Can I Recover Care Home Fees Already Paid?

Author:
Abdul Aslam
Medical Negligence Paralegal
Date:
27/03/2019

The simple answer is yes. However, this will depend on a number of factors. In simple terms, care home fees can be claimed back if they were wrongly paid at the time.

This might occur when the individual concerned had a Primary Health Need at the time when the care home fees were paid, but the NHS failed to assess their eligibility for Continuing Healthcare Funding at the time and failed to make funding provision.

To find out more, get in touch with our Care Home Fees Lawyers.

Call us on 08002605010 or request a callback and we will help you.

Legal Authority to Recover Fees

In order to recover care home fees already paid, you’ll need to prove that you have the required legal authority to bring the claim. If the patient you’re claiming on behalf of is living, then this might be the appointed Attorney under an Enduring or Lasting Power of Attorney, or the Court Appointed Deputy.

If the individual making the claim doesn’t hold a Power of Attorney, then you may still be able to make a claim. But in this instance, it is definitely worthwhile getting in touch with our expert Care Home Lawyers for more information.

If the patient is deceased, then it’s the Executor of their Will who has a right to bring the claim and a Grant of Probate may be required depending upon the size of the Estate and the amount of care home fees to be recovered. It may also be possible to bring a claim where the patient died without leaving a Will and again, you may wish to seek advice regarding this from our Care Home Lawyers.

Assessments

In most circumstances, the NHS should conduct a Continuing Healthcare Funding assessment of a person’s eligibility every year. If a person has previously been assessed as ineligible then an appeal should be lodged against that assessment within 6 months.

If no appeal was lodged at the time, then it’s not usually possible to pursue a retrospective claim. However, there may have been flaws in the assessment or process, which might be grounds to seek a fresh retrospective assessment. We recommend that you seek legal advice in these circumstances, for more information see Making a Retrospective Continuing Healthcare Funding Claim.

Importance of Evidence

If you want to claim back care fees already paid, it’s useful to check that the care home and medical records will be available to the NHS to carry out the assessment. Without these records, a claim to recover previously paid care home fees may weaken, though even where certain records are no longer available, there may still be sufficient evidence to make a retrospective claim. A clinician at the NHS will review all of the available evidence and produce a Needs Portrayal Document which will inform the eligibility assessment.

Reimbursement and Financial Evidence

Where care home fees are recovered on a retrospective basis, reimbursement will usually include reimbursement of the actual fees paid for the period of eligibility, plus interest calculated at the Retail Price Index (RPI) Rate.

However, it’s vital to have evidence of the care home fees paid, such as invoices, receipts and historic bank statements, which prove that payments were made during the claim period. If the claimant is unable to provide invoices and bank statements, then alternative evidence can be considered, such as a statement of account from the care home.

We recommend retaining as much evidence as possible. If contributions were made by the Local Authority, such as on a means-tested basis or under a deferred payment agreement, then evidence of this is also required. If in doubt, our Care Home Lawyers can advise you. If you believe you’ve provided sufficient evidence of the care fees paid and the NHS refuses to accept, it’s crucial that you seek legal advice.

Backdated Claims

Please note that the Department of Health announced a deadline for individuals who wished to request an assessment for NHS Continuing Healthcare Funding for periods of care between 1st April 2004 and 31st March 2012, which has now lapsed. It’s unclear whether another deadline will be announced from 31st March 2012 onwards, so we would recommend getting in touch so we can assist you in making an application for Continuing Healthcare Funding to recover care home fees already paid.

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