Scope

BWC will reimburse home modifications specifically needed by the IW due to physical limitations due to the result of allowed claim conditions.

 

A. BWC will authorize home modifications on a one-time basis only.  An exception would be for a ramp, which must be replaced if deterioration has occurred.

 

B. Home modifications will be limited to the interior of a residence with exception of ramps, lifts, and platforms necessary for accessing and exiting the home.  The residence to be modified must be owned by the injured worker or a member of the injured worker’s immediate family.  BWC does not modify any property other than privately owned property.  If renting, the injured worker can have limited modifications (i.e., grab bars, portable ramps, etc.) upon the written approval from the property owner. It is recommended that modification equipment for rental units be transferable, if possible.  Any amount put into rentals may be deducted from future home modification requests.  If the injured worker moves, he/she is responsible for costs involved with transferring any modification equipment to the new residence.  BWC will not reimburse dismantling of constructed ramps.

 

C. BWC will not authorize construction for room additions, except where two contractors advise the home is not modifiable due to the total size of the home.  If the existing home is not modifiable, construction of a room addition will be considered.  The injured worker may be responsible for paying a portion of the cost of construction in certain circumstances.  If modifications are recommended by the home evaluator and they are not medically necessary, BWC will not pay for the modification. BWC will educate evaluators regarding the scope of the BWC home modification policy.

 

D. Home improvements which are of general utility, and are not of direct medical benefit to the injured worker (i.e., carpeting, roof repair, central air conditioning), are not covered modifications.

 

E. Specific home modification guidelines are:

 

1. Bathroom – Only one bathroom will be modified.  Bathroom modifications may include installing a roll-in shower, a roll under sink, a handicap toilet, single style vanity/medicine cabinet, etc.  A bathroom may need to be added to a bedroom, or an existing room may need to be remodeled for accessibility.  Two (2) rough scale drawings (current situation and proposed modification) must be submitted for approval.  Built-in whirlpool baths and Jacuzzis/hot tubs/spas are not approved.

 

2. Kitchen – BWC may approve limited kitchen modifications for injured workers who are living alone.  If the injured worker has no live-in caregivers, modifications may include,but are not limited to, handicap cabinets, and  roll-under sink.  If the injured worker has a live-in caregiver, pays for caregiver services, or IW has long term home health care services needs, BWC will approve widening a doorway for access into a kitchen, but will deny other kitchen modifications.

 

3. Elevator or stair-lift – A stair-lift can be approved for an injured worker on an individual case-by-case basis, for example, in cases where the injured worker is unable to climb stairs and bathroom facilities are on the second floor.  A stair-lift is less expensive than alternative modifications and provides accessibility.  If an injured worker receivesa stair-lift, a second manual wheelchair may be approved.  It may be less expensive to provide a first floor bathroom rather than to install an elevator if the residence structure will not accommodate a stair-lift.  Elevators should only be approved when there are no other alternatives.

 

4. Garage/Garage Door Opener/Carport – Garages and garage door openers are generally not reimbursable. In limited cases such as quadriplegia, BWC  may consider payment  for a carport or raising a pre-existing garage door and a garage door opener. 

 

5. Driveway/Sidewalk – BWC does not widen driveways to allow injured workers to drive up and get out of a vehicle.  BWC may approve paving of an area of a driveway or sidewalk for providing an operable surface for a scooter or wheelchair. 

 

6. Air conditioning/Air purifying systems – Upon receipt of a request for air conditioning or air purification system, a physician review of the claim file may be completed to determine medical necessity.  Pulmonary function studies are considered when the injured worker has an occupational disease affecting the cardiovascular or respiratory system.  Quadriplegics may require a room air conditioner for body temperature consistency. If an injured worker desires central air conditioning for the entire home, BWC will reimburse the percentage of cost for air conditioning for the IW’s room only. BWC will authorize a room air conditioning unit. BWC does not reimburse central air conditioning for the whole house. Air purifiers should be the portable type. Only claims allowed for pulmonary conditions, quadriplegia and burns qualify for air conditioners and only claims with pulmonary conditions for air purifiers.

 

7. Ceiling installed lift tracking mechanism – The injured worker must ensure that the home structure can accommodate this equipment. 

 

8. Handicap accessible home – If the injured worker chooses to purchase a new handicap accessible home, BWC will reimburse limited amounts for items such as a special shower, widened doorways, ramps, etc.  An itemized list of handicapped accessories should be obtained from the builder and submitted for review and authorization prior to purchase.  Reimbursement will be made after the house is built and the injured worker furnishes a copy of the deed/closure documentation showing ownership.

F. Non-Covered Services include:

§         Swimming pools of any type

§         Hot tubs portable, freestanding or installed

§         Spas portable, freestanding  or installed

§         Whirlpool baths portable,  freestanding  or installed*

§         Jacuzzis portable, freestanding or installed

§         Central air conditioning or air-purification systems

§         Dismantling of constructed ramp

§         Removal, dismantling or transfer of home modifications

§         Reimbursement of routine maintenance contracts

§         Home improvements which are of general utility, and are not of direct medical benefit to the injured worker (i.e., carpeting, roof repair)

 

*Note:  A portable whirlpool device that is placed in the IW’s tub can be approved/reimbursed by the MCO as DME  if medically necessary and related to the allowed claim condition..