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Why has my claim been rejected?
Claims received outside of the one calendar month claims period will be rejected. The school can appeal against this by writing to the Mutual Fund Board. Please email your appeal to the Mutual Fund Team. They will ensure that the your appeal is presented to the Board for consideration.
Your letter/email should lay out your basis of appeal and any extenuating circumstances which may have led to the late submission of the claim.
The Board meets at 3 times a year and appeals will be heard at the next meeting.
How do I find out if my claim was successful?
Once a claim form has been submitted online it is sent to the Mutual Fund Team mailbox in the form of an email. This email is then processed within 5 workings days into the Mutual Fund database. If a field has been completed incorrectly then the claim form will be rejected by the database, and the Mutual Fund team will contact the school via email or phone to ascertain the correct data. The claim will then be processed and either accepted, accepted with an adjustment or rejected. This will create a PDF file notification which will be sent via AnyComms within the Finance Information Community to the school regarding the claim. Should the claim be accepted or accepted with an adjustment the PDF file will state the amount to be paid and the reason for the adjustment. If the claim has been rejected, the PDF file will state the reason for its rejection. All Mutual Fund payments will then be paid at the end of the month and another PDF file will be sent to the school via the AnyComms System which will also list all school adjustments and payments.
When can I claim for staff absence?
All claims for long term sickness must be made within the claims period and for all claims, schools are required to complete the online claim form. This can be accessed on the main Schools Mutual Fund webpage.
What are we entitled to claim?
Depending on the level of cover purchased and the type of school you will be subject to a waiting period: a number of days at the beginning of the absence for which you cannot claim – in effect an excess. This only affects the first claim period of any absence. Thereafter reimbursement is made at the relevant rates for teachers and support staff.
How much does it cost?
The cost of membership is based on the number of full-time equivalent staff employed at the school and the level of cover purchased.
Premiums for teachers and support staff are set and reimbursed at different rates.
A calculator for yearly premiums can be found at the top of the page under the Mutual Fund heading.
Information regarding the levels of cover and reimbursement rates can be found on the Mutual Fund Website.
How do I claim for a phased return?
For a phased return claim to be paid an independent report from IMASS (Industrial Medical & Safety Services Ltd) will be required, confirming that a phased return is necessary. Additional details such as the length, start date, end date, type (physical or mental) and total number of days absent will be required when completing the claim form linked on the Mutual Fund Webpage.
What absences are covered by the scheme?
- Any long-term sickness covered by certificate (including stress)
- Suspension from duties (including gardening leave)
- Full cost of staff transferring to half-pay for 6 months absence
- Adoption Support Leave
- Paternity Leave
- Phased Return (starting 1st April 2012)
- Pre existing conditions *
- Trade union activities
- Jury Service
- Reserve Forces activities
- Maternity leave
- Compassionate leave
* Applies only to schools joining the scheme for the first time or rejoining the scheme after a break of a year or more.
Which members of staff are covered on the scheme?
Teachers, Teaching Assistants, Admin, Residential, Technician/Resource, Premises, Catering, Meal Time Assistants.
Premises, catering and meal time assistants are now covered depending on cover option chosen (From 1st April 2013)
How does my school leave the scheme?
All schools currently in the Mutual Fund will automatically be assumed to be scheme members for the following year, unless the school completes the following form by 31st March opting out online form.
How does my school join the scheme?
Those schools wishing to join the Mutual Fund scheme need to apply on an annual basis. Reminders and links to the online form will be sent out towards the end of each financial year via the blog, Need to Know and by email. New applications should be returned by 31st March each year.
Is membership compulsory?
Membership is not compulsory. However, those schools choosing not to join the scheme need to consider entering into an arrangement with an external provider or risk meeting the cost of cover from within their delegated budgets.
Note: Not all external insurers cover all medical conditions.
Can a reduced claim be submitted for a member of staff who is self-isolating and able to complete elements of their role remotely?
January 2021 – A claim can now be submitted in this scenario as Schools Mutual Fund claim form now provides the opportunity to create a reduced claim, in response to the Covid-19 national lockdown. This added flexibility will allow schools to submit a Mutual Fund claim at a reduced percentage, where an employee has been able to complete a proportion of their role remotely, provided they have not been signed off by a GP.
