Claiming NHS continuing healthcare funding: Do I need a solicitor?

20 Dec 2017 | Comment


If you and your family are in a position where you want to challenge a decision regarding Continuing Healthcare funding, or you want a loved one to be assessed, you may ask yourself whether you need to instruct a solicitor.

The short answer is no – you do not need to instruct a solicitor. Claiming for Continuing Healthcare funding, or challenging a negative decision, is not a legal process. It is mainly settled through an internal NHS appeals system or their complaints procedure. Also, the National Framework (the guidelines relating to Continuing Healthcare funding issued by the Department of Health) is not technically law. They are guidelines and set out a standard practice in order to achieve fairness across the country. Very rarely would there be a need to go to court regarding a Continuing Healthcare claim.

Nevertheless, we believe there are benefits to instructing solicitors. At Hugh James Nursing Care, we have been representing clients for over twelve years. Here are our top five reasons why instructing us to manage your Continuing Healthcare claim would be beneficial to you.

1) Expertise

Possibly the most common reason why we are instructed to act in these claims is due to the knowledge and expertise we have built up over twelve years. Continuing Healthcare funding is extremely complex and it is often very difficult for lay people to understand what the difference between being found eligible and being found not eligible is. Our expertise helps families to understand what the strength of the claim is and where to focus arguments. Also, health authorities can find a number of reasons to refuse to complete a review, which is not always easily understood by families. We have a great deal of expertise in challenging health authorities who refuse to complete a review for Continuing Healthcare funding.

2) Time

These claims are time consuming. Not only do they take a long time by the NHS to be processed due to a lack of resources and backlog of claims, but preparing evidence and arguments is time consuming. Particularly if a claim is retrospective, it is crucial to use GP and care home records to prove your relative’s care needs. If the claim period spans several years, or if your relative had complex and changing needs, reviewing records can take several days – even weeks. Preparing appeal submissions can also take a long time. Therefore, by instructing Hugh James Nursing Care to act on your behalf, the time consuming work will be done for you by professionals with extensive experience working in this area.

3) Confidence

You can have complete confidence your claim is in good hands. You can be sure that the best possible arguments are being put forward on your behalf. Our track record should also provide you with confidence in us: we have recovered over £100 million of wrongly paid care home fees since 2006.

4) no win, no fee

Instructing a solicitor will of course incur fees, however wherever possible we will always offer a no win, no fee structure. This means that unless we are successful in reclaiming wrongly paid fees, then you will not be liable to pay any legal fees, regardless of how long we have been working on your case. In addition to this, we will also offer a free no obligation assessment to all clients. This involves a thorough investigation of your relative’s care needs to determine the strength of their case before you formerly instruct us. We will always outline our fees to you before taking you on as a client, so there won’t be any surprises at the end of the process.

5) Protection

You can be sure that no deadlines will be missed to make an appeal or complaint. Our knowledge of the system means that any deadlines which are not made clear are picked up and dealt with. Further, as our office is always open, if you are away from home any issues will be dealt with promptly and your claim will be protected.

We often find that some people, care homes in particular, can discourage families from instructing solicitors to help with continuing healthcare funding claims because they believe a patient will not be found eligible for funding. This is especially the case in residential care homes, where there are no nurses employed by the home to care for residents. However, this belief stems from a misconception of continuing healthcare funding and the type of health needs that can meet the criteria.

This happened to Mr Gibson, who was told several times by his father’s care home that his father would not be eligible. Only after his father had passed away did he approach us to reclaim the care fees. With our help, Mr Gibson recovered over £200,000 in wrongly paid fees. Read more about Mr Gibson’s story on The Telegraph article ‘I reclaimed £226,559 in care fees. Here’s how you can too’.

Overall, there is no legal need to instruct a solicitor to represent you in making a Continuing Healthcare claim. However, there are huge benefits in doing so and having a solicitor who specialises specifically in this area by your side will ensure your claim is in the best possible hands.

If you are wondering if instructing Hugh James Nursing Care may be beneficial to you, call 02920 391 129 to speak to a member of our team to see if we can help or for more information, visit the Nursing Care section of our website.

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