After a serious Nevada work accident and hospitalization, the injured worker may require a nurse, then unskilled nursing care at home to go to the bathroom, bathe, and make meals. This need for home health care often falls through the cracks if the treating surgeon forgets to prescribe attendant care, or the hospital coordinator doesn’t follow through getting it authorized with the claims adjuster. If a nurse case manager isn’t assigned to the claim, the adjuster may get the request, but may not arrange for it on time. What often happens is that the injured worker’s family or closest friends must step in to provide home care during the critical time following the patient’s release from the hospital or from a surgical center.
If a spouse or other family member takes time off their own jobs in order to provide necessary care, they are unfairly losing valuable vacation, family medical leave time, and wages. On many claims where the injured worker isn’t represented by counsel, there hasn’t been any telephone communications between the claimant and the adjuster. The injured worker and his family expect that the doctor, the insurance company, or their employer will take care of this need. Wrong. You can’t just expect things to happen in the workers’ comp world.
The claimant or his family should try to make sure that home health care is authorized and scheduled before the claimant comes home from the hospital or from the surgical center. It’s important also that any home health care agency that supplies home health care bills the workers’ compensation carrier so that the injured worker isn’t billed for co-pays.
If you want your spouse or another family member to get paid for taking care of you, don’t wait until after care is provided to ask the insurer about reimbursement. Almost twenty years ago, the Nevada Supreme Court decided that a family member who wants to be reimbursed for providing home health care must request this from the insurer before providing care. Additionally, the injured worker must show that a doctor prescribed it as medically necessary. SIIS v. Snyder, 109 Nev. 1223, 865 P2d 1168 (1993).
In addition to having a physician prescribe home health care, the adjuster has to be persuaded that your family attendant is a reasonable substitute for unskilled help from a home health care agency. The amount the insurer must pay for home health care is set forth at p. 4 in the Nevada fee schedule, and the insurer will not pay a family attendant more than it would have to pay for outside agency help.
I have had cases where I have been retained after a family member has provided attendant care without requesting preauthorization. Some adjusters are willing to pay a reasonable amount of money, not to exceed the fee schedule, after the fact. However, the better practice is to ask for it before it is necessary. NRS 616C.440(1)(c) is the statute that allows for attendant care expenses on a claim.
–Written by Virginia Hunt, Hunt Law Office