Continuing Healthcare Direct Terms and Conditions
Effective, July 2016
We want your decision to use Continuing Healthcare Direct Ltd. to be the right one for you. We are committed to providing a professional, simple and easy to use service. We aim to be completely transparent in all our dealings with you and these Terms and Conditions explain our obligations to you and yours to us. They are at the heart of our relationship, and our contract with you. Please read them carefully and retain for future reference.
“Continuing Healthcare Framework” means the practices and processes relating to the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care November 2012 (Revised)
“Claim” means the Client’s claim of Eligibility for Continuing Healthcare against the CCG.
“Client” means either the individual legally acting as the claimant’s representative and/or the Claimant themselves.
“Claimant” means the individual receiving care and claiming Eligibility for Continuing Healthcare against the Clinical Commissioning Group. Their details are set out in the Letter of Authority to appoint Continuing Healthcare Direct Ltd. In providing the Services.
“Clinical Commissioning Group” (CCG) means the statutory body assuming responsibility for the Eligibility of NHS Continuing Healthcare (except for prisoners and military personnel).
“Eligibility” means the decision made by the CCG from the assessed needs of the Claimant, having followed the practices and processes set out in the Continuing Healthcare Framework.
“Appeal” means the processes to challenge the CCG, as set out in the Continuing Healthcare Framework.
“Fee” means the fee set out more specifically in clause 5.
“Letter of Authority” means the letter from the Claimant or Client instructing Continuing Healthcare Direct Ltd. to act on their behalf.
“Services” means the work which We will undertake on Your behalf in respect of your Claim including investigating the viability of, preparing and submitting your Claim which is set out more specifically in clause 3.
“Terms” means these terms and conditions.
“Us”, “We” and “Our” means Continuing Healthcare Direct Ltd., a limited liability company registered in England and Wales with number 10265156 having its registered office at Westbury Court, Church Road, Westbury-on-Trym, Bristol, BS9 3EF
“You” and “Your” means the Client(s).
The contract shall commence on receipt of payment unless terminated earlier, as per clause 6 or 7.
3. We Agree To:
a) Undertake a telephone assessment to interview and assess the likelihood of Your Claim being successful against the Continuing Healthcare Framework.
b) If after we have reviewed the telephone assessment, it is Our opinion that Your Claim is unlikely to be successful We may decline to act for You. We will notify You of this fact in writing.
c) If We accept Your Claim application, We will confirm this to You in writing and make an offer to investigate your Claim further and prepare your Claim submission to your CCG.
d) Liaise with the CCG and use reasonable endeavours to pursue Your claim.
e) Notify You of any requests for additional information or documentation that the CCG need to investigate Your Claim.
f) Notify You in writing of any requests or offers made by the CCG.
g) Obtain Your agreement before accepting or rejecting any offer from the CCG.
h) Notify You of any circumstances beyond Our control which prevent us from performing the Services under this contract.
4. You Agree To:
a) Provide full authority to Us to deal with the CCG on Your behalf.
b) Provide truthful and accurate information regarding Your Claim.
c) Provide copies of all documentation that are in your possession and which relate to Your Claim.
d) Provide access to, or authority to request, medical records of the Claimant
e) Respond promptly to requests by Us for further information, or documents that may be needed to progress Your Claim.
f) Pay Our Fee as set out in clause 5.
g) In some instances, the CCG may contact You directly. This may include communication by letter, email and/or telephone. In the event that You receive correspondence or communication from the Company, You agree to notify Us of such communication and forward to Us any correspondence You have received direct from the CCG.
Our Services are provided on a fixed basis payable in advance. Other fees may arise upon cancellation of this Agreement outside of the “cooling off period”, please refer to 6(c)
a) Our fee for a telephone assessment is £95 +VAT.
b) Our fee for managing your Claim until a decision made by the CCG is dependent on your claim, prices start from £995 +VAT
c) Our fee for requesting Medical records is £50 per record
d) Our fee for undertaking a Client ID check is £18
e) If the Claim is Eligible, We will not receive any payments directly from the CCG
f) Our fee for managing Your Appeal process with the CCG is dependent on your claim, prices start from £1,800 +VAT
g) Our fee for any personal attendance at meetings is available on request
h) We do not offer any refund if Your Claim or Appeal is unsuccessful
6. How You Can Cancel This Agreement
a) You have 14 days from receipt of payment to cancel your authority for us to act on your behalf. Cancellation is without charge and you will have nothing to pay under this agreement.
b) You can also cancel this Agreement at any time after the 14 day period, referred to in Clause 6(a), but not after an application in writing is made to the CCG. Cancellation can be notified to Us, or can arise as a result of a breach of Clause 4 by You.
c) If a Cancellation of this agreement occurs in accordance with clause 6(b) above, We reserve the right to charge You a fee of £75 +VAT per hour to cover Our reasonable costs (up to a maximum of £450 +VAT (£540)) for the work undertaken in administering your Claim up to the date of cancellation.
7. How We Can Cancel or Change This Agreement
a) We can cancel this agreement in respect of Your Claims by giving You 14 days’ notice in writing if any of the following events occur:
I. We become aware that Your claim is unlikely to succeed.
II. Evidence is not provided that you are legally entitled to act as a representative for the Claimant.
IV. You do not follow any reasonable recommendations made by Us.
V. You provide information which You knew to be false or misleading in support of Your Claim(s) and this information is material to the success of Your Claim(s).
VI. You fail to respond to reasonable requests for information in a timely manner and this prevents Us from providing the Services.
VII. You breach a term of these Terms of Business and You do not correct this breach within 14 days of receiving written notification from Us detailing the breach and the action required to resolve the breach.
b) We will always give You at least 30 days’ written notice of any changes before they take place. If You are not willing to accept the proposed change, You will be free to end the agreement but may be subject to a Cancellation Fee in accordance with Clause 6(c).
8. General Conditions About This Agreement:
a) This Agreement is governed by English law.
b) You cannot transfer Your rights and obligations under this Agreement but You can terminate the Agreement in accordance with Clause 6 above.
9. Health Ombudsman Service:
You have understood that you can apply to Your CCG directly for Continuing Healthcare, without the use of a Claims Management Company, and that applying yourself is free. In addition, should Your Claim be refused by the CCG, You can also refer the matter to the Health Service Ombudsman, again, without any charge. The Health Service Ombudsman is an independent service in the UK for settling disputes between individuals and the NHS.