If you are pursuing a claim for past care fees that were incorrectly paid, for example if the individual in care was wrongly assessed for their eligibility for NHS Continuing Healthcare Funding (CHCF) or even not assessed at all, then you may be able to re-claim those fees paid. This could potentially amount to many thousands of pounds! – see How Do I Claim Back Care Fees That Have Been Paid?
In order to maintain a retrospective claim, you can only go back to care fees paid after 31st March 2012, unless you have already lodged a claim with the CCG before that date.
Note: In addition, you are entitled to claim interest on the fees that have been paid on the refunded sum. This can often be a very substantial sum, and in some cases can be equivalent to the amount of refund itself!
The interest often gets so high because of the inherent and inordinate delays in the NHS processing these retrospective claims – largely due to the high volume and back-logs, compounded by a lack of resources to be able to in obtain and collate the care home and medical notes and records quickly, assess them and then process claims efficiently. We hear of cases where the NHS have put up hurdles and have been obstructive to try and defeat a case, rejecting it unfairly – causing families untold stress as they have to appeal – all adding to delays. Sometimes a Local Resolution Panel decision may go against the individual necessitating an appeal – which also takes time. In the meantime, if the claim is ultimately successful, interest has been accruing all the time at our, the tax-payer’s expense – whilst the NHS get their act together to review and process these claims through their pipeline.
As retrospective claims are usually made by family members, long after the individual has passed away, far too frequently, we hear that family members have thrown away key evidence to prove their entitlement to claim. So for example, where a family get a positive decision and it is found that their relative was eligible for Continuing Healthcare Funding (CHCF) – that is not the end of the matter. You have to quantify your loss.
What proof do I need to claim for past care fees?
Usually statements of account from the nursing/care home is a good start to prove what you have paid during the win period of eligibility. If you haven’t already got them handy, you can always ask the home to provide a copy set for you – preferably on their letter-headed stationary.
In addition keep all letters, correspondence and documents which might show changes in the annual fees to be charged.
Invoices from the care home are essential, as proof of what has been charged as this should marry up with the statement of account provided by the care home.
Quite often CCGs will also ask for bank statements as actual proof of what was paid to the care home in fees – to double check that what the care home has invoiced for was actually the same amount paid. If you haven’t got the bank statements for the win period, ask your bank to send you copies, but be aware that some banks like Barclays have a policy of only keeping bank records for 6 years.
What if I don’t have proof or have thrown papers away?
After the individual has passed away, it is not the family’s first thought to make a claim for a retrospective review. It is quite reasonable that without thinking, that critical documentation may be thrown out believing it not to be relevant in an effort to de-clutter the place. However, these key documents and papers are VITAL and will be needed as future evidence to prove the level of fees paid and to calculate loss to be claimed. The ‘defunct’ papers are thought to be useless now that the individual has passed on and therefore not worth keeping.
However this is critical evidence and must be retained. In the event of a successful claim for retrospective care fees, the burden of proof is on the individual to prove their loss. Without the supporting documentation, such as statements from the care home, proof of any increased fees, invoices etc., the CCG will often reject the entitlement to be paid out on the grounds of insufficient proof.
You will have a tough uphill battle to persuade them to pay without sufficient proof. Rest assured the CCG will not be rushing to help you in this quest, no matter how hard you plead or try and persuade them – as it is not in their best interests to do so.
It is your claim – you have to prove it to their satisfaction. You have therefore possibly spent a good number of years in successfully arguing your case for a refund against the NHS only to find that it is a ‘Pyrrhic victory’ and you have wasted your time after all that trouble. How frustrating! No evidence means no payment – unless you come across a very sympathetic CCG who will do a deal.
Circumstantial evidence is second best to having actual hard proof of care fees charged and paid – but it may be the best you can do to build your case.
TIP: It is therefore vital to keep such documents, particularly statements of account, invoices and any bank statements.
TIP: As soon as you have decided that you are going to make a retrospective claim – look for evidence to prove your claim and keep it safe. Tell someone else where you have put the documents as well in case you forget as it may be some months or years before your case is finalised. If moving house be sure to note where you store the records.
What if the care home has closed?
We have also heard from families where they have tried to approach the care home for information, but too late – as they have either now closed down or the home has been destroyed, staff have moved on and don’t know where the records are archived, the records have been destroyed, the financial records are in an administrative mess, computer systems have changed, manual records have been destroyed or lost, ownership has changed and the new owners are unco-operative to help track and trace any records etc. Therefore, we cannot stress enough that you must get and keep the evidence at the outset, as you never know if the care home will close and you simply can’t get the records.
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What details are need on a carer’s invoice, please, where CHC have agreed in writing that they will reimburse carer costs? Is is sufficient for the carers invoices to record the number of sessions offered for each dated period of 1 week and to and clarify the rate of pay of those sessions & the subtotals per week? Or is it essential for the date of every single individual session to be recorded? thank you
I had a virtual Independent Review Panel (IRP) hearing today to try and get NHS to pay for mum’s CHC. I had collected evidence to support mum’s case but was shocked to find that they would not accept my evidence from 5th March 2020 to 19th January 2021 (the date of the DST) My evidence has not been considered because of a Fictitious time period that the MDT accepted as its evidence time period.
