Home Healthcare and Workers’ Compensation

All conscientious employers work hard to make sure that their employees are safe and do not sustain an injury while on the job.  Unfortunately, despite the most diligent efforts, it is still possible that employees may sustain an injury during the course and scope of their employment.  When this occurs, the employee will be entitled to workers’ compensation, which covers their medical costs, as well as a percentage of salary replacement.  The medical costs that are covered by workers’ compensation cover a wide variety of treatments, ranging from surgery to acupuncture to psychiatric treatment.  One issue that may come up during your employee’s workers’ compensation case is home health care.

Workers’ compensation covers the treatment and cure costs for injuries sustained through the course and scope of employment.  Once a medical professional has diagnosed your employee with a particular injury, the medical professional will then provide a treatment plan for your employee.  The treatment plan may include home health care.  A determination that an employee requires home health care will require an assessment of several issues and the employee’s needs for three types of services.  These services include skilled nursing and therapy services, assistance with personal tasks, and assistance with activities that allow a person to remain at home.  Personal tasks include tasks such as grooming, dressing, and eating.  Activities that allow a person to remain at home include shopping, cooking, and housework.  It is important to note that these services are not inherently medical services, meaning that no medical training is required to complete these tasks.  Nevertheless, they qualify under home health care services for purposes of workers’ compensation.

In 2015, the California Senate passed a bill requiring the California Workers’ Compensation to establish a fee schedule for workers’ compensation schedule.  Before that bill, the Official Medical Fee Schedule established the fee schedule for home health care services under workers’ compensation.  The bill also provides that the treating physician of the injured employee needs to prescribe home health care services, and also request authorization.  The process of utilization of review will allow the insurance provider or other payer to determine whether home health care services are necessary and appropriate.

We have extensive experience helping our clients understand what benefits their employees may receive through workers’ compensation.  Call us today to talk about your case and your business.

Workers’ Compensation and Medical Marijuana

Healthcare is a major industry in the United States, and advances are frequently made in medical technology, genetics, and pharmaceuticals.  Medical Marijuana is one area where there have been many recent advancements.  These advancements include not only medically and understanding how marijuana can help treatment a variety of conditions, but also in the law.  When an employee sustains a work-related injury, he or she may be prescribed medical marijuana to address their injury.  As an employer, it is important for you to understand how medical marijuana fits in the workers’ compensation system.

California Labor Code section 4600 states that any treatment that is reasonably required to cure an injury or relieve the employee from the effects of the injury will be covered under workers’ compensation.  The Workers’ Compensation Appeals Board has determined that this can include medical marijuana.  Naturally, a worker must receive prescription from a doctor for the costs to be covered.  Moreover, if the treatment plan includes medical marijuana, the plan is subject to independent medical review and utilization review to make sure that independent providers agree the marijuana is medically necessary to address the work related injury.

There are some other important issues to be aware of.  First, although California has passed law legalizing the use of medical marijuana, marijuana remains illegal under federal law.  Although these federal laws are not typically enforced in terms of medical marijuana dispensaries, this does not change the fact that the possession and sale of marijuana – even for medical use – remains illegal  under federal law.

In addition, just because an employee is using medical marijuana, that does not mean he or she is not subject to certain restrictions.  Just as an employee taking prescribed opiates may not be a suitable person to continue to operate heavy machinery, an employee may not be able to use medical marijuana during the work day.  Employers also need to keep in mind that there are rules about when an employer can require drug testing.  In addition, firing an employee for testing positive for medical marijuana can run afoul of regulations under the Americans with Disabilities Act.

We have extensive experience with the workers’ compensation system and explaining an employer’s rights and responsibilities.  Contact us today for a consultation.

Home Healthcare and Workers’ Compensation

For obvious reasons, workers’ compensation is intricately intertwined with the health care industry. This may include hospital stays, physical therapy, chiropractic services, psychological treatment, or an enormous variety of other services, depending on the nature of the work-related injury. With respect to home healthcare, employers need to be aware of two different potential issues that are related to workers’ compensation.

The first potential issue is if the employer’s own business is to provide home healthcare services. In California, it is required that all employers provide workers’ compensation insurance for all of their employees, with a few limited exceptions. The home healthcare industry is not one of those exceptions, in and of itself. In other words, chances are that your home healthcare business is required by California law to carry workers’ compensation insurance. Although home healthcare is not typically thought of as a “high risk” industry, there are many hazards inherent in the home healthcare business. Home healthcare providers are always inside of unfamiliar homes that may not be very clean or safe. Even if the home is completely free of typical hazards, simply being unfamiliar with surroundings can lead to more injuries. Accordingly, it is essential that home healthcare business owners not ignore the workers’ compensation insurance mandate.

The other potential issue could be whether an employer of a worker who has sustained work-related injuries is required to pay out a claim for home healthcare. This issue was addressed in a WCAB case called Hernandez v. Geneva Staffing, Inc. that was handed down in June 2014. In that case, a worker had a severely injured hand and received home healthcare services from his wife. He submitted a claim to his employer for payment for those home healthcare services. The employer denied the claim, based on the fact that the employee failed to provide a valid medical prescription for the home healthcare services. The WCAB explained that an employer may be liable to pay for home healthcare services where certain conditions are met, such as a valid medical prescription. The WCAB also explained that the amount that the employer may be liable for is limited by the Official Fee Schedule.

Employers of any industry have many responsibilities toward their employees when it comes to workers’ compensation. Call me today at (714) 516-8188 and let me review your business’s obligations with you.

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