Drive, Linford Wood, Milton Keynes, MK14 6XTCOMPENSATION OF VICTIMS OF UNINSURED DRIVERS(Agreement dated 13th August 1999)ImportantFree Legal Expense CoverMIB has arranged access to free Legal Expenses Insurance cover to assist the victims ofuninsured drivers. The cover is provided by the FirstAssist Group Ltd, at no cost to theclaimant. Completion of this form will place the claimant in contact with FirstAssist unless theclaimant requests otherwise.The Legal Expenses Insurance is provided by FirstAssist Group LtdRegistered in England No 4617115Registered Office: Marshall’s Court, Marshall’s Road, Sutton, Surrey SMI 4DUPlease tick this box if you have requested the free legal expense insuranceIt is essential that you read the Data Protection information overleaf and the“Notes for the Assistance of Claimants” before completing this form

Data Protection and ConsentData Protection.For the purposes of the Data Protection Act 1998, its amendments and statutory instruments, theData Controller in relation to any personal data you supply is the Motor Insurers’ Bureau (MIB).Information Use.Information you supply may be used for the purposes of claim(s) administration by the MIB, itsmember insurers and agents. Your information may also be used for crime prevention, research andstatistical purposes.Non-sensitive personal information such as addresses, which is provided to us about you, and othersnamed in your claim, may be used by us and other companies, if you or others named in your claimapply for other financial services including credit and insurance. This information may also be used fordebt tracing and the prevention of crimes like fraud and money laundering.The MIB and insurers pass information to the Claims and Underwriting Exchange Register (CUE), runby Insurance Database Services Ltd (IDS Ltd) and the Motor Insurance Anti-Fraud and TheftRegister, run by the Association of British Insurers (ABI). The MIB and the Motor Insurers’ InformationCentre (MIIC) may search the Motor Insurance Database (MID) to ascertain relevant policyinformation. Furthermore, in assessing any claims made, the MIB or its agents may undertake checksagainst publicly available information (such as electoral roll, county court judgments, bankruptcyorders or repossessions) and CUE Registers. Information may also be shared with insurers eitherdirectly or via those acting for the insurer (such as loss adjusters or investigators).Consent for Sensitive Data UseIn order to assess or administer claims, the MIB may need to collect data which the Data ProtectionAct defines as sensitive (such as medical history or criminal convictions). By proceeding with thisapplication you will signify your consent to such information being processed by the MIB, its memberinsurers or its agents, as outlined above.Data Subject’s right to informationIn the case of personal data, on payment of the appropriate fee, you have, with limited exceptions, theright to access and if necessary rectify information held about you. Again, by payment of theappropriate fee, persons with a valid claim in respect of a road traffic accident (including citizens ofother countries) may also obtain relevant information which is held on the MID. You can find out moreabout this from your insurer, or at www.miic.org.ukMIB 184(9.8.00)

