Case studies & success stories

Retrospective Reimbursement Success Story

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CHC retrospective reimbursement

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.

We approached FD for help in appealing a faulty CHC funding decision. Highly impressed with the in-depth & very detailed investigation by their expert nursing practitioner. Eventually we got a very good result which was entirely the result of FD’s work. Definitely recommended.

Rob

We would thoroughly recommend Farley Dwek as an organisation and Debbie Payton in particular. We feel that all that she has achieved on behalf of my father is worth every penny and we believe we could not have got this outcome without her. We cannot thank Debbie enough.

Rachel W

A sound investment! I had researched a number of firms offering assistance to help secure CHC funding for our Mum. I was very glad I chose Farley Dwek. Both my brother and I are retired solicitors and are able plough our way through regulatory material and legislation, However, neither of us had any experience in this area of law. I really appreciated Farley Dwek’s transparent and sensible advice. I would recommend doing the initial screening exercise with one of their nurses, we had the excellent Diane Jenkins for screening (and eventual support at the MDT).

CHC client

Thanks to Andrew’s guidance, we were able to articulate and feedback our reservations to the CHC and they ended up ruling in our favour. We therefore did not end up having to formally instruct Farley Dwek for representation but our impression was that they were an exemplary firm with judicious invested leadership and noble ethics.

CHC client

I cannot recommend FARLEY DWEK enough should you find yourself in this unfortunate situation. They ring you when they say they will, they write to you with updates and keep you informed all the way. I'd like to especially thank Ruth Pople and Jonathan Dwek who I regularly spoke to during the process.

Chris Gregg

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Call 0161 272 5222 Email help@farleydwek.com

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