Can You Claim Back Care Home Fees After a Family Member Has Died?

Yes, and this is one of the most important and least widely known aspects of the NHS Continuing Healthcare system. Retrospective NHS Continuing Healthcare claims can be made after a person has passed away. For families who funded care privately, often for years, the amounts that can be reclaimed are significant.

What is a retrospective NHS Continuing Healthcare claim?

A retrospective NHS Continuing Healthcare claim is a formal application to the NHS to recover care costs that should have been funded by NHS Continuing Healthcare during a person's lifetime. The claim is made on the basis that the person's needs during that period met the NHS Continuing Healthcare eligibility threshold, but that they were either never assessed, assessed incorrectly, or wrongly refused.

Who can make a retrospective claim?

A retrospective claim can be made by the person's estate, typically by the next of kin, executor, or power of attorney representative. The claim is pursued on behalf of the person (or their estate), not the individual making it.

How far back can a claim go?

Retrospective claims can typically go back up to 14 years. The timeframe depends on the circumstances, the availability of records, and the ICB responsible for the relevant period of care.

The further back the claim goes, the more important it is to gather medical and care records from the relevant period. These records form the basis of the assessment of whether needs at that time would have met the NHS Continuing Healthcare threshold.

What is the claim process?

A retrospective claim involves a review of the person's clinical and care records from the period in question. An assessor (usually from the ICB, overseen by NHS England) reviews the records and applies the NHS Continuing Healthcare eligibility framework retrospectively.

The process can be complex and time-consuming. Having an experienced nurse advocate manage the claim significantly improves the prospects of success, because the clinical evidence is presented within the correct framework, and any attempt to under-score needs can be challenged at each stage.

Does SG67 handle retrospective claims?

Yes. SG67 handles retrospective NHS Continuing Healthcare claims on a no-win, no-fee basis. There is no upfront cost, and no fee if the claim is unsuccessful. Families who are not sure whether a claim is worth pursuing can discuss the circumstances in a free initial consultation.