NOTES FOR THE ASSISTANCE OF CLAIMANTSPlease detach and retain for future referenceThe following notes appear in question and answer form and deal with the questions that are mostcommonly asked. These notes do not replace or modify the Agreement and claimants are advisedthat it is essential that they read the Agreement carefully.More information about MIB and the Agreements is available from MIB’s website at www.mib.org.uk orthat of the Department for Transport (DfT) at www.dft.gov.uk.Q What is the Motor Insurers’ Bureau?A The Motor Insurers’ Bureau (MIB) is an independent organisation, authorised by the Department forTransport to compensate the victims of negligent uninsured motorists.Q Where does the money come from?A Honest motorists automatically contribute part of their premiums to meet claims paid by MIB each year.Q What is the “Uninsured Drivers’ Agreement”?AThis Agreement between the Secretary of State for Transport and the MIB sets out the circumstances in which claims willbe paid. Whilst the Agreement requires that a judgment be obtained in the Civil Court against the uninsured motorist, theMIB will wherever possible try to reach a settlement by agreement as opposed to insisting on a judgment being obtained.Copies of the Agreements can be obtained from the Stationery Office or large bookstores for a small fee, or downloadedfrom MIB’s website or those of the Stationery Office or the Department for Transport.Q When should I claim on the MIB?A Before approaching the MIB you should have made reasonable enquiries to try and discover if themotorist who has caused the accident is uninsured. Those enquiries will include but not necessarilybe limited to:a Contacting the motorist.b If you have the registration number of the offending vehicle, asking your own insurer oryour solicitor to search the Motor Insurance Database for insurance information. Solicitorshave a special facility to do this via a website at www.midis.org.uk (where a MIDIS search ismade, please enter the enquiry case number on the front of this form).c Obtaining details of the registered keeper from DVLA at Swansea and contacting him.d Making a formal request to the police. Section 154 of the Road Traffic Act 1988 makes it anoffence for a person against whom a claim is made to withhold details of insurers.Q How do I obtain any legal advice that I may need?A If you have legal expense insurance (often supplied with other insurance policies or financialproducts, or even under credit card agreements) your legal expense insurer will direct you to asolicitor.Alternatively, advice can be obtained from a Citizen’s Advice Bureau or a solicitor, who can generallyoffer a variety of arrangements for funding legal action.If you have no legal expense insurance you can take advantage of a free legal expense schemeset up by the MIB with the FirstAssist Group Ltd, from its office at:Bowling MillDean Clough Office ParkHalifaxHX3 5JATel 08457 125357 (calls charged at local rate)The scheme can provide you with cover for:a your opponent’s/MIB’s costs and the costs of your solicitor up to a total figure of£100,000

Free choice of solicitor, save in limited circumstances as can be advised by FirstAssistc Legal disputes in England Scotland and WalesAll you have to do is, when signing this form, complete the signature clause to request contactfrom FirstAssist. The MIB will forward your request to FirstAssist immediately and you will then becontacted by telephone, the scheme fully explained and put in touch with a solicitor of your choice.If you are not on the phone, FirstAssist will write and invite you to call them.The MIB has no involvement in any decisions relating to your application to FirstAssist,who will at all times act completely independently.QAQAQAQAQAQAQAWhat if a solicitor is already acting for me?You should still be able to take advantage of the free legal expense scheme. Just ask your solicitorto contact FirstAssist so they can discuss whether your case can be dealt with under the scheme.If I decide not to accept the offer of free legal expense insurance, will that prevent me fromrecovering my legal costs?Not necessarily, the Uninsured Drivers’ Agreement requires the MIB to meet a civil court judgmentincluding any order for costs. However, some pre-existing funding arrangements, such asConditional Fee Agreements, could be affected.What will happen if after taking up the offer of the free legal expense insurance an insurer isidentified?The cover will continue to apply for your claim against the negligent motorist, unless it is clear thatthe original application to the MIB was frivolous, or solely intended to take advantage of the freecover.What information and/or documents should I provide when returning this form?Copies of all correspondence with the motorist, the owner of the vehicle, the motorist’s employer oranyone acting on their behalf, including any insurer regardless of whether the insurer denies issuingcover.Your claim will have to be proved, so much time can be saved by enclosing documents supportingyour claim. For example, estimates for any repair required, or if you have lost earnings, a letter fromyour employers confirming exactly what has been lostWhat will happen after I return this form?The MIB will confirm receipt and explain what action is being taken, which action will varydepending on the facts and the information you have been able to supply. However, first we musttry to contact the uninsured motorist to obtain his account of the accident as well as his permissionto intervene, as he has a legal right to conduct his own affairs and defend any claim made againsthim.What if the uninsured motorist does not cooperate or cannot be traced?If, after our best efforts, the uninsured motorist does not co-operate, we will tell you what optionsappear to be available to progress your claim, including legal action. If necessary, MIB can be madea party to a legal action (even though MIB is not responsible for the accident) as set out in the“Notes” at the back of the Uninsured Drivers’ Agreement.If the uninsured motorist cannot be traced, then so long as it can be established, on the balance ofprobabilities, that he was correctly identified at the scene of the accident then MIB will consider yourclaim under the Uninsured Drivers’ Agreement.What if the motorist cannot be identified?If the accident has occurred on or after 14th February 2003 you can submit a claim under theUntraced Drivers’ Agreement 2003, although compensation for damage to property will be limited tocases where the vehicle can be identified. For accidents prior to 14th February 2003 you can submita claim for injury (but not damage to property) under the Untraced Drivers’ you can submit a claimfor injury (but not damage to property) under the Untraced Drivers' Agreement.

