I speak with a lot of injured workers.

A common misunderstanding among injured workers is that workers' compensation insurance does not cover home healthcare.

However, if an injured worker meets the requirements of the New Mexico Workers' Compensation Act, workers' compensation insurance can cover the cost of home healthcare.

The basic requirements in the New Mexico Workers' Compensation Act for covering medical treatment are the following:

• An "authorized" healthcare provider must request or recommend the medical treatment for a work injury. The request/recommendation should be in writing.
• The medical treatment for the work injury must be "reasonable and necessary".

So, if an authorized healthcare provider requests or recommends home health care for an injured worker, there is a presumption that that home health care is reasonable and necessary. The workers' compensation insurer can deny the home health care, but probably must have admissible medical evidence that the home health care is not reasonable or necessary to treat the worker's injuries for the denial to be valid.

If an injured worker is getting home health care, the injured worker must make sure that the home health care provider is billing the workers' compensation insurer.

Sometimes an injured worker will pay for home health care out of pocket and then be reimbursed by the workers' compensation insurer. I generally try to avoid that arrangement. But, if it is the arrangement, then the injured worker must ensure that he or she keeps excellent records that document the days and hours that home health care was provided as well as the hourly rate of pay for the home health care worker. This information should be given to the workers' compensation insurer every week.

If there is any dispute about home health care or any medical billing in a workers' compensation claim or any workers' compensation questions, contact me immediately.