Can you trust claims handlers to get back your care costs?

by , Senior Advocate Consumer Rights 13 August 2012
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We’ve all seen the ads offering to help you if you’ve had an accident or taken out payment protection insurance. There’s a new tactic on the horizon and it involves claiming back on care fees…

Bills on red background

Local Primary Care Trusts (PCTs) carry out assessments to determine whether you or a loved one is eligible for NHS funding for care. If your care needs are not assessed as being primarily due to your health needs then you won’t be eligible for continuing health care, a service funded solely by the NHS.

The Department of Health is changing the way the recipients of care or carers can appeal against the cost of care. For assessments made between 1 April 2004 and 31 March 2011 you have until the 30 September 2012 to get your appeal in. After that date, appeals can only be made for assessments made in the past year.

Cue an influx of Claims Management Companies offering to do the job for you.

Claiming back care costs

If you’re not satisfied with your care assessment and feel that you should have had your care funded by the NHS, then you can ask for a reassessment by the PCT (which can be retrospective, even if your loved one has died). Failing this, your case can be looked at by an Independent Review Board at the Strategic Health Board for your region.

Now reclaiming continuing care funding is very different from reclaiming mis-sold PPI. The research we’ve seen suggests that only a small number of claims brought against PCTs’ continuing care decisions are successful.

Which? isn’t against Claims Management Companies per se but we do want to see poor practice stamped out. Remember – you don’t need to use a claims handler to appeal.

Appeal to your Primary Care Trust

You can write to your relevant PCT and start the process directly with them. Age UK has useful information on its website to help with the process.

However, if you’re uncomfortable doing this yourself and choose to use a Claims Management Company remember they will take a cut of any money you’re reimbursed. I sussed this out with three companies and found their cut was between 25% and 30% plus VAT.

If you’re talking to a Claims Management Company on the phone don’t feel pressured to sign up on the spot. Always read the T&Cs carefully before committing to using them and don’t pay anything in advance until you’ve received the contract in writing.

Have you made an appeal against healthcare funding? Will you be submitting an appeal before this new deadline takes affect?

4 comments

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Julie Shrive

Yes & got ICAS [ equally negligent[] to take up. The LA became the Care Homes one after home had to be sold using a Nurse on Corporate Remit to ignore severe cognitive impairment &medical conditions NHS refused to treat such as TIAs [ Multi infart dementia] .
The Solicitors are using Call centres with lay people not directed by the legal who allowed an unfair Independent Review when requested litigation .At the end suggested litigation Judicial Review at excrutiating cost .
Having tried before they deliberately unmonitored HMCS lose the papers causing further injustice.This was Royal Courts of Justice causing my MA to be extended a year as a result Only offering £50??!!!It has also happened x2. The deregulated Government & Treasury [ Inheritance Tax] have a lot to answer for ??!!

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Michael Stampton

I’m about to sign a contract with Keypointlaw {Mysolicitor.com Ltd.} to make a claim against PCT for fees we have already paid for Care Home for my late mother 2004 – 2008. we are accepting their offer of a No Win No Fee. They will be Taking 25% of the total claim plus VAT, which we will accept.
My question is how do I know it this is a bona fide company and I’m not going to be taken for a ride ?

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Erica

Hi Michael,

Thanks for your comment. Which? is not able to comment on particular cases but I would recommend you look at either the Solicitors Regulation Authority or the Law Society website, they both have useful tools that allow you to search for a firm and see their status. You can either use the firms postcode or SRA number, both of which are at the bottom of their webpage.

Good Luck

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Julie Shrive

Unfortunately who you suggest is another call centre like all Governmental Regulatory ones winding up & colluding with the criminal as accountant directed & they all copy each other. The stress has contributed to cardiac arrest,

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