QAQAHow long will my claim take?This is difficult to predict as many different factors are involved:• If your claim involves contested liability, conflicting evidence, or serious injury the police reportmay have to be obtained, which can take some time, especially if it is delayed by criminalprosecutions.• If your claim is limited to property damage or minor injury it should be resolved relatively quickly.• Injury claims can take longer if it is difficult for your doctors to agree on the effects. You mayalso be advised by your solicitor to wait until you have recovered fully, before agreeing anycompensation.• The MIB will make every effort to reach a decision on responsibility for the accident within threemonths and to keep you informed. Where a long delay seems likely, the MIB will consider aninterim payment.Will my claim be paid in full?Responsibility for the accident has to be agreed, or decided by a Court, on the evidence and yourclaim may be reduced by a proportion, or even rejected, if the evidence is that you were partly orwholly responsible.Where the MIB accepts a claim for payment, property damage claims (which include claimsfor losses arising from the damage to property) will have an excess of £300 deducted. Injuryclaims including loss of earnings are subject to a legal obligation on MIB to refund to theDepartment of Social Security certain benefits that you have been paid as a result of the accidentand to deduct that amount from your claim for loss of earnings. You are advised by the DSS as tothe amount MIB has to pay and if you disagree, you have a right of appeal to the DSS.COMPLAINTS PROCEDUREQAWhat can I do if I think I have grounds for complaint?The MIB deals with all claims in accordance with service standards, and provides a reasonedresponse. Nonetheless, if you are dissatisfied, you should:(a) Contact your solicitor or representative and ask him to resolve the problem by telephone.(b) If you are not represented, telephone the person handling the claim. If you are not satisfied,write to the Technical Director, The MIB, Linford Wood House, 6-12 Capital Drive, Linford Wood,Milton Keynes, MK14 6XT, marking the envelope “Private and Confidential”.(c) The Chief Executive of the MIB is always prepared to review decisions on complaints. Shouldyou wish to, please write to him at the same address.(d) If your problem involves a matter of principle, which may be of public interest and you considerthat it has not been dealt with adequately under the above procedure, you can write to theMinister for Roads and Traffic at the Department for Transport, Great Minster House, 76Marsham Street, London, SWIP 4DR.The Minister will normally require to be satisfied that the above procedure has been followedbefore he will intervene.

