Retrospective Reimbursement Success Story

Farley Dwek Solicitors represented two separate families both seeking retrospective reimbursement for wrongly paid care home fees for their respective relatives.

Both cases went to appeal at NHS England, who found that each of the NHS Clinical Commissioning Groups’ decision to refuse NHS Continuing Healthcare Funding was fundamentally wrong and unsound.

The outcome decisions meant that both claimants should be reimbursed their care home fees, in fulll, for the approved period of eligibility.

The CCGs asked both families for proof of payment to substantiate the care fees paid, so that they could make proper restitution repayment (plus added interest). However, as both cases had taken so many years passing through the NHS assessment and appeal’s process to come to a final decision, the claimants had died in the meantime. In an effort to clear out waste, the families had thrown away the necessary key evidence to prove what care fees had been paid (ie care home invoices, statements of account and bank statements), not realising their value further down the line now that their relatives’ claim were successful. Worse still, one care homes had closed and the other’s records couldn’t be located due to a take-over. The trail of proof had gone cold with no way of retrieving the evidence, so many years later.

The CCGs were understandably reluctant to make any payment without the necessary evidential proof of the care fees paid, and so further delays ensued whilst the CCGs considered their positions.

Both cases were looking like ‘pyrrhic’ victories – ie a win on eligibility, but no payment! However, we presented the CCGs with supporting case studies from the little known Parliamentary and Health Service Ombudsman’s Guidance – which states that reimbursement should still be made even where evidence is no longer available – both CCGs agreed to make restitution. Both client families will now receive reimbursement after many years battling with the CCGs for justice.