Jul 14 2016

In Sickness and in Health: New Hampshire Supreme Court Rules that Spouses’ May Qualify as “Health Care Providers”

Under the Workers’ Compensation Act Can a claimant’s spouse with no medical training bill worker’s compensation for taking care of her husband at home following a work-related injury? You may be surprised to learn that the New Hampshire Supreme Court in Appeal of Northridge Environmental, LLC (“Northridge”) recently answered that question in the affirmative. Barring legislative action, the husband or wife of an injured worker may now seek compensation for the “reasonable value” of alleged home “health services” that aid in their spouses’ recovery if prescribed by a doctor.

The claimant in Northridge suffered a serious injury. Following his hospital discharge, he was prescribed “home health services through the VNA . . .” to “include physical and occupational therapy, a home health aide, and nursing services.” There was no apparent dispute that the claimant “had multiple open wounds that required daily cleaning, and [that] he needed 24/7 care, due to balance problems, short term memory loss, and inability to perform certain regular activities of daily living.” Rather than use the VNA, however, the claimant chose to have his wife with no medical training provide the necessary care instead.

The then-applicable version of RSA 281-A:24 required carriers to pay the full value of “a health care provider’s bill. . .,” if medically necessary as the result of a compensable injury. Health care provider is defined in RSA 281-A:2,XII-b: “[h]ealth care provider as used in this chapter includes doctors, chiropractors, rehabilitations providers, [and] health services as defined in RSA 151-C:2, XVIII . . .” Health services are “clinically related diagnostic, treatment, or rehabilitative services. . .” The carrier argued on appeal that the claimant’s wife failed to meet the definition of a health care provider because she was not a trained or licensed medical professional similar to a doctor, chiropractor, or rehabilitation provider as specifically referenced in the statute. The Court disagreed.

The Court reasoned that the list of specialties in RSA 281-A:2,XII-b is not exhaustive, and that “one may be able to render ‘health services,’ and, thus qualify as a ‘health care provider,’ without being a trained medical professional” under RSA 151-C:2, XVIII. The Court held that the claimant’s wife’s services qualified as “clinically related . . . treatment . . .” under RSA 151-C:2, XVIII because “she acted pursuant to a doctor’s prescription. . . , and her services aided in his recovery” (emphasis added). When faced with bills from persons who are not medically trained or licensed, including from the “Visiting Angels” and other similar firms, as well as from friends or family members of the claimant, the key questions will be whether the care is prescribed by a doctor, and whether it will aid in the claimant’s recovery and eventual return to workforce.

In addition, statutory changes to RSA 281-A:24 since Northridge may make it easier to contest the amount of the bill submitted by a claimant’s wife or other care giver who is not medically trained or licensed. The claimant’s wife in Northridge charged $15.00 per hour, 12 hours per day for her care and did not keep detailed written records as medical providers customarily do. Yet, under the then-existing version of RSA 281-A:24, the carrier was required to show “just cause” why the amount of the bills were not reasonable—a burden that it could not carry to the Court or Compensation Appeals Board’s satisfaction. Amendments to RSA 281-A:24 would now flip the burden of proof on the claimant’s spouse to demonstrate that her billing was in fact reasonable.

The result in Northridge was driven by the oft-referenced rule that “[w]e construe the Workers’ Compensation law liberally to give the broadest reasonable effect to it remedial purpose. Thus, when construing it, we resolve all reasonable doubts in favor of the injured worker.” The carrier argued that allowing spouses and others with no medical training or licensure to bill workers compensation will lead to fraudulent claims, and is otherwise unreasonable and is not consistent with the intent of the Legislature. Even the Court acknowledged that the carrier’s concerns “may be legitimate . . .,” noting that “if the legislature disagrees with our construction of its statutory scheme, it is free to amend the statues as it sees fit.” With any luck, it will do so soon.

 

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