CONDITIONAL ASSIGNMENTThis Conditional Assignment is made the ………..…..…day of ……………… between ………….……………………….…………………………………………….. of ………………………….………………….………………………………………………………………………………….………(hereinafter referred to as ‘the Claimant’) andthe Motor Insurers’ Bureau, whose registered office is at Linford Wood House, 6/12 Capital Drive, Linford Wood, MiltonKeynes, MK14 6XT (hereinafter referred to as MIB).WHEREAS(a) an accident occurred on about …………………………….. at or near ………..…………………………………………………………………………………………..… (hereinafter referred to as “the accident”).(b) the Claimant establishes that he or she has suffered damage to property and/or bodily injury caused by or arising out ofthe accident (hereinafter referred to as “the damage to property and/or bodily injury”), brief details of which are set out insection C to F of the application form.(c)MIB’s investigations establish that:(i)(ii)(iii)(iv)the person(s) named in the section G of the application form (hereinafter referred to as the Defendant) is liable tothe Claimant in respect of the damage to property and/or bodily injury,the liability is a relevant liability as defined in paragraph 6 below,there is no insurer (or no insurer whose identity can be ascertained) who is obliged to indemnify the Claimant inrespect of this liabilityunder the provisions of the Motor Insurers’ Bureau (Compensation of Victims of Uninsured Drivers) Agreement1999 (hereinafter referred to as “the Agreement”) MIB will become liable to satisfy a judgment obtained against theDefendantIT IS AGREED AS FOLLOWS:PAYMENT1. The Claimant will accept a payment to be agreed or ordered (after deduction of the excess of £300 applicable to claimsfor damage to property). Save as provided in paragraph 5 hereof this payment will be made and accepted in full and finalsatisfaction of all claims whatsoever which the Claimant may have or acquire against MIB in respect of the damage toproperty and/or bodily injury caused by or arising out of the accident and any obligation to satisfy any judgment obtainedin respect thereof.Insofar as the payment received is an interim payment on account, this assignment shall only operate as fully effectiveeither once the full and final settlement/award is agreed/ordered or the claim is not pursued further such that the interimpayment stands as the final award.ASSIGNMENT2.1 Subject to receipt of the aforementioned payment in full and final settlement, this assignment ceases to be conditionaland becomes fully effective such that the Claimant assigns to the MIB absolutely, all rights of action (other than incontract) of the Claimant against the Defendant, or any other person who may be discovered to have a liability, in respectof the damage to property and/or bodily injury caused by or arising out of the accident.2.2 Accordingly the MIB shall be free, but not obliged to make claims and take legal proceedings in its own name against theDefendant or other persons referred to in 2.1 above. The costs of such claims or legal proceedings shall be borne by theMIB.The following provisions operate only after settlement is made in full and final settlement and the assignment is fullyeffective

CONSENT TO MAKE CLAIMS AND TAKE PROCEEDINGS IN THE NAME OF THE CLAIMANT3.1 Additionally the Claimant irrevocably agrees to permit the MIB to make claims and take or continue legal proceedings inthe name of the Claimant. Subject to paragraph 5 hereof the benefit of such proceedings shall be the property of the MIBabsolutely.3.2 The costs of such claims and legal proceedings shall be borne by the MIB and the MIB agrees to indemnify the Claimantagainst any and all orders for costs which may be made against the Claimant.INFORMATION AND ASSISTANCE4.1 The Claimant undertakes to give the MIB or its agents all information and assistance in his/her power, to enable the MIBto make any claim or prosecute any proceedings as referred to in paragraphs 2 and 3 above.4.2 Without prejudice to the generality of the foregoing the Claimant undertakes to make available to the MIB or its agents allwitness statements, expert reports and other evidence in whatever form in his/her possession or power or in thepossession or power of his/her solicitors or other agents (upon the MIB undertaking to pay the reasonable costs of suchsolicitors or other agents in supplying such information) which may enable or facilitate the MIB to make any such claim orto prosecute any such proceedings.4.3 The Claimant further undertakes, if so requested by the MIB or its agents to provide a witness statement setting out anyrelevant evidence, submit for medical examination, co-operate in the preparation of any medical or other expert report,and give evidence in legal proceedings (upon the MIB undertaking to pay the reasonable expenses incurred in so doing).4.4. If without reasonable excuse the Claimant shall fail to fulfil the obligations set out in subparagraphs 4.1, 4.2 and 4.3hereof, the sum referred to in paragraph 1 hereof (including any proceeds thereof) shall revert to the MIB and theClaimant will repay that sum to the MIB.4.5 If any dispute or difference shall arise between the Claimant and the MIB as to whether the Claimant has fulfilled theobligations set out in paragraphs 4.1, 4.2 or 4.3 hereof or as to whether the Claimant has failed to do so withoutreasonable excuse such dispute shall be referred to the Secretary of State as set out in Clause 19 of the Agreement.RECOVERIES5. If the MIB is successful in recovering any sum or sums from the Uninsured Driver and/or other persons referred to inParagraph 2.1 or 3.1 above then if and insofar as the same exceeds the sum paid to the Claimant (after deducting allcosts and expenses incurred by the MIB or its agents in effecting such recovery) the MIB will pay to the Claimant a sumequal to the balance of such excess up to but not exceeding the applicable excess referred to in paragraph 1 above.DEFINITIONS6. In this Assignment and Agreement—“contract of insurance” means a policy of insurance or a security;“insurer” includes the giver of a security;“relevant liability” means a liability in respect of which a policy of insurance must insure a person in order to comply withPart VI of the Road Traffic Act 1988;“accident” includes two or more causally related accidents.Signed ………………………………………… Claimant

