What Financial Evidence is Needed to Make a Continuing Healthcare Claim?

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Under the NHS Continuing Healthcare Funding (CHC Funding) claim process, if you’re found to be eligible for a past period of time, you’ll need to provide evidence of the care fees or care home fees paid before the NHS will reimburse you. But what type of evidence do you require? And when will you need it?

Obtaining the evidence at the very beginning of a care home fees claim is essential, particularly in retrospective claims where we may be reclaiming someone‘s care home fees going back to March 2012; unless an appeal was lodged with the Clinical Commissioning Group before this date. 

As specialist Care Homes Fees Solicitors, we’ve seen occasions where people have gone through the appeal process to finally be awarded retrospective funding and the claimant is unable to provide any evidence of care home fees paid. In these instances, the Clinical Commissioning Group (CCG) is unlikely to pay out any reimbursement, so all the hard work has been in vain.

For legal advice, call our Care Home Solicitors and we will help you. Ask if we can deal with your care home fees claim on a No Win, No Fee basis.

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How Can You Avoid Missing Out?

Care home fees can range from a few hundred pounds to several thousand pounds a month, so a potential refund can be significant. It’s therefore crucial that you keep hold of any documents which evidence the care home fees being paid. These can include the following;

  • Invoices from the care home/s
  • Statement of Account from the care home/s
  • Any correspondence from the care home/s showing increases in fees
  • Bank statements showing the funds being paid to the Care home/s
  • Details of any Deferred Payment agreement or assessed contributions with the Local Authority.

Care homes will destroy records after a certain period of time. Alternatively, they can close down or be taken over, which makes obtaining this information very difficult. So the quicker this information can be obtained, the more beneficial it will be to your case.

Also bear in mind that some banks only keep records for a certain period of time, so it’s also important to contact them to obtain bank statements showing care home fee payments as soon as possible.

If you or a family member had a deferred payment agreement in place, whereby the Local Authority paid the care home fees and placed a charge over a property to be discharged once the property was sold, it’s important to keep hold of any letters from the Local Authority confirming this and bank statements or final estate accounts showing the charge being paid.

Whilst Local Authorities do also destroy records after a certain time, they do tend to keep this information longer than care homes would, but it’s still important to obtain this sooner rather than later.

If the NHS has agreed that you or your family member should have been eligible for NHS Continuing Healthcare Funding, you should be able to recover the backdated care home fees that were paid during this time.

This is set out in the NHS Continuing Healthcare Refreshed Redress Guidance 2015, which states:

“The purpose of redress is solely to restore the individual to the financial position they would have been in had NHS Continuing Healthcare been awarded at the appropriate time. As set out in “Principles for Remedy”, “remedies should not lead to a complainant making a profit or gaining an advantage.”

So providing you have the supporting evidence, you will be able to recover the full amount of care home fees paid for the period of eligibility. You will also be entitled to interest on the care home fees paid as well. This is paid at the Retail Price Index (RPI) rate and can amount to a substantial amount of money, so always check the offer of redress includes interest.

If you have any questions about the care home fees claims process, please get in touch with our Care Home Solicitors.

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