This time period has never been quoted to me, is not contained in any NHS CHC documentation and was not mentioned to me at the Assessment on 19th January 2021. The IRP chair agreed with the CCG rep that the period is usually a day, week or at most a couple of months. Given that the strong evidence I had was from the time she entered the home up until the DST assessment, what can I do? The IRP was a sham as a result.
Hi,
Thanks for another great article.
After reading it I have two questions that I hope someone can help me with.
Firstly, I have just won a retrospective claim dating back to 2012 and 2013 and whilst I have provided the CCG with all the relevant official invoices (from social services regarding my father’s payments and the top up fees I paid during this period), they are now insisting on bank statements as well as the invoices or they state they will not be able to pay me. Therefore my question is, can they do this, even though I have provided them with all the official invoices.
Secondly, I started my claim for the period 2012-13 in June 2016, after I spent 2 years fighting for the 2014 period which I won via a independent review panel in May 2016. Therefore my second question is can I claim 8% interest on the 2012-2013 period, or will I be restricted to the RPI rate? My understanding from your article is that as I started the 2012-13 claim after 2015 I may not be entitled to the 8%, but I also wonder whether my circumstances may warrant me arguing for the 8% as during 2015 I was fully wrapped up fighting my father’s 2014 period?
I would appreciate any input on any of these matters.
Thanks
Hi – they can ask for whatever they like but if you are able to evidence the payments via invoices etc then they should not be insisting on the bank statements in addition.
It is no longer possible in our experience to claim 8% interest on retrospective claims. Kind regards
Thank you very much for your answers. I have written back to them asking why they are insisting on bank statements, considering that the invoices I have provided prove that my father must have paid, otherwise the subsequent invoice would be showing arrears – not to mention the fact he would have been thrown out of the home if he hadn’t paid. Its ridiculous, obviously they are just trying to find a way of not paying. As of yet they haven’t replied. Thanks again.
Just an update, as I forgot to do so at the time.
The CCG did insist on bank statements going back to 2012, luckily I was able to get these from the 2 banks involved at no cost, as one, LLoyds, provided them online for 7 years and I just fell into that group, and the other, Barclays, said if I agreed to go paperless then they would send them to me free of charge. However before I knew this I did write to the CCG and said that if I had to pay for any statements then I expected to be refunded as it clearly states in the National Framework that my father’s estate should be returned to what it would have been had he not be charged fees. The CCG did not argue the point, but as it stands I never had to go down that root, so don’t know if they would have fought it or not. The CCG did reimburse the money which means all of my father’s fees, from when he entered care in 2012 to when he died in 2015 (three and a half years) have finally been reimbursed and my 5 year battle with them has finally come to an end. (Although they did stop £600 out of the final amount that they sent to HMRC, which I am currently pursing as my father was on pension credit, had no savings and had never paid taxes since he retired 30 years earlier – but that’s another story.) During this horrendous journey I had to go through the CCG local resolution system, then an Independent Review Panel, followed by an official complaint against Patient Services, then the Ombudsman, then an official complaint against NHS England and finally back to the Ombudsman to ask then to review their decision, before it finally came to an end. So as you can imagine when it eventually ended on the 21st December 2019 it was the best Christmas present ever and since then I have tried to get on with my live. But after so many years and so many fights it’s been very difficult to return to normal, and even now 6 months on, I still find my mind won’t let it go, as I have been in battle mode for so long. I know it’s affected my health, with my biggest remaining problem being insomnia that started back in 2016 when I would spend hours on the computer, often into the early hours of the morning, writing my statements and gathering evidence, but I am determined to get through it and every day I know I am heading in the right direction. For everyone on this awful journey I wish them the best of luck in their fight for justice for your relatives.
And finally a great thanks to this website whose information I found invaluable and which made me believe it was possibly to challenge the CCG and win. Keep up your fantastic work as there are so many people out there who need your expertise, advise and support.
I’m currently waiting to hear from the CCG regarding a retrospective review on an unassessed period leading up to and being awarded funding for the last four months of my dear dads life. He was due to have an annual review in September 2017, but it didn’t take place! I have been fighting for funding for him whilst in care since 2016.
Hi Joanna – Do get in touch if you would like to chat this through with us. We may be able to assist you. 0161 979 0430. Kind regards
This really interests me as I am in the same boat my mum was awarded fast track funding within half an hour on her last admission to hospital, the Dr who organised it was shocked that mum wasn’t already in receipt of of chc as her needs were complex she had mental health problems along with a vascular dementia and ckd stage 4/5 was doubly incontinent and completely immobile although I asked for an assessment to be done on the numerous occasions she was admitted to hospital in the last year of her life this was never done! Unfortunately for us and our proximity our local hospital is in Devon and upon discharge from there you go to a local convalescent hospital in cornwall and because of different IT programs notes do not go with the patient!
Can I ask a question? My father was given nursing funded payments but not assessed for CHC before nursing funded payments. The nursing home took these payments and kept them without making an allowance against their fee and as this was not in their contract the Ombudsman found in our favour and the nursing funded payments reimbursed. This was thanks to your website. The National framework makes it clear in bold ink that an assessment for CHC should be done before nursing funded payments are granted. What are the legalities of this please. What is the time limit for retrospective claims? Diane