£27,000 in Care Fees Claimed Back in Retrospective CHC Claim

Author:
Hannah Morris
Care Home Fees Lawyer
Date:
09/12/2019

A Care Home Fees Refund Case Study

Client Situation

Mrs G contacted us in August 2012 regarding her late mother. Her mother had been in a care home from 2007 until she died in 2012. Mrs G had heard about NHS Continuing Healthcare Funding, also known as CHC Funding. She had heard about the new deadlines for making claims on periods of unassessed care in the papers and this prompted her to call us.

Before this, Mrs G didn't know that CHC Funding was available or that she might be able to retrospectively claim back some of the care home fees her mother paid. These fees totalled thousands of pounds. 

The deadlines in place limited the time a Clinical Commissioning Group has to consider and then they only considered unassessed periods of care after 1 April 2012.

Because Mrs G’s mother was in a care home before then, she needed to register her claim before the 30 September 2012 deadline. As Mrs G had contacted our Care Home Fees Solicitors, we registered the claim for her with the relevant Clinical Commissioning Group.

How We Helped

Because such large numbers of claims were made before the deadline, the NHS took a long time to deal with them.

Mrs G’s claim was no different. The initial administrative stages took a number of years to complete. During this time, the Clinical Commissioning Group tried to close the claim without sufficient reason. We represented Mrs G to argue against this successfully.

But the delays took their toll. Mrs G was not well and found it difficult to have to remember and discuss the late stages of her mother’s life. But, family involvement in retrospective CHC Funding claims is very important. Mrs G gave us information about her mother that we wouldn’t otherwise have been able to access.   

Hannah Morris gave Mrs G support and advice throughout the process and helped her continue with the claim.  She provided detailed written accounts, which Hannah used to produce strong written submissions to support her CHC Funding claim.

Initially, the Clinical Commissioning Group awarded Continued Healthcare Funding, but only for the last month of her mother’s life.  Our retrospective claim focused on an 18 month period so one month was not an acceptable outcome and Hannah advised Mrs G to appeal this decision.

Despite Mrs G’s frustrations at the decision and the delays, she agreed with Hannah’s advice. She accepted the CHC Funding refund offered and immediately appealed the decision and asked for the remaining period from the Clinical Commissioning Group.

A local level appeal happened and the Clinical Commissioning Group stood by their decision. But Hannah was confident that the decision was incorrect. She was determined to see Mrs G get a positive outcome to her claim. So after discussions with Mrs G, a request was made for an Independent Review with NHS England.

Hannah reviewed the case in great detail and produced detailed submissions based on the evidence. All of this helped Mrs G to produce a strong personal statement. Mrs G also instructed Hannah to represent the family at the Independent Review Panel.

During the Independent Review Panel meeting, the decision was made that Mrs G’s mother was eligible for CHC Funding, and was awarded the additional 17 months.

The Outcome

Mrs G got a positive outcome with Hannah’s involvement. She was reimbursed the total 18 months of her mother’s care home fees, which totalled £27,000.

Continuing Healthcare Funding is complicated. Having an experienced Care Home Fees Solicitor on your side can make a huge difference because they can use their experience and apply it in your claim.

You can see from this case study that the retrospective CHC claims process is long and time consuming, with cases being incorrectly closed and wrong initial decisions being made. Make sure you've got an experienced Care Home Fees Solicitor to support you and your family.

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