Injured employees who qualify for worker’s compensation in North Carolina and Virginia are entitled to payment for their medical expenses. In addition to payment for surgeries, doctor visits, physical therapy, and other medical care with health providers; employers are generally entitled to payment for any medical devices to improve their health.
Medical devices are more commonly called durable medical equipment. Some durable medical equipment helps to improve an employee’s health. Durable medical equipment (DME) may help an employee do his/her job. DME also helps injured employees function at home and while they are away from both home and work. Medical devices also include assistive devices for vehicles and the home – and medical supplies.
In North Carolina, the North Carolina Industrial Commission has a schedule of acceptable charges for durable medical equipment. The employee should not have to pay these charges. The employer or the employer’s insurance company should pay for your durable medical equipment and any other medical devices.
What are the different types of medical equipment an employee might use?
Injured employees may need medical equipment for many injuries and illnesses including orthopedic injuries, cancer, respiratory illnesses, diabetes, heart diseases, and many other injuries and diseases.
Medical equipment includes:
- Medical supplies. These may include bedpans, catheters, wipes, shoes, creams, bandages, and other supplies.
- Durable medical equipment. DME includes the following:
- Bath safety fixtures
- Blood sugar monitors and blood sugar test strips
- Canes, crutches, and walkers
- Commode chairs
- Glucose control solutions
- Hospital beds
- Nebulizers and corresponding medications
- Orthopedic pillows
- Oxygen equipment
- TENS unit
- Traction equipment
- Wheelchairs and scooters
- Modifications to a vehicle and a home. Some employees may need hand controls to drive or a ramp for a wheelchair or other modifications to their home due to their permanent handicap. If the employee is ruled to be incapacitated from all work, and the Commission orders it, the employer or its insurance company may be required to pay for these improvements. In Virginia, as of 2022, there is an aggregate cap on such modifications of $55,000.00. See VA Code 65.2-603 (A)(1)(a). The balance of funds used the purchase said vehicle can be used for maintenance on said vehicle or the modifications or on home modifications. That being said, as of 2022, unfortunately, Virginia lumps in the aggregate cap on modifications to a vehicle and home together at $55,000.00.
The employer/insurance company may be required to pay for the widening of hallways and doors so you can use a wheelchair in your home, as well as bedside lifts, adjustable beds, ramps, handrails, or any appliances prescribed by the treating physician. Again, in Virginia, as of 2022, like automobile modifications, the cost of such modifications on a home and vehicle together have an aggregate cap of $55,000.00. See VA Code 65.2-603 (A)(1)(b).
When might your employer contest your need for durable medical equipment?
An employer or insurance company will normally be required to pay for your medical equipment provided your doctor writes a written prescription or recommendation for the medical equipment.
An employer or the employer’s insurance company may contest your right to the DME or other medical devices on one or more of the following grounds:
- Your injury has healed enough so that you don’t need the DME.
- Your injuries are due to a prior existing condition.
- Your injuries happened while you were working outside the scope of your employment – such as when you are injured in a car accident after you completed your work for the day.
- In Virginia, the cost of the modifications to your home and/or vehicle exceeds the statutory cap imposed by 65.2-603 (A)(1) (a) and (b).
- There are other alternatives to vehicle modification such as continued payment by the carrier for medical mileage costs or transportation.
In some workers’ compensation cases in North Carolina and Virginia, the employer may assign a Nurse Case Manager to your claim. The nurse case manager works for the employer or the employer’s insurance company and is interested in helping the employer and not you. The nurse case manager may monitor whether you are really using the durable medical equipment or assistive devices.
In some cases, the employer or the employer’s insurance carrier may request that you complete an Independent Medical Examination (IME). The IME is conducted by a physician other than your treating doctors and is picked by the Insurance Company. If the IME doctor says that you don’t need the DME anymore, the employer or the employer’s insurance company will request that the payment for the DME be terminated and you may have to head to a Hearing to get your medical device.
The long-term need for durable medical equipment and assistive devices
Most employees who have permanent injuries will need durable medical equipment for the rest of their lives. Employees who are entitled to workers’ compensation benefits are entitled to these benefits for as long as they improve the employee’s health or prevent the employee’s health from getting worse.
This means that the employer’s duty to pay for your durable medical equipment and other medical equipment may last for the rest of your life. If the durable medical equipment fails because it breaks down or for other reasons, you should be entitled to replacements. Many employees may need multiple crutches, wheelchairs, and other equipment during their lifetime.
Medical equipment and returning to work
Your need for durable medical equipment can affect the amount of your benefits. Once your medical condition reaches the point of maximum medical improvement (MMI), the point when additional medical help is not likely to improve your health – an evaluation is made to determine if you have a permanent disability and the severity (impairment level) of that disability. The amount of permanent disability benefits you can claim depends on both factors – the type of disability and the impairment level of the disability.
Your impairment score can shift if medical equipment helps you function. It’s generally the custom that you receive compensation for the medical equipment you need (normally, the insurance company pays the supplier directly, according to the state workers’ compensation schedules) instead of being assigned a higher impairment rating (and thus a higher permanent disability paycheck). There are other considerations that our skilled workers’ compensation lawyers review – such as whether your employer can actually accommodate the medical equipment you need.
For example, suppose you need a wheelchair because you can’t walk due to paralysis or amputated legs:
- If you cannot work at all, even with the wheelchair, then we will claim permanent partial disability benefits for you and a 100% impairment rating and in Virginia, as you approached your 500th week of ongoing workers comp weekly checks, we would apply for permanent and total disability. If granted, this would entitle you to ongoing weekly benefits at 2/3rds of your weekly benefits for the remainder of your life.
- If you can work with a wheelchair and the employer can accommodate a wheelchair at the place of business, then you may only be able to claim workers’ compensation benefits if you can’t earn the same living with the wheelchair as compared to your prior injury, (temporary partial disability) plus permanent partial impairment benefits, assuming the impairment is located in a ratable body part such as your lower extremities. Temporary partial disability is paid at 2/3rds of the difference between the average weekly pay in your pre-injury job and your current pay in your “accommodation” or “light duty” job for up to 500 weeks.
- If you can work with a wheelchair and the employer cannot accommodate the wheelchair, and your disability is due to a major loss of functionality in both lower extremities, in Virginia, and you remain under an Award, as you approached your 500th week of benefits, we would apply for permanent and total disability. If granted, this would entitle you to ongoing weekly benefits at 2/3rds of your weekly benefits for the remainder of your life.
Contact Joe Miller Law Ltd. to discuss your right to medical equipment for a work injury or illness
At Joe Miller Law Ltd., our North Carolina and Virginia workers’ compensation lawyer fights for all the compensation you deserve including the smaller bills that can make a big difference in your recovery and ability to function. We’ve been fighting for injured workers for more than 30 years. To discuss your right to workers’ compensation benefits, call attorney Joe Miller, Esq., at 888-667-8295 or use my online contact form to schedule a free consultation.
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