When a person is injured on the job, all of their medical costs are covered by their employer’s Workers’ Compensation insurance. Compensation is given for typical expenses like doctor visits, prescriptions, and medical tests, as well as broader categories like mileage to and from medical appointments.
But what if you need in-home assistance with things like bathing, dressing, and other daily care? Do you have to hire an in-home nurse or can your own family member care for you and be paid for it?
Most families would just take on the duties of caring for their disabled loved one not knowing that there may be other options, even if it’s a sacrifice for the family member providing the care, but in providing home health services in place of a home health aide, that family member is deserving of financial compensation for their time.
Case Study: John Nicholson and Northridge Environmental, LLC
In July of 2010, John Nicholson was severely injured while working for Northridge Environmental, LLC in Northwood, NH. After a period of hospitalization, John was sent home the following month on August 25th and was prescribed in home care “through VNA of Southern Carroll County․ This will include physical and occupational therapy, a home health aide, and nursing services.” John rejected the offer for the home health aide and opted rather to have his wife help him with his medical needs.
Upon release from the hospital, John required round the clock care “due to balance problems, short term memory loss, and inability to perform certain regular activities of daily living.” His wife provided daily care by regularly cleaning his multiple open wounds, bathing and dressing him, assisting him with ambulation and toileting, and providing constant supervision.
In September 2011, John billed his employer’s insurance carrier to reimburse his wife for her caregiving from the date of his hospital release (August 25, 2010) until the present. The carrier refused. Then John asked for a hearing before the New Hampshire Department of Labor, which eventually took place on June 4, 2012. The Dept. of Labor also denied John’s request. Next John appealed to the New Hampshire Compensation Appeals Board. When they too denied John’s request for his wife’s reimbursement, he appealed to the New Hampshire Supreme Court.
The Supreme Court cancelled the Appeals Board’s ruling and sent the case back to the Board for them to determine which part of John’s wife’s care was compensable. In the end, John won his appeal and his wife was compensated for 12 hours of work per day at $15 per hour from August 25, 2010 until the date of his Dept. of Labor hearing, June 4, 2012. Even though the insurance carrier argued that John’s wife did not qualify for compensation because she was not a trained healthcare professional as listed in NH statute RSA 281–A:2, XII-b, the Board ruled that because of the way that the statute was worded, the list was not exhaustive, but merely for exemplary purposes. The insurance carrier did appeal this new decision to the NH Supreme Court, but the Court upheld the Board’s decision, bringing finality to the case in March 2016.
Two Important Details
The case we discussed above sets a precedent in New Hampshire for family members to bill the insurance for their in-home services. If you have a family member who needs at-home care for a Workers’ Compensation injury, then there are two details that are important to remember.
1. Get a doctor’s prescription for an in-home caregiver.
Reimbursement is possible for medical treatment that has been prescribed by a doctor. This has two parts to it that are important to note.
First, you MUST have a doctor’s prescription for an in-home caregiver in order to be reimbursed for taking care of your family member. Workers’ Comp will only pay for that which a doctor has prescribed.
Second, only the at-home care which a hired caregiver would do will be reimbursed. If you would normally do your family member’s laundry, cook the meals, or clean the house, then these are not reimbursable under the doctor’s prescription.
2. Keep records.
Keep detailed daily records as to what you did as a caregiver and what hours you worked. If the insurance company denies your request, these records will be invaluable in proving that you did the job of a health care provider. In John Nicholson’s case, his wife had not kept records, but they won on appeal anyway. You may not be as fortunate.
When In Doubt, Get an Attorney’s Help.
Your loved one deserves the choice of being cared for by family rather than by a stranger. Having a New Hampshire Workers’ Compensation Attorney on your side helps you know that you’re covering all of your bases to get the compensation that you deserve. If you have any questions about your Workers’ Comp case, call us for a free consultation.