April 20, 2019

Can my Spouse Get Paid by the Insurance Company for Helping Me Recover at Home from my Injury?

workers comp reimbursementMany of my clients are surprised to learn that their husband, wife or significant other can ask for payment for “attendant care” of an injured worker at home.   Why?  Often my seriously injured clients cannot take care of basic necessities such as:

  • bathing
  • dressing
  • meal preparation
  • driving
  • cleaning

Given that hospitals often release patients home as soon as possible, I see more and more instances where my clients recover mostly at home, with outpatient visits to rehab.

Under Georgia law (Georgia Code Section 34-9-200(a)), the employer/insurer must provide care that “shall be reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.”   In the case of Medical Office Management v. Hardee, the Georgia Court of Appeals held that:

There is no express prohibition in the Workers’ Compensation Act against the recovery by an employee of attendant care services provided by a family member, including a spouse. Nor does the employer show that a family member cannot provide attendant home care under the Board’s rules and regulations…

The employer had argued against this “spousal reimbursement” on the grounds that the spouse was performing tasks he/she would do otherwise.   The Georgia Court of Appeals, as you can see, ruled otherwise, and permitted Ms. Hardee’s husband to collect a fee under the State Board fee schedule for attendant services.

What does this mean to you?

  • First, do not expect your employer or its insurance company to offer to pay your spouse or significant other for attendant care.   Many insurance adjusters are not aware of the Hardee case and even some who are will tell you (incorrectly) that your spouse cannot collect.
  • Second, it helps tremendously to have your authorized treating physician note the need for attendant care.  In my experience it sometimes is necessary to have the doctor write a letter specifically setting out the requirement for attendant care.
  • Third, non-medical attendants like spouses or family members can get paid based on the State Board’s fee schedule, which sets a specific hourly rate and other limits
  • Fourth, insurance companies will look for ways to avoid paying an injured workers’ spouse.  At a minimum, your spouse must have the physical and mental capacity to care for you.   You should seek legal counsel before submitting a request for spousal reimbursement.

If you would like to know more about spousal attendant care, please call me at 770-351-0801or send me an email.

 

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Jodi Ginsberg

Attorney Jodi Ginsberg represents employees who are injured on the job and who need medical care and missed wage benefits available under Georgia's workers' compensation laws.

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