Could Electrocuted Foreman who Lost Hand get Jacuzzi, Porch Repairs?

What Do You Think?

Claims administrators should not automatically deny every request for medically related equipment, even if it seems at first glance far out. But they should consider whether the claimant has provided anything to support his medical need for the equipment.

That issue arose in the case of a foreman for a paving company who was electrocuted at work. It happened when a dump truck hit a power line, causing a live wire to land on the paver he was operating. He suffered severe burns to much of his body, underwent several surgeries, and had to have his right hand amputated.

The claim administrator awarded the foreman workers’ compensation benefits. Later, a physician’s assistant prescribed the foreman a walk-in jacuzzi tub and shower so he could sit down when cleaning himself. The foreman said he needed it because he couldn’t use his prosthetic hand in the shower to safely clean himself without assistance and that he was otherwise in danger of falling.

The foreman’s nurse case manager indicated that his front porch boards needed to be replaced because they were old. They had been deteriorating for over 20 years.

An independent medical examiner found that neither the jacuzzi was not medically necessary. He stated that with "the various means and implements available for disabled persons with limited mobility to reach their back and groin areas, [the claimant’s] continued use of his existing shower is both possible and practical."

The claims administrator denied both requests. The workers’ compensation board affirmed that decision. The foreman took his case to court.

Under West Virginia law, a claims administrator must provide funds for health care services, rehabilitation services, durable medical and other goods and other supplies and medically related items as may be reasonably required.

Should the board have granted the claimant’s requests?

A. No. The evidence didn’t clearly show he needed the jacuzzi or porch repairs as a result of his accident.

B. Yes. Given that he was missing a hand, he needed to be able to sit down when he showered.

If you selected B, you agreed with the court in Carey v. AAA Paving and Sealing, Inc., No. 24-ICA-436 (W. Va. Interm. Ct. App. 06/06/25), which affirmed the board’s finding that the foreman didn’t show he medically needed them.

The court relied in part on the fact that the claimant didn’t explain why the jacuzzi or porch repairs were medically necessary as a result of his injuries.

Further, although the physician's assistant prescribed the walk-in jacuzzi tub and shower, she did not provide information supporting the medical necessity of these requests. On top of that, the independent medical examiner found the jacuzzi was not medically necessary. As to the front porch boards, the foreman admitted they had been deteriorating for over twenty years prior to his injury, indicating that they were disconnected not only from the porch itself, but also from the accident.

Finding the evidence supported the board’s conclusion, the court affirmed that decision.

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