North Carolina Workers’ Compensation: Attendant Care Services
In North Carolina, as in other states, when an employee gets a work-related injury or occupational illness, the legal remedy is usually a workers’ compensation claim. Very basically, the workers’ compensation system is almost always the exclusive remedy for work injuries, paying benefits to injured workers no matter who was at fault. In exchange, the worker may normally not sue his or her employer in court for the harm.
North Carolina workers’ compensation statutes require that the employer provide “medical compensation” to an employee with a covered work injury or illness. Medical compensation includes not only typical medical expenses like physician, hospital, nursing, pharmaceutical and rehabilitation costs, but also “attendant care services” and more.
Attendant care services are provided when a family member or another person stays with the injured or sick person because the patient cannot provide self-care; is too vulnerable to be alone; needs assistance with activities of daily living like eating, toileting or bathing; requires help with mobility, medication, therapies or health equipment; cannot perform household chores and so on. Typical conditions requiring attendant care include brain injuries, cognitive impairments, restrictions to mobility and degenerative conditions like advanced cancer or lung disease.
The statute also says that to be covered the services should “effect a cure or give relief” or “tend to lessen the period of disability.”
If the employer or the employer’s insurer refuses to pay for necessary attendant care services, the worker, or sometimes his or her family, can request review of the case by the North Carolina Industrial Commission, the state agency responsible for enforcing and administering the workers’ compensation laws. Adverse decisions are appealable to the appellate courts, in the same way as any other Industrial Commission decision.
Some important features of the developing North Carolina workers’ compensation law affecting attendant care services:
- Attendant care expenses may be recoverable retroactively for services already provided.
- Family members may provide covered attendant care services and do not necessarily need to give up their regular jobs to qualify.
- Payment for attendant care services is usually at the going hourly rate in the local community.
- Types of evidence that may support a claim for attendant care include physicians’, nurses’ or “life care planners'” assessments; hospital reports; or testimony from the injured employee and family members; sometimes the severity of an injury or disease alone makes the need obvious.
- A doctor’s prescription for attendant care would be strong evidence of the need, but a prescription or order from a physician is not required for the expense to be covered where there is other supporting evidence.
- Coverage of attendant care services can be obtained, even if they were not preapproved.
- In some situations when a claimant has to fight for attendant care service coverage, attorneys fees may be recoverable.
- North Carolina law requires the payment of interest on unpaid attendant care services if they are ultimately found to be a legitimate part of the workers’ compensation claim.
If you or a loved one faces the need for attendant care services for a work-related illness or injury, talk to a North Carolina workers’ compensation attorney about your claim. Employers and their insurance companies may be reluctant to step up and cover these needed expenses because in severe cases with long-term conditions, the need for attendant care can be ongoing and expensive. An experienced lawyer can help you fight for what the law requires.