A. DETAILS OF CLAIMANT Accident Ref:Title: Mr/Mrs/Miss: First Names: SurnameAddress:Town:County:Postcode:Status: (delete those in applicable)Vehicle owner/Driver/Passenger/Pedestrian/Cyclist Occupation: VAT registered? Y/N VAT Reg No:Date of Birth / / Telephone No. Home: Business:B. DETAILS OF DRIVER OF YOUR VEHICLE AT TIME OF ACCIDENT (or person in charge of vehicle)Title: Mr/Mrs/Miss: First Names: Surname:Address:Town:County:Postcode:Occupation: Date of Birth: Telephone No: VAT registered?: VAT Reg. No:C. DETAILS OF YOUR VEHICLE AND INSURERS/ / Home: Business: Y/NMake:Model:Est/Value: Price Paid & Date Year of Registration:Registration Number:Is the vehicles owned by you? Y/NIf no, who is the owner?If vehicle insured please supply identity of:Insurers (not Broker):Address:Address:Details of damage to your vehicle sustained in this accident (pleaseattach estimates from 2 repairers unless undrivable, where 1 is adequate).Policy Cover: Comp/TPF&T/TPIs claim being made on your insurer? Y/NPolicy No./Insurers reference:Address where vehicle can be inspected and time:If any other insurers, for example Legal Expense Insurers are involved in your claim,or any other organisation is responsible for your legal expenses please enter:Insurer/Organisation:Address:Is the vehicle in use? Y/NShow area of damagePolicy/Contract No:Have you hired a vehicle? Y/NIf yes, Make:Model:If you have hired a vehicle, please enclose proof of any payments that you havemade.Have you been provided with a vehicle free of charge? Y/N*If yes, were you advised at any stage by the provider, or anyone acting for the provider, that you would have to meet any hire charges in the future? Y/N

C. (Continued)Have you taken out any insurance, or made any other arrangement for any hire charges to be paid, in the event that they cannot be recovered? Y/N*If yes, please explain the arrangements entered into and provide the name and address of the insurer together with their policy number:Have you obtained a replacement? Y/N*If yes, Make:Model:D. DAMAGE TO YOUR PROPERTY (if not a motor vehicle)Type of property:Address of Location:Town: County: Postcode:Description of Damage:Estimate of cost of repair (please attach two estimates):Is damage covered by insurance? Y/NInsurers Name:If yes complete section below:Policy No./Reference to Insurers:Address:E. PERSONAL INJURY OF CLAIMANTName of Insured Person : Title (Mr/Mrs/Miss) First Name: Surname:Hospital:Address:Name and address of GP:TelephoneTown:Postcode:Brief details of injury:Name and Address of Employer:Are you claiming any benefit of losses from any other organisation:If yes, please set out the nature of the benefits claimed and the name and address and reference numbers of those against whom you are claiming:Nature of benefit or loss:Reference No:Name and address:Period of work: From: To: National Insurance No:Driver/Passenger/Pedestrian/Pedal Cyclist* (delete where necessary)Reg. No. of vehicle in which traveling:

