Three million people in the United States receive home health care each year. Many of these people were injured on the job. If you or a loved one is hurt at work, you need to know if workers’ comp covers home care in North Carolina.
Horton & Mendez Injury Attorneys explains home health care in NC workers’ compensation.
Can You Get Home Care in North Carolina Workers’ Compensation?
Yes. Home care may be a covered benefit of North Carolina workers’ compensation. Care must be necessary. It is typically ordered by the treating physician. If home health care is denied, the injured person can challenge the decision and ask for a hearing.
Understanding Home Care in Workers’ Compensation Claims
Home care is called attendant care for North Carolina workers’ compensation. It is medical or personal care that is provided in a person’s home. Home care allows a person to live at home where they would otherwise need to live in a nursing home.
N.C.G.S. § 97-2(19) says that a person who is hurt and covered by workers’ compensation, may receive medical compensation. Medical compensation is more than hospitalization or emergency care. Medical compensation includes attendant care services, which is home health care.
More generically, medical treatment and supplies may cover treatment that is necessary to cure, provide relief, or lessen the period of disability. (N.C.G.S. § 97-25)
Note: Lawmakers amended N.C.G.S. § 97-2 to expressly include attendant care in the types of treatment available to an injured worker.
Types of Home Care Services Covered by Workers’ Comp
- Bathing
- Brushing hair and teeth
- Laundry, housekeeping
- Eating, dishes
- Shopping, personal errands
- Dispensing and tracking medication
- Physical therapy, movement
Home care services may be personal or medical in nature.
Attendant care may be needed for short periods or 24 hours a day. Either one may be covered, if it is appropriate for the person’s medical condition.
Is home care provided by a family member covered under NC workers’ comp?
In many cases, yes. Home care by a family member may be paid under NC workers’ comp if it is care that a professional would otherwise provide. Care must be more than normal household duties, and there must be a way to determine with proper certainty the value of services performed by a family member.
Medical Conditions
Medical conditions that may be appropriate for workers’ comp home care benefits include the following:
- Traumatic brain injury
- Paralysis, nerve damage
- Broken bones
- Torn ligaments and tendons
- Back pain
- Loss of limb
- Occupational exposure, toxic exposure
- Cancer, degenerative disease
- Loss of vision
Home care may be preferred for an injured person for multiple reasons. First, it may be provided at a lower cost than residential care.
When home health care is needed for only a few hours, it is less expensive than living in a facility. Home care also allows the person to remain in their home. The person may heal better in their home environment and may have less exposure to infections that can spread in a group home.
Cases and History
Shackelton
Home care benefits in NC workers’ compensation have been discussed significantly in North Carolina case law. In Shackelton v. Southern Flooring & Acoustical Co., the decedent was exposed to asbestos in his employment. He developed breathing problems that eventually resulted in his death.
As his illness progressed, his wife helped him at home for six hours per day. His daughter then helped up to 10 hours per day. Finally, the person had 24-hour care.
The insurance company challenged the request for attendant home compensation. They said that no physician had ever prescribed home care.
On appeal, the court said that requiring a physician’s prescription was too rigid. They said that the framework for deciding a particular case should be more flexible and that the evidence supported the need for home medical care.
Thompson
In Thompson v. International Paper Co. (2017), the worker suffered burns and required a skin graft. The doctor said the worker needed attendant care for the rest of their life. However, the doctor never wrote a prescription. The court said that the doctor effectively wrote a verbal prescription. The court said that the doctor’s verbal directives could be given sufficient weight to support an award of care.
Reid
In Reid v. Carolina Holdings Wolseley Management (2017), the worker suffered a traumatic brain injury. The court awarded reimbursement for attendant care from the date of the hearing request. They declined to award attendant care back to the date of injury because the injured worker hadn’t sought approval for attendant care before the hearing request.
The case underscores the importance of both requesting care early and case procedure. A person may have an attorney representing them from the time they are injured and throughout their case.
How to Apply for Workers’ Comp Home Care Coverage
To apply for workers’ comp home care, speak with your treating physician. Ask them to order it.
If they refuse, ask for an authorized second opinion. If that is unsuccessful, you may ask the North Carolina Industrial Commission to authorize a second opinion. You may also build the evidence on your own and ask for a hearing about your benefits. You may appeal from the Commission to the courts.
We invite you to contact Horton & Mendez Injury Attorneys for assistance in applying for this important benefit.
Challenges in Getting Home Care Approved by Workers’ Comp
The plaintiff bears the burden of proof that attendant care is appropriate. In building a claim, a victim may work with an independent physician or life planner who may speak to the need for home care. Testimony of family members and other lay witnesses can be helpful.
However, that testimony alone is unlikely to sustain a claim for home care.
When services are provided by family, there must be a showing that the care rendered is what would be provided by a trained attendant.
Contact an Experienced Jacksonville Workers’ Compensation Lawyer
Are you applying for workers’ comp home care? Do you need help applying? Has your attendant care request been denied? Horton & Mendez Injury Attorneys can help. Contact an experienced Jacksonville workers’ compensation lawyer to talk about your case.