This would be ideal in the following example scenario:If a teacher completed equivalent to 20% of their contracted hours remotely during a month, then a Mutual Fund claim can be submitted for the 80% of hours that weren’t worked during the month, provided that cover was required for the post-holder, as per standard Mutual Fund Terms and Conditions. To make the example claim, you would need to enter ’80’ for question 3A in the claim form.
Question 3A has been added to the Mutual Fund Claim form to request the claim percentage. Note that this is a mandatory field, so you must always add a claim percentage, even if you are completing a full claim at 100%
Please note: Claims relating to this new flexibility are from January 2021 until further notice, no retrospective claims are permitted. As the Covid-19 pandemic evolves, this guidance will remain under review and may be removed. If this is the case, a blog post will be released to members to inform them.
A Teacher is currently self-isolating and is unable to complete all of their duties as a teacher from home, can a claim be entered for this situation?
A Mutual Fund claim can be entered for the absence, provided that there would be a requirement for a member of staff to cover the absent teacher.
Where there is no requirement to cover the absent teacher, for example, where a partial or full closure of the school is in effect, then the claim would be considered invalid as no replacement cover is necessary.
Where the teacher is able to complete a proportion of their hours remotely, a claim can now be submitted as of January 2021 until further notice for the proportion of hours NOT worked, that required replacement cover. This additional flexibility will remain under review and may be removed as the Covid-19 pandemic situation develops. Please see FAQ title: ‘Can a reduced claim be submitted for a member of staff who is self-isolating and able to complete elements of their role remotely?’ for further information.
Can a school become a member of the Mutual Fund or add a membership option during the course of the current financial year?
Yes, the school can join the Schools Mutual Fund or add coverage during the year. The school will be subject to a 7% joining fee if they were not part of the scheme the previous year. In these circumstances, the premium plus joining fee will be pro-rated from the point of joining the scheme.
The claim was submitted late due to school staffing difficulties, with no cover available to send the Mutual Fund claim in prior to the deadline, will the late claim be accepted?
It is recommended that every school have in place cover to make sure that Mutual Fund claims are submitted on time and that late claims submitted due to the lack of support cover within the school, will not be accepted as an exceptional circumstance as to why the claim was submitted late.
A member of staff was absent from work to provide emergency transport/care to a relative, can this be claimed by the Mutual Fund?
A claim will only be accepted if the individual was subject to a qualifying absence reason as stated in the ‘Mutual Fund Benefits’ drop-down on the linked page: Mutual Fund – Support for schools (devon.gov.uk).
The School was not aware that they had automatically enrolled in the Mutual Fund for the new financial year and therefore did not know that they could claim for staff absences, which is why the claim was submitted late.
This is not a valid reason for a late claim to be submitted and will be rejected by the board. As all schools (including academies, free or maintained) currently in the scheme will automatically be enrolled in the Mutual Fund for the following year unless the Mutual Fund is informed otherwise, prior to 31st March. All schools remaining in the Mutual Fund or joining the scheme for the following year will be provided with a premium notification via AnyComms during April. All schools will be given two weeks in which to contact the Mutual Fund team to raise any query relating to their premium. The Mutual Fund premium will then be raised in the middle of May with a further confirmation sent via the Finance Information Community by AnyComms and all claims received for April and May, will then be processed and paid by the end of May.
An individual has been absent from work since XX. It was agreed that the individual will return to work on a 3 week phased return from XX, but on the XX the individual fell ill again with depression linked to the primary ongoing back problem. Can this claim be treated as continuous or will the waiting days be required to be applied again?
With this type of claim if an individual has been absent for a long period of time, the school will need to check with the Payroll Team to check when half pay can be claimed. If the individual has returned to work as a phased return and then falls ill again with a different illness, the date of the half pay entitlement will be delayed and therefore a new claim will need to be submitted to the Mutual Fund that will include the waiting days.
