Attendant Care in Workers’ Compensation Cases: What Insurance Companies Don’t Want You to Know

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What is Attendant Care in Workers’ Compensation?

Attendant care is the provision of assistance to individuals who cannot care for themselves due to physical or cognitive limitations. Generally, it involves someone else providing help to those who cannot perform basic activities of daily living (ADLs) or Instrumental ADLs (IADLs) on their own.

One of the most “overlooked” benefits available under North Carolina workers’ compensation law is payment for attendant care provided by family and friends. Insurance companies will never tell you about it and are generally reluctant to pay for it when they know they owe it. Why? Money! It’s very costly. Thus, the insurers “hide” the benefit. 

After severe injuries to workers, they may not be able to take care of themselves for a short time or permanently. While this can mean discharge to a rehabilitation facility, assisted living facility, or nursing home, the burden instead too often falls on spouses, significant others, other family members or even friends. The injured worker is receiving “attendant care” from family and friends, but they are not getting paid. Thus, the insurance carrier receives a windfall. In the absence of the family members or friends, the workers’ compensation carrier would have to pay for home health care aides/CNAs to come to the injured worker’s residence or pay for the worker to live in a facility that can care for them. 

The insurers purposely ignore or turn a blind eye to their obligations to pay for family members or friends providing the attendant care. Although it may be clear from medical records or nurse case manager reports that the injured worker needs attendant care, the insurance carrier does not want to pay for such services. Thus, insurers do not request the doctor address the issue of the need for attendant care or the amount of care needed.  

Despite their obligation to provide all reasonable and necessary medical care to the injured worker, they do not send an expert to do an in-home evaluation to help determine potential home modifications or attendant care needs. They continue to take advantage of the medical care provided by family members and friends. 

What is an ADL? 

The National Institute of Health categorizes ADLs into six primary categories:  

• Ambulating: The extent of an individual’s ability to move from one position to another and walk independently.  

• Feeding: The ability of a person to feed oneself.  

• Dressing: The ability to select appropriate clothes and to put the clothes on.  

• Personal hygiene: The ability to bathe, groom oneself, and maintain dental hygiene, nail, and hair care. 

• Continence: The ability to control bladder and bowel function. 

• Toileting: The ability to get to and from the toilet, use it appropriately, and clean oneself.  

According to N.C.G.S. §97-2(19), attendant care must be prescribed by an authorized healthcare provider. This can be in the form of a written prescription or noted in medical records.

What is an IADL? 

More complex daily activities, called Instrumental ADLs (IADLs), require more complex thinking skills, including organizational skills.  

• Transportation and shopping: Ability to procure groceries, attend events, and manage transportation, either via driving or by organizing other means of transport.  

• Managing finances: This includes paying bills and managing financial assets.  

• Shopping and meal preparation: This includes everything required to prepare a meal and shopping for clothing and other items needed for daily life.  

• House Cleaning and home maintenance: This includes cleaning kitchens after eating, keeping living areas clean and tidy, and keeping up with home maintenance.  

• Managing communication with others: The ability to manage telephone and mail.  

• Managing medications: Ability to obtain medications and take them as directed.  

About Attendant Care  

What Types of Injuries or Disabilities Typically Qualify for Attendant Care Benefits?  

Attendant care is a type of support that assists individuals with daily living tasks (ADLs) and other activities they may be unable to do independently. This type of care is often necessary for individuals who have suffered severe injuries that have left them unable to care for themselves temporarily or permanently and unable to live alone safely.  

Some examples of severe injuries that may require this type of care include:  

• Traumatic Brain Injury (TBI). 

• Quadriplegia. 

• Paraplegia. 

• Complex Regional Pain Syndrome. 

• Post-Traumatic Stress Disorder (PTSD). 

Some individuals may require assistance with ADLs after their injuries, while others may not be able to safely be left alone for more than short periods or not at all for various reasons. Depending on the severity of the injury, the care needed can range from several times a week, a few hours a day, to 24 hours per day, seven days a week.  

If you or a loved one has suffered a severe work-related injury that has left you or a loved one unable to care for themselves, obtaining attendant care can be a significant help and reduce the significant financial burden caused by the injury. 

What Legally Counts as Attendant Care?  

Employees who suffer work-related injuries may be entitled to attendant care services in North Carolina. If medically necessary because of a work-related injury the workers’ compensation carrier must provide:  

“Attendant care services prescribed by a health care provider authorized by the employer or subsequently by the Commission.” N.C.G.S. §97-2(19).  

A ‘prescription’ can be an actual prescription, a letter, or be present in the medical records. The prescription must be from a health care provider authorized by the employer or subsequently by the Commission. While not required to be in writing, it is better to obtain the need for attendant care in writing to avoid any confusion and hopefully reduce potential disputes later. 

Who Can Provide Attendant Care?  

• Rehabilitation facility. 

• Assisted living facility. 

• Nursing home. 

• Home Health Care Agency. 

• Anyone can provide non-professional attendant care to an injured worker.  

Attendant Care & Workers’ Compensation  

What Is Attendant Care in the Context of Workers’ Compensation, and How Does It Differ from Other Benefits?  

• Workers’ compensation covers medical and indemnity benefits (reduction or loss of wage-earning capacity). It does not cover pain and suffering. 

• Attendant care is considered a “medical” benefit.  

• Attendant care aims to assist injured workers in maintaining their independence and quality of life, despite having suffered a severe injury.  

• Insurers hide the fact that they owe “attendant care” provided by family members or friends and virtually never pay for such without a fight. 

• Unlike insurance payments to a doctor or hospital, when the attendant care is provided by a family member or close family friend the payment can be made to them or the injured worker which helps the family unit financially and reduces the overall burden caused by the injury.  

• When Things Go South in Workers’ Compensation Cases addresses attendant care compensation, which involves addressing challenges like contesting necessary care amounts, establishing fair service rates, and understanding insurance companies' motivations to reduce care hours. 

Doug Maynard Fights for You  

Doug Maynard, a seasoned attorney based in North Carolina with extensive experience in handling workers’ compensation cases, excels in ensuring compensation for attendant care services rendered by the loved ones of injured workers.  

Although such services are covered under North Carolina workers’ compensation law, insurance companies frequently resist covering them due to their costliness. In a notable instance, Doug advocated for a client who sustained partial quadriplegia from a workplace accident. With the insurance company’s denial of the entire claim contending that the employee was an “independent contractor” the client relied on their partner and a family member for 24/7 care. Undeterred by the complexities of the case, Doug navigated these challenges adeptly, ultimately achieving a $3,500,000 recovery for his client several months after a one and a half day hearing. 

Ironically, the employer in the case wanted their insurer to accept the claim, but the insurance carrier denied it instead to save money. At the hearing, a representative of the employer while exiting the witness stand whispered to Doug’s paralegal, “I hope you win the case.” 

Attendant care is a crucial benefit for workers who have suffered severe injuries. If you or a loved one are struggling with obtaining compensation for such care, it’s important to seek legal help. Experienced attorneys like Doug Maynard can fight for your rights and ensure you receive the benefits you deserve. Contact us today for a consultation.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal advice. Reading this article or interacting with its content does not establish an attorney-client relationship with Maynard Law. To create such a relationship, a formal agreement is required. Past results mentioned in this blog post do not guarantee future outcomes. Each case is unique and must be evaluated on its own merits. For legal advice tailored to your specific situation, please contact a qualified attorney.