Do You Feel Like You Could Have a Retrospective NHS Continuing Healthcare Claim?
As specialists in NHS Continuing Healthcare (CHC), we frequently speak to families who have faced the immense financial strain of paying for care. While securing CHC funding for a client’s current and ongoing needs is a huge victory, it can uncover a crucial question: what about the care fees already paid?
To speak to a CHC specialist call 0113 320 5000
Many people are unaware that it is possible to reclaim care fees that have been incorrectly paid in the past. This process is known as a retrospective NHS Continuing Healthcare claim. If the NHS, through its local Integrated Care Board (ICB), should have been paying for your loved one's care but failed to do so, the estate or the individual may be entitled to full reimbursement.
Here are two of the most common situations where a retrospective NHS Continuing Healthcare claim should be seriously considered.
1. The "Unassessed Period" Before a Current CHC Award
This is a scenario we see often. After a long and challenging process, a client is assessed and found eligible for CHC funding. Their care home fees will now be covered by the NHS going forward. While this brings immense relief, it's vital we don't ignore the past.
Consider this: An individual moves into a care home. Their health deteriorates over a period of two years. In the third year, they are finally assessed by the ICB and awarded CHC funding. But what about the first two years, during which they paid tens of thousands of pounds in fees?
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If their health needs likely met the eligibility criteria during that prior period, a retrospective claim can be made for that "unassessed period of care."
The core principle is that the duty to assess an individual for CHC funding lies with the ICB. A failure to assess in a timely manner does not absolve them of their responsibility to pay if the criteria were met. We can work with you to request a retrospective review for that specific timeframe, gathering crucial evidence from care records, GP notes, and hospital discharge papers to build a robust case demonstrating that eligibility was met long before the funding was actually granted.
2. Pursuing a Claim on Behalf of a Deceased Loved One
When a loved one passes away, the right to claim for wrongly paid care fees does not die with them. As the executor or administrator of their estate, you have a duty to act in the best interests of the beneficiaries. This includes investigating and recovering any assets owed to the estate, and this absolutely includes wrongly paid care fees.
This situation typically applies where an individual:
- Had significant and complex health needs (e.g. severe needs arising from advanced dementia, Parkinson's disease, post-stroke needs, Motor Neurone Disease, diabetes and other problems).
- Paid for their own care, either in full or in part (as a "self-funder" or paying an "assessed contribution to the local authority").
- Was never assessed for CHC funding by the ICB, or there were lengthy periods of time where eligibility was never considered.
The key is the concept of a "primary health need." If the main reason for the individual being in care was due to their health needs, rather than social care needs, the NHS should have covered the full cost. The sums involved can be substantial, often running into six figures, and a successful claim can make a profound difference to the value of an estate.
Navigating a claim for a deceased relative is a complex, evidence-based process, but one which could be essential for ensuring the estate is rightfully reimbursed. This is because the system for referral and assessment of eligibility for CHC is not always reliable, and many people have “fallen through the cracks.”
How We Can Help with Your Retrospective NHS Continuing Healthcare Claim
The CHC assessment process is notoriously complex and bureaucratic. For a retrospective NHS Continuing Healthcare claim, the challenge is amplified by the need to gather and interpret historical evidence.
Our specialist CHC team can manage this entire process for you. We will:
- Conduct a no-obligation assessment of your potential claim.
- Analyse the evidence against the criteria set out in the National Framework for NHS Continuing Healthcare.
- Construct and submit a claim to the relevant ICB and argue your case at every stage.
If you believe you or a loved one paid for care that should have been funded by the NHS, please do not hesitate to get in touch.
Contact our specialist CHC team today on 0113 320 5000 or @email for a free, confidential assessment of your potential retrospective CHC claim.