F. PERSONAL INJURY OF SECOND CLAIMANTName of Insured Person: Title (Mr/Mrs/Miss) First Name: Surname:Hospital:Telephone No:Address:Name and address of GP:Town:Postcode:Brief details of injury:Name & Address of Employer:Are you claiming any benefit or losses from any other organisation other than the MIB? Y/NIf yes, please set out the nature of the benefits claimed and the name and address and reference numbers of those against whom you are claiming:Nature of benefit or loss:Reference No:Name and address:Period off work: From: To: National Insurance No:Driver/passenger/Pedestrian/Pedal Cyclist*Reg.No. of vehicle in which traveling:G. DETAILS OF UNINSURED VEHICLE INVOLVEDReg No: Colour: Name of Driver: Title: Mr/Mrs/Miss First Names: Surname:Make & Model:Description of Driver:Address:County:Town:Post Code:Indicate Age of Driver: Telephone No. Home: Business:Under 15/Under 20/21-30/31-40/41-50/51-60/6 1-70/Over 70Name of Owner: Title: Mr/Mrs/MissFirst names:Surname:Area of Impact:Address:Town:County:Telephone No. Home:Postcode:Business:H. ENQUIRIES WITH UNINSURED MOTORISTPlease specify what enquiries you have made to identify the insurers of the uninsured motorist:Letter/phone call to motorist YES/NO — If yes, please enclose a copy of the correspondence or the event of a phone call details of any reply:Enquiry with the DVLA YES/NO - If yes, please enclose DVLA. response.Enquiry with vehicle owner YES/NO – If yes, please enclose a copy of the response.Enquiry with possible insurers YES/NO — If yes, please enclose copies of the correspondence.Name & Address of any Insurers/Brokers mentioned:Town: County: Postcode: Policy/Reference No:

I. OTHER VEHICLES INVOLVEDReg No:Make & Model:Name of Driver:Name of Owner:Title (Mr/Mrs/Miss) First Name: Surname: Title (Mr/Mrs/Miss) First Name: Surname:Address:Town:Address:County: Postcode: County: Postcode:Tel No. Home: Business: Tel No. Home: BusinessArea of Impact:Town:Town:Name & Address of Insurers/Brokers:Postcode:County:Policy/Reference No:J. DETAILS OF ACCIDENTLocation:StreetTownDate and timeof accidentCountyWas the accident reported to the Police?: Y/NReference and name of Reporting Officer:Town: County: Postcode:K. DESCRIPTION OF ACCIDENTL. RESPONSIBILITY (who do you consider to blame and why?)

M. SKETCH OF SCENE (please indicate direction of vehicle(s), road markings, etc)N. WITNESSESTitle (Mr/Mrs/Miss) First Name: Surname: Title (Mr/Mrs/Miss) First Name: Surname:Address:AddressTown:Town:County: Postcode: County: Postcode:Tel No. Home: Business: Tel No. Home: Business:Title (Mr/Mrs/Miss) First Name: Surname: Title (Mr/Mrs/Miss) First Name: Surname:Address:Address:Town:Town:County: Postcode: County: Postcode:Tel No. Home: Business: Tel No. Home: Business:0. DECLARATIONI declare that the replies and information above are true and so as to satisfy the requirements of Clause 13 of theAgreement I authorise Motor Insurers’ Bureau to make any application on my behalf in accordance with theprovisions of Section 154 of the Road Traffic Act 1988.I require the free legal expense insurance and wish the MIB to forward this form to FirstAssist Group Ltd*Signed:___________________________________ Dated:_______________________*Please delete this sentence if the insurance is not requiredFOR OFFICE USE ONLYHandler:_________________________________________ Diary Date: ______________________________________Reserve: PI PD Class DVLA Check Reg: ________________________________Claimant 1: ____________ ____________ ___________ MIAFTR? Y/NClaimant 2: ____________ ____________ ___________ Other: __________________________________________Claimant 3: ____________ ____________ ___________NB: If there is insufficient space on this form, please attach an additional sheet.