By: Ya’Sheaka Williams, Partner, Tampa

What is the employer/carrier’s responsibility to an injured worker when an injury causes such disability that their current residence cannot accommodate them? This occurs in cases where the claimant sustains a catastrophic injury such as paraplegia, quadriplegia, or other wheelchair bound injuries. In short, the employer/carrier must provide reasonable and medically necessary accommodations. If an injured worker is confined to a wheelchair, his home may need modifications to include ramps, wider doorways, lowered kitchen cabinets, shower rails in the bathroom, and a walk-in shower. There must be competent substantial medical evidence to support the modification.

What happens if the residence cannot be modified? Carriers may be responsible for purchasing a new home. In Adams Bldg. Materials v. Brooks , 892 So.2d 527 (Fla. 1^st DCA 2004), the JCC awarded a new home with a life estate. In making this award, the JCC considered economic factors; however, the First DCA found that this was in error. Economic considerations cannot be the basis for awarding a new home. See Polk County Bd. of Comm’rs v. Varnado, 576 So.2d 833, 838 (Fla. 1st DCA 1991). While circumstances may exist which would entitle a claimant to an award of a new house, the “new” house must be medically necessary. A new home should only be awarded when an existing home cannot be modified. See Id.; cf. Peace River Elec. Corp. v. Choate, 417 So.2d 831, 832 (Fla. 1st DCA 1982) (finding that unique circumstances were sufficient reason why existing home could not be modified).

The employer/carrier is not required to provide additional housing for family members who provide “emotional support” to the injured worker. Timothy Bowser Construction Co. v. Kowalski, 605 So.2d 885 (Fla. 1^st DCA 1992). In fact, the housing is only to accommodate medically necessary accommodations for the injured worker.

The employer/carrier may also be responsible for other home related expenses to include electricity and homeowners expenses. The expectation is that the employer/carrier will pay the difference in what the claimant paid prior to the home modification and what it costs after the modification. For instance, when an injured worker’s medically necessary care requires the use of electricity, the employer/carrier is responsible for the difference in the cost of the claimant’s electricity every month. This can be seen in cases where an injured worker’s utilities increase from operating medical equipment, or when air conditioning bills increase as a result of a claimant’s inability to regulate his body temperature. Employer/carriers may also be responsible for the payment of homeowners insurance if the premiums exceed those amounts paid by injured workers prior to home modifications.

What if the claimant’s home cannot be modified and the claimant does not qualify for an apartment rental? Employer/carriers may have to be pay for hotel rooms with kitchens, or for assisted living facilities. If a claimant has a criminal background or other similar limitation, housing issues may become complicated. Even so, it is important to ensure that employers/carriers provide only medical necessary modifications/accommodations.

Home modifications and vehicle modifications have the exact same standard of medical necessity. In the case of a vehicle modification or replacement, the First DCA has held that an employer/carrier is only responsible for expenses that are uniquely attributable to providing the medically necessary options. In Temps & Co. Services v. Cremeens, 597 So.2d 394 (Fla. 1^st DCA 1992), the claimant sustained a partial amputation of her hand, which prevented her from operating her car because her car lacked an automatic transmission and power steering. Although the employer/carrier attempted to modify the vehicle, the modification failed. The JCC ordered the employer/carrier to pay for the purchase of a new vehicle; however, the First DCA disagreed. The Court held that the claimant was entitled to the difference between the trade in value and the cost of the replacement. The First DCA held that the power steering and automatic transmission were the medically necessary apparatus, not the car itself. Therefore, the employer/carrier was not responsible for the entire cost of expenses such as insurance, repair, gasoline, license tag, and so forth. The question of medical necessity may mean that a claimant is entitled to a special type of vehicle, which may open the employer/carrier to additional exposure for the cost of vehicles, repairs, and maintenance.

Although not common, these types of claims can cause significant headaches and litigation. When the situation arises, please contact our attorneys to assist with outlining medically necessary items. We can also assist with stipulations on the benefits so that the claimant is aware of his rights and responsibilities when employers/carriers provide housing or vehicle modifications.