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Understanding Home Modification Requirements in Workers’ Compensation

31 Oct, 2023 Donita Stacker

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By Donita Stacker, Sr. Manager, Operations, Apricus, an Enlyte company

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When a 33-year-old man, we’ll call Bill, was grievously injured at work, the last thing he expected he would need as part of his recovery was a real estate agent. But that’s exactly what the father of two required after falling from a second-story balcony on the job and becoming a paraplegic. 

When Bill’s landlord wouldn’t allow renovations that could have enabled him to use a wheelchair more easily, he knew he would have to move, so his employer agreed to purchase a house that could be modified to meet his needs. In this case, considerations included the budget for the home purchase, the desired location of the property, and the proposed timeline. 

While the particulars of Bill’s case are unique, the steps taken to address his challenges shed light on the kinds of questions that can come up when undertaking home modifications and illustrate the invaluable benefits that can arise from home modifications following workplace injuries. His situation also underscores how broad-based specialty networks offering a range of services can meet the sometimes-extraordinary needs of those who get hurt on the job.

Home modifications can involve everything from installing railings, ramps, and high seat toilets to widening doorways to accommodate wheelchairs. Working with a knowledgeable home modification coordinator can simplify this process.

When planning modifications, it’s essential to understand the individual’s needs. Trusted, skilled home modification coordinators will start by gathering high-level information from the injured employee and their family members to understand the patient’s needs for managing daily activities. Seeing the space also helps answer numerous questions including the width of various doorways, the size of bathrooms, and how well the injured employee might be able to move from room to room.

Home modification coordinators facilitate communication across all parties including the case manager, builder/contractor, and the injured employee. They can also work with an occupational therapist who can play a critical role in helping identify the injured employee’s needs and mapping out what interventions are most likely to be successful in meeting needed requirements. This is typically when the questions around a home modification start to become more detailed and might include:

Are disabilities temporary, progressive, or permanent? Modification requirements may change over time based on the longevity and type of injury.

Does the injured employee rent or own? If the injured employee is renting, a letter from the landlord permitting modifications to the home will be necessary. If the employee owns the home, it may be necessary to determine whether there are any regulations from an entity such as a homeowners’ association, and a copy of the deed might also be required.

How many stories does the home have? If it’s more than one, does the injured employee need access to all floors? Will a stair lift, or an elevator be required?

How old is the home? If it’s older, wiring might be outdated or the structure itself might not be suitable for modification without expensive upgrades, which may need to be considered.

How many entrances does the home have? Will it be necessary to modify multiple entry points, or will one meet the injured employees’ access needs? 

What limitations or special circumstances does the injured employee have? For example, are there children in the home?

What equipment does the injured employee own? It’s wise to obtain any details about the type of equipment such as a power wheelchair, lift or bed and to factor the existing equipment into modification plans.

What equipment is planned? As with existing equipment, it’s wise to factor any planned equipment into the proposed modifications.

Relying on a home modification coordinator that has a network contractor capable of executing home modifications is important because they can also identify reputable occupational therapists and other experts within a region who can determine which modifications are necessary. Having experienced providers that are regularly evaluated in performing this work can help ensure changes to an injured employee’s living environment are done correctly and in a timely manner to meet the goal of improving an injured employee’s day-to-day ability to function.

You should be able to place confidence in a home modification coordinator to ensure the injured employee’s needs are being met by the contractor across various touchpoints, to obtain several quotes, check references for quality of work, and work with several contractors to ensure an overall cost-effective modification is performed. In addition, you need cost transparency and may want estimates broken down by material and labor, to know project costs by room, and to know how much flooring costs. It’s also important to realize throughout this process that the payer’s role is to make modifications that accommodate the employee’s injury, but at a level comparable to what was in place before the modification.

There are so many practical considerations around home modifications that it might be easy to lose sight of the injured employee. But it’s essential that the individual’s needs and desires are considered. Injured employees who feel they are a part of the process are more likely to believe the resulting alterations will enable their activities of daily living. That resulting sense of self-sufficiency can help drive better injury outcomes.

Home modifications have the ability to improve the lives of injured employees in a wide variety of ways including improving mobility, preventing additional injury, and promoting rehabilitation. Taking advantage of a specialized home modification coordinator that focuses on workers’ compensation requirements to facilitate this increases case efficiency and overall program savings because they contract with a broad range of cost-effective local and national home modification partners that cover many specialties. While home modifications may not occur routinely, they provide vital access, and relying on a knowledgeable specialized coordinator you can trust with these complex cases is crucial.

About the author

Donita Stacker has over 16 years of experience in the workers’ comp industry. In her current role as Manager of Strategic Implementations and Complex Care, she is responsible for delivering exceptional customer experiences during various implementation stages. As an operational leader, Donita collaborates with technical and operational teams to establish conversion strategies, capacity planning and outcome monitoring to ensure an overall successful program.

Donita is also a regular contributor to our Specialty Solutions Spotlight where portions of this article originally appeared. To ask and find the answers to more work comp specialty questions visit our website and subscribe to our monthly series.

www.apricusinc.com


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