My IMASS referral report states that an additional supply teacher/teaching assistant is required to work with, and assist the returning teacher throughout the phased return. Can the school claim through the Mutual Fund, the days that the supply teacher and the returning teacher are working together?
If a teacher is returning to work and IMASS (Industrial Medical & Safety Services Ltd) referral report states that the School has to provide supply teacher/teaching assistant cover in order to work with and assist the returning Teacher throughout their Phased Return, then you are able to claim for this through the Mutual Fund. If this occurs, please email the Mutual Fund Team, who will be able to assist you. The Mutual Fund Team will require a timetable of the arrangement to calculate how many days you will be able to claim for.
What if my Phased Return is greater than the standard 6 week phased return claim limit?
If you are claiming for a phased return for an individual, an independent report must be received by IMASS (or similar) confirming that a Phased return is necessary for 7 weeks or more. This claim will then be put forward to our Mutual Fund Appeals Board as it is above and beyond normal practice. Submit your claim via the online claims form on the main Mutual Fund webpage: Mutual Fund – Support for schools (devon.gov.uk). You will also need to email the Mutual Fund Team providing details of the absence, why a phased return of greater than 6 weeks is necessary and details of how many days per week for each week the member of staff will be at work for. For example, week 1 the member of staff worked 1 day a week, week 2 the member of staff worked 1.5 days a week and so on. The board meets 3/4 times a year, and your claim will then be heard at the next meeting.
How do you calculate how much I will receive for each claim?
he Education Finance Team uses the following method to calculate Mutual Fund Claims.
Number of days claimed X Pay Factor Rate X Reimbursement rate (£136.68 per day for teachers and £56.10 per day for support staff)
The total number of days that you are claiming will be every working day the school is open in the period you’re claiming for, even if the member of staff is part time and wouldn’t have worked all of the dates that are being claimed. This is because we then multiply the number of days claimed by the member of staff’s Full Time Equivalent
A few examples of claims;
If you are claiming for a whole month’s absence (for example 20 days) for a teacher whose pay factor rate is 0.4 the claim would be worked out as follows.
20 Days X 0.4 pay factor rate X £136.68 Teachers Reimbursement Rate = £1093.44
If the teacher’s pay factor rate is 1.0, the claim would be worked out in the same way, as follows.
20 Days X 1.0 pay factor rate X £136.68 Teachers Reimbursement Rate = £2733.60
I have a member of staff who is currently on half pay and has been for almost 6 months and who has now been given their notice. They are now entitled to 3 months full pay before they leave, can I claim this from the Mutual Fund.
Yes, if the individual has been dismissed or resigns then you may claim for the period of their notice.
A member of staff has returned to work but on the same day went absent again, can I claim for the day that they returned to work?
A school can only claim for the day that the individual returned to work, if a return to work form was completed and the individual was sent home on the same day they returned to work. If no return to work form was completed and the individual went off absent several days later, then this would be classified as a new absence and the waiting days would start again.
A member of staff who is currently on a phased return has taken time off during which time they were supposed to be working as agreed in the phased return. Can I claim for those days that the individual is absent on top of the phased return?
If the individual requires additional time off with the same illness on top of the phased return, the school can claim for the additional days. However, if the added days out of work is due to an unrelated illness then the waiting days still apply as this is classified as a new absence.
My school has been part of the Mutual Fund for more than a year, but we would like to include support staff. If a support member of staff is already off work due to illness prior to paying the premium, can I still claim for that individual?
Unfortunately, if a member of staff is already absent prior to the initial premium being paid then you cannot claim for this individual. If however, the individual does come back to work but unfortunately goes absent due to a new illness, then you can claim for that individual.
My school is converting to an academy, is it possible for the premium to start in September rather than April so that it is in line with the academy financial year?
Membership periods run in line with the financial year, running from 1st April to 31st March each year. This has previously been discussed by the Mutual Fund Board and no changes are to be made at this time.
If we don’t claim, will we receive a refund?
Each year, the Mutual Fund balance is rolled forward and the premiums adjusted accordingly. Therefore, whether the fund is in surplus or deficit at year end, schools will not receive a refund.