Workers' Compensation Dilemma: Reimbursement for Home-Health ...

15
May

The Scenario
A worker sustains very serious on-the-job injuries and is taken by ambulance to the hospital. The worker is hospitalized for a period of time and is then discharged from the hospital. Upon discharge, the doctors make it clear that the worker must receive ongoing medical care in that the worker cannot take care of his basic daily needs (medications, walking, personal hygiene, etc.) The workers? compensation insurance carrier must authorize and provide for post-discharge care and treatment. That is the law under California Labor Code Section 6400. However, what happens in fact is quite different.

The Reality
Most injured workers upon leaving the hospital want to go home and be cared for by their loved ones, including their non-injured spouse. This makes sense. Going home is often a much better option than having to go live at a skilled nursing facility at some far distance away from home and family. What these injured workers do not realize is the great amount of time and effort that their care and treatment will require of their family members. These family members are entitled to be paid for their services rendered to the injured worker. What often happens is that the insurance company allows the family members to take care of the injured worker for free, never telling the family members that they are entitled to reimbursement. Once in a while a family member will ask for reimbursement and the insurance company will simply say, ?look it?s your time to take care of your loved one? or more likely, ?the treating physician did not prescribe home health aid care so we don?t have to pay for it.?

Slice of Appel PI Analysis
The worker?s compensation insurance industry has gotten away for decades without paying family members for services rendered to injured workers. This is a multi-million dollar farce perpetrated by the insurance industry upon family members. The Appel Law Firm LLP highly recommends the following:

Prior to discharge from an acute care hospital or other similar type of facility, the injured workers and their families must discuss the post-discharge plan of care with their treating physicians.
If it is decided that the injured worker will go to his or her home for treatment, then the injured worker and their family must make the doctors issue prescriptions for this type of care and fax that type of prescription directly to the insurance companies.

This will force insurance companies to set up a plan of care which will timely and sufficiently reimburse the family members for care and treatment rendered to injured workers. If it is not done, the injured worker?s family members stand great risk of having to provide uppaid labor for the insurance companies at the cost of their own family time. Thanks for reading Slice of Appel PI today regarding worker?s compensation and we hope you continue to read and share our blog with others.
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