FAQ’s

At Care Fee Recovery we will provide advice for all enquiries within the United Kingdom. However some of our services are restricted to England and Wales, we will advise you of this upon initial contact.

At Care Fee Recovery we do not employ solicitors and therefore we cannot carry out legal processes or any type of litigation. Our team are experts in the field of NHS Continuing Healthcare and can guide you through the relevant processes.

NHS continuing healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a “primary health need”.

A ‘Primary Health Need’ is defined by the nature, complexity, intensity, and unpredictability of a person’s health needs. A Primary Health Need may be determined by one overriding issue, such as breathing, where, without interventions, medication and treatment the person would be unable to breathe, or a combination of needs requiring health interventions over a 24-hour period. A Primary Health Need may also be present towards the end of a person’s life, where there may be no possible improvement despite health interventions.

The criteria for establishing a Primary Health Need is a highly subjective concept, and as such is difficult to precisely define. However, it is essential for a Primary Health Need to be present for a claim to be successful.

There are two stages to the assessment process.

Stage 1

The first stage in the process is the NHS Continuing Healthcare Checklist. The Checklist takes into account 12 aspects of the patients needs (care domains), each one of these needs is analysed and given a ‘score’. The scoring of this dictates whether a full assessment of the patients needs is required.

Stage 2

If the patient ‘screens in’ on the Checklist then a full Assessment will be carried out. This will usually include the completion of a Decision Support Tool, again an analysis of the 12 care domains. The Assessor will review all available information and make a recommendation as to whether the patient will be granted Continuing Healthcare funding. This recommendation will then be reviewed and signed off by more than one health professional known as , the Multi Disciplinary Team (MDT).

The current guidance in place dictates that if you have more than £23,250 in assets then you will have to pay for your own care. This can sometimes include the value of your home, but certain circumstances will dictate this. If you think that the patient has a ‘primary health care need’ then the NHS may contribute to the cost of your care.

If you have less than the £23,250 threshold the the local authority will provide some financial assistance (All of the patients fees will be paid if their assets are worth less than £14,250).

You are well within your “rights” to request an assessment of your eligibility to NHS Continuing Healthcare Funding yourself. The application and assessment process can be quite complicated, our services help to remove the complications and we can act on your behalf directly with the NHS.

Care / nursing home claims are by no means clear-cut, and no two cases are the same. Different authorities interpret the criteria for a ‘primary health need’ in different ways and all tend to err on the side of caution due to the seriousness of the financial implications for the NHS.

Our team will work tirelessly on your behalf scrutinising records, liaising with the NHS, drafting detailed documents for submission, and generally ensuring that your claim proceeds as smoothly as possible. Through diligence and attention to detail, we endeavour to handle your claim with sensitivity and understanding. Pursuing care home fee reimbursement on behalf of a loved one can be a delicate matter, and we will always ensure that you receive the best possible support throughout your claim.

Some benefits will change when you become eligible for Continuing Healthcare funding. If you receive Attendance Allowance (AA) or Disability Living Allowance (DLA) in a care home with nursing, these will normally stop 28 days after continuing healthcare begins, however DLA will not normally stop if you are not receiving care from a qualified nurse or you receive care in your own home. If AA or DLA benefits stop, other disability-related premiums may also be affected.

We work on a No-Win-No-Fee basis. Our fees in the event of a successful outcome are 25% + VAT of any compensation awarded, and we do not make any charges throughout the duration of your claim. We do not make any charges throughout the duration of your claim, with the exception of any “disbursements” – for example, a hospital may charge an administration fee of £50 to copy and provide available medical records.

If you should receive an outcome from the NHS which states that you or your relative are not entitled to Continuing Healthcare Funding, we have the option of appealing the decision. We will examine all available evidence alongside the decision documentation and, if a case can be made, we will draft a submission document detailing our areas of disagreement. We will also seek advice from our nurse, who has many years of experience with these claims and a high level of clinical expertise.

Any work that is conducted on an appeal is covered by your No-Win-No-Fee agreement and will be at no additional cost.

The current guidance from the Government states that you cannot currently recover any Care Costs paid prior 31st March 2012, unless you had already submitted a claim within their given dates.

Claims can be submitted for 1st April 2012 up until the the current day.

For more information about our Retrospective Care Cost Claims Service please contact us and speak to a member of our team.

In terms of our Retrospective Claims Service, this service is only offered under a Damages Based Agreement.

The Fast Track Pathway Tool should be used where a patient has been diagnosed with a terminal illness. The Fast Tracking gives priority to those with a terminal illness for an appropriate placement into a care home and to what funding is required.