Ability to cook, clean, drive undermines claim for assisted living

In Kentucky, even when a worker requires certain assisted living services, residence at an assisted living facility may not be compensable medical care.

Case name: Senninger v. Kentucky Farm Bureau, et al., No. 2009-SC-000381-WC (Ky. 08/26/10, unpublished).

Ruling: In an unpublished decision, the Kentucky Supreme Court held that a worker was not entitled to compensation for residence at an assisted living facility.

Sub-subcontractor's employee not entitled to coverage from contractor (02/25/13)
Cleaner's use of helpers indicates independent contractor status (11/01/12)
Statement made weeks before termination moves claim forward (09/30/11)
Failure to rebut rehab counselor's report boosts driver's claim (04/19/12)
Hospital not subject to penalties for worker's fall in elevator shaft (04/19/12)

What it means: Even when a worker requires certain assisted living services, residence at an assisted living facility may not be compensable medical care. Kentucky courts consider the facts and circumstances of a case to determine whether assisted living is reasonable, necessary, and compensable.

Summary: A worker sustained injuries when she slipped on some steps and fell headfirst into a brick wall. She was permanently and totally disabled. The worker's doctors thought that her pain and medical conditions made her a candidate for assisted living and she sought compensation for residence at an assisted living facility. The Kentucky Supreme Court held that the effects of the worker's injury were not so severe to make residence at an assisted living facility reasonable and necessary.

The worker asserted that assisted living was a form of medical treatment. The worker lived with a friend. She testified that she used a walker and she could dress herself, cook, clean, and drive. Her doctors did not specify the types of services she needed or whether the services could be provided effectively in a non-institutional setting.

The court noted that injured workers generally are responsible for providing their own personal care, housing, and housekeeping services, as they would if they had not been injured. Severe impairments may make some services necessary and compensable. The court found that the worker was entitled to compensation for some medical services, such as certain durable medical equipment.

Read more at the WorkersComp Forum homepage.

December 9, 2010

Newsletter Sign-up