How Brain Injury Case Management Is Funded

When a family finds out that their loved one needs a case manager following a brain injury, the first question is often: who pays for this?

The answer depends on the circumstances, but for most of the people we work with, the cost of case management is met by insurance, not by the individual or their family. Here is an explanation of the main funding routes.

Personal injury claims

The most common route to case management is through a personal injury claim. When a brain injury results from an accident, a road traffic collision, a medical procedure that went wrong, or another event where someone else may be liable, a solicitor will typically be instructed to pursue a claim. In these circumstances, the other party’s insurer is responsible for funding rehabilitation, including the cost of a case manager.

This is not an unusual arrangement. Personal injury insurers fund rehabilitation routinely. It is in their interest to do so: good rehabilitation reduces long-term care costs and helps injured people recover as much function as possible.

The Rehabilitation Code

Since 2015, personal injury cases in England and Wales have been governed by the Rehabilitation Code, a voluntary framework agreed between insurers and claimant solicitors. The Code is clear: rehabilitation should not wait for the legal case to be resolved. It should begin as early as possible after an injury.

In practice, this means a solicitor can approach the defendant’s insurer at an early stage to agree funding for a case manager and an Immediate Needs Assessment. Rehabilitation can be underway within weeks of instruction, long before any settlement is reached.

Interim payments

Where insurers do not agree to fund rehabilitation voluntarily, or where greater funding is required, a solicitor can apply to the court for an interim payment. This is a payment made in advance of the final settlement, based on the likely value of the claim.

An interim payment for rehabilitation comes out of the overall settlement eventually, but it does not reduce the final award pound for pound. Courts take a pragmatic approach: good rehabilitation reduces long-term need, and therefore the overall value of the claim.

Court of Protection deputyship

Some clients come to us through a Court of Protection deputyship. This applies where a person lacks mental capacity to manage their own affairs, and a deputy, usually a family member or a professional deputy, has been appointed to act in their best interests.

Where the client has assets, such as a previous personal injury settlement, the deputy can fund case management from that estate. Case management fees are treated as a reasonable welfare expenditure and can usually be authorised by the deputy without returning to the court.

NHS Continuing Healthcare

For people with long-term complex health needs, NHS Continuing Healthcare may be worth exploring. This is free NHS funding for care outside hospital, and can sometimes include a personal health budget covering case management. Eligibility depends on the nature and complexity of a person’s needs, not their diagnosis, and is assessed by a multidisciplinary team.

NHS CHC can be slow, and eligibility is not guaranteed. We can advise on whether it is worth pursuing in a given situation.

Private funding

Some families fund case management privately, at least initially, while waiting for other funding to be confirmed. We are transparent about our rates from the outset, and we do not carry out work that is not justified by the client’s needs.

If you are not sure which applies to you

It is not always obvious which funding route is relevant, particularly in the early stages after an injury. If you are not sure, the best starting point is to speak to a solicitor who specialises in personal injury or clinical negligence. They can advise on whether there is a viable claim and how rehabilitation might be funded.

If case management has already been recommended and you are waiting for funding to be confirmed, Get in touch. We can advise on the options and, where appropriate, begin work while funding arrangements are being finalised.