Employer on the hook for costs of home-based care

In Wisconsin, for an injured worker subject to a protective placement order, the department can't review whether the worker is in the least restrictive placement. The department may determine only whether the medical expenses associated with the worker's placement are compensable.

Case name: Laberee v. Labor and Industry Review Commission, No. 2009AP1628 (Wis. Ct. App. 10/05/10, unpublished).

Ruling: In an unpublished decision, the Wisconsin Court of Appeals held that the Labor and Industry Review Commission exceeded its authority by evaluating the medical necessity of a worker's court-ordered home placement. The court sent the case back to the Department of Workforce Development to determine which expenses associated with the worker's placement were reasonable and medically necessary.

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What it means: In Wisconsin, for an injured worker subject to a protective placement order, the department can't review whether the worker is in the least restrictive placement. The department may determine only whether the medical expenses associated with the worker's placement are compensable.

Summary: A worker was severely injured when a train struck his vehicle. He sustained traumatic brain injuries and was a spastic quadriplegic requiring around-the-clock care. His injuries occurred in the scope of his employment, and his employer paid all of his medical expenses. After the accident, the worker was deemed in need of protective placement and institutionalized. A court later changed his placement to home-based care. The worker filed a workers' compensation claim, alleging that the employer refused to pay the additional expenses of his home care. The commission concluded that the worker failed to prove the home-based care was required. The Wisconsin Court of Appeals held that the commission exceeded its authority by evaluating the medical necessity of the court-ordered home placement. The court sent the case back to the Department of Workforce Development to determine which expenses associated with the worker's placement were reasonable and medically necessary.

The court said that a protectively placed individual whose employer conceded liability for workers' compensation should not have his personal liberty conditioned on his ability to pay for medical treatment by allowing the department to assess the placement. The department may only evaluate the treatment a worker receives within a placement. The court disagreed with the employer's argument that the worker should be required to pay the additional cost of care even though the worker could not show that his transfer to a residential setting was medically necessary.

Read more at the WorkersComp Forum homepage.

January 10, 2011

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