As a workers’ compensation adjuster, you may occasionally handle cases involving attendant care issues. When you do have a case involving attendant care issues, you will need to mindful of when your claim arose because different legal standards will apply depending on whether your claim is a pre-reform case or a post-reform case. The N.C. General Assembly reformed the Workers’ Compensation Act on June 24, 2011.
Post Reform: On or After 6/24/11
According to N.C.G.S. § 97-25 (a) (2013), medical compensation shall be provided by the employer in compensable cases. For claims arising on or after June 24, 2011, medical compensation has been defined to include attendant care services prescribed by a healthcare provider authorized by the employer or subsequently authorized by the Commission. N.C.G.S. §97-2 (19) (2013). Therefore, if you have a case necessitating attendant care that arises on or after June 24, 2011, an authorized healthcare provider must prescribe the attendant care services for the person providing attendant care to receive compensation.
Pre-Reform: Before 6/24/11
However, for claims arising before June 24, 2011, there are different legal standards in place. Several appellate court decisions have helped shed light on when attendant care compensation will be issued in these pre-reform cases. In claims arising before June 24, 2011, the physician does not necessarily have to prescribe attendant care for compensation to be awarded for the same.
Practice Tips for Carriers: Be aware of whether your claim is a pre-reform claim or post-reform claim – so you know which legal standards apply to your case.
- For claims arising on or after June 24, 2011, a healthcare provider authorized by the employer or Commission must prescribe the attendant care services for the attendant care to be compensable.
- For claims arising before June 24, 2011, the physician does not have to prescribe attendant care services for compensation to be awarded, but the employee must obtain approval for the attendant care from the Commission within a reasonable time after the employee selects an attendant care provider.
If you are required to pay attendant care but are having difficulty determining the rate, my blog post on the issue provides helpful tips. If you have questions, you can reach me at 704-940-3442 or firstname.lastname@example.org.