Can Workers Compensation Pay My Family Member for Taking Care of Me While in Treatment? I recently received this question from a client who was recovering from surgery:
Can workers compensation pay my family member for taking care of me while in treatment?
The only answer I could offer him (or to anyone for that matter) was “it depends”. I say that because the actual answer depends on whether or not home attendant care is deemed a medical necessity.
So what exactly constitutes a medical necessity?
Well, this short answer here is “whenever a judge or insurance company says so”. The long answer is that there are several things that go into this decision post-surgery, and you’ll need a statement from your treating physician explaining why attendant care is necessary. Factors that can contribute to such a decision include lack of mobility (for example, not being able to visit the bathroom by yourself), inability to feed or clothe yourself, etc. Before deciding to undergo a surgery that has the potential to leave you unable to care for yourself for a short amount of time, do be sure to consult with your physician beforehand regarding home care.
Okay, the doctor signed off on home care…now what?
If your plan is to have a loved one administer home care to you, one key thing to understand is how reimbursement operates. The rates for reimbursement are set by the Workers Compensation Commission under what’s known as the fee schedule. This is a state-mandated list that dictates how much a medical care provider can be compensated for their services. In the case of a significant other being the care provider, the fee schedule will determine a maximum amount for which he or she can be reimbursed.
For example, your wife or husband brings in a salary of 300k per year. He or she takes a week off from their job to provide post-surgical in-home care. Worker’s compensation will not reimburse your spouse the equivalent of a week’s worth of their salary; it’s likely to be far, far less. This is important to keep in mind for financial planning purposes during your recovery time.
If for whatever reason, you do not intend to have a loved one provide in-home care after your operation, worker’s compensation can arrange for professional attendant care. As usual, this is very fact-dependent and is typically only offered for a short window of time. Like we saw above pertaining to care provided by a spouse or significant other, a doctor’s statement explaining the need for in-home care will be required.
Can Workers Compensation Pay My Family Member for Taking Care of Me While in Treatment? As always, we’re here to help!
If everything falls perfectly in line, a good attorney will be able to get you or a loved one reimbursed for in-home care, whether it be provided by a loved one or a professional. Helping injured workers and their families is our passion here at Kaplan Morrell, and we’ve been doing it for 25 years. If you or someone you know has been injured on the job in Colorado, please reach out to us at 866.356.9898. We work with people on a contingent fee basis, and there’s never a charge to talk with us for an initial consultation. Let us know how we can help you!