One challenge facing many NHS Continuing Healthcare claimants is dealing with delays in the claim process. Nursing care claims can often take around 2 to 3 years to resolve fully, however, we have seen this increase over the years. The reasons why delays occur are not always made clear by those responsible and understandably this can be a source of frustration. Here we explain why our clients need not worry if delays occur and focus on some of the positive steps we will take to efficiently progress your claim.
Problems with Assessments
We often deal with cases where NHS Continuing Healthcare assessments have either been completed incorrectly or not completed at all. Communication between the health authority and the family can be difficult for a number of reasons. This can lead to families paying huge sums of money for care, only to find out years later that this could have been funded by the NHS. Assessments should be completed on entering the care home, three months later and reviews should take place annually. Hugh James Nursing Care has several years of experience of dealing with health authorities at every step of the process, from chasing an initial assessment to landmark successes such as the case of Dennison so if you choose to instruct us to look after your claim you can rest assured that we will contact the health board to ensure that the correct procedure is followed and we will provide you with expert advice at every step of the process.
Deadlines and Backlogs
Deadlines have previously been imposed both in England and in Wales which bar a family from bringing an NHS Continuing Healthcare claim if their claim is not registered before a specific cut off date. The Nursing Care department at Hugh James has a proud history of widely informing the public of deadlines, including several appearances on TV. We have often worked extremely hard to register thousands of cases at the same time to meet those deadlines. These deadlines are set so that health authorities save time and resources in the long term, but in the short term the vast number of claims that have to be registered, with the limited resources of many overstretched public bodies means it takes years to clear the subsequent backlog of work. Many health authorities are under so much pressure to clear backlogs by reviewing the oldest cases first that they must ignore requests for updates on individual cases, causing uncertainty. An example of this was the Department of Health deadline in 2012. The health authorities received approximately 60,000 claims. An already under resourced scheme was not fit for purpose and many families have still not received a decision. At Hugh James Nursing Care, we keep our clients regularly updated and are happy to answer any queries you may have, so that even if delays cannot be avoided you know how your case is progressing. We also help the health authorities ease their backlogs by complying with reasonable requests to undertake admin tasks to avoid work being duplicated and by completing an initial assessment of the merits of your claim so that you know your claim is worth pursuing before choosing to instruct us to proceed with it.
Obtaining Evidence
The test for eligibility for NHS Continuing Healthcare is based entirely on whether a person’s primary care need is a health care need. While this is clearly a fair policy, it means assessing eligibility for NHS Continuing Healthcare is a complex exercise, requiring a review of medical evidence. This means requesting copies of records, most importantly any care home records that show the day to day needs of the person being assessed. This can be problematic, as we are reliant on third parties to comply with requests in a timely manner. Chasing these third parties can therefore be a significant undertaking, and the health authority may give up on obtaining these records. Hugh James Nursing Care will not give up on chasing records and will obtain medical records from all available sources, helping record holders to process requests more efficiently where possible, to ensure that your claim is investigated as fully as possible.
Negotiations
We have seen cases where the health authority will recommend short periods, when it is clear eligibility should be much greater.This means that in many cases, claims will be prolonged due to appeals with the health authority to try to secure the best outcome possible. If an agreement cannot be reached, the case may then need to be referred to an independent review panel or to another public body such as the Ombudsman. We have a wealth of experience in negotiating with health authorities and the vast majority of claims we refer to an independent review panel are successful.
Proof of payment
Health authorities will not refund any wrongly paid care home fees unless they are given evidence of the care fees paid by the claimant. We have dealt with several cases where health authorities have been over restrictive in interpreting their criteria for sufficient proof of payment. We would recommend that you keep hold of any and all information relating to all care home fees paid, including bank statements and invoices. In this age of smartphones and online banking copies of documents can be easily made and stored. We have had a lot of past success in persuading health authorities to relax strict interpretations of the proof of payment requirements, and where needed we have completed exhaustive searches for proof of payment using our links with local authorities, care companies and other solicitors to ensure that reimbursements due are paid in full.
Conclusion
We appreciate that the process of claiming for NHS Continuing Healthcare can be protracted for the above reasons. Please note that a claimant will not be financially disadvantaged by any delay. Interest must be applied to reimbursements to ensure that individuals are put into the position they would have been in had eligibility been awarded at the appropriate time. If you instruct Hugh James Nursing Care you can be assured that your claim is expertly handled to achieve the best outcome possible.
