FAQs

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.

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 31^st March each year.

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.

As of 2011 all schools currently in the Mutual Fund will automatically be assumed to be scheme members for the following year, unless the school signals by the end of March of the current financial year that the school wishes to opt out. To opt out of the Mutual Fund please complete the opting out online form.

Staff Covered

Teachers, Teaching Assistants, Admin, Residential, Technician/Resource, Premises, Catering, Meal Time Assistants.

Staff Not Covered

Premises, catering and meal time assistants were not covered in the scheme until 1st April 2013.

Covered

• 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)

Not Covered

• 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.

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 online claim form.

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.

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.

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.

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.

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** or emailing the Mutual Fund Team.

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.

To improve the efficiency of claims, Devon Finance Services has developed an online claims form. On completion of the online form a PDF notification file will be sent back to the school within 5 working days via AnyComms within the Finance Information Community, informing the School if your claim has been accepted, rejected or adjusted. If you have not received a notification in that time, please contact the Mutual Fund Team to ensure your claim has been received.

Claims will continue to be paid at the end of the month and a further snapshot file will be available confirming the payment.

Should you realise that a mistake was made on completing the claim form, please email the Mutual Fund Team or phone 01392 382784.

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 nor will monies be clawed back from those schools who have claimed.

Appeals Address:
Mutual Fund Board
c/o Devon Finance Services
Room 180
County Hall
Topsham Road
Exeter
EX2 4QJ

Email: financeschoolsmutualfund-mailbox@devon.gov.uk

If a school was part of the Mutual Fund after 1st April and prior to it converting to an academy, then the new academy will continue to be part of the Mutual Fund and will be able to continue to submit claims as per usual.

Yes, the school is required to submit a claim form for each contract the member of staff holds.

This issue was raised in the June 2012 Schools Finance Group meeting and the Mutual Fund board agreed not to make any changes at this time.

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.

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.

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.

Yes, if the individual has been dismissed or resigns then you may claim for the period of their notice.

The 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

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, however, 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.

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.

With this type of claim if an individual has been absent for a long period of time, the school will need to check with payroll to see 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.

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 31^st March. All schools remaining in the Mutual Fund or joining the scheme for the following year will be provided with a premium notification via SecureNet 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.

Unless the individual employed by the school is actually ill, a school cannot submit a Mutual Fund claim.

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.

The April claim was received within the claim period and will be paid, but the March claim is outside the claim period and therefore will be rejected.

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.