How to claim Domestic Assistance for a work injury

How to claim Domestic Assistance for a work injury

Picture this: you’ve been injured at work. You make a claim for workers compensation which is accepted, and you start the long hard road to rehabilitation. All of your time, and energy, now goes toward attending doctor’s appointments, working through your pain and your trauma to rehabilitate and try (if it’s possible) to get back to work.

Amid all of this, those general household tasks that you could do before like cleaning, laundry, lawn and garden care, and, depending on the type of injury you’ve had, transport, fall by the wayside. You’re either not physically or mentally capable of doing those things, or, your energy is totally spent after rehabilitation for your injury.

Perhaps you’re lucky enough to have family members, good friends or a partner to take over these tasks for you. Often, however, your family or friends or partner have their own responsibilities and their own jobs to do, and they can’t always be available to drive you to a medical appointment, cook some meals, clean your bathroom or do some laundry for you.

What is Domestic Assistance?

Under the Workers Compensation Act 1987 (NSW), injured workers are entitled to claim paid domestic assistance from the insurer to do tasks that they could do before their injury, but now can’t do after their injury.

However, as with most entitlements under the NSW workers compensation scheme, there are a few limitations to this.

If an injured worker hasn’t been agreed or awarded with at least 15% whole person impairment, the insurer is only required to provide temporary domestic assistance. “Temporary” means up to six hours a week for up to three months, but the insurer does have a discretion to allow for temporary assistance to go on for longer than this.

However, if an injured worker has been agreed or awarded with at least 15% whole person impairment, the entitlement to claim domestic assistance is unrestricted.

To help illustrate what this means, here are a couple of examples:

Mark has an injury to his knee for which he must have surgery. He lives alone in a ground floor unit with a little backyard. Due to his injury, Mark cannot stand or walk unassisted, nor can he drive a vehicle. Because he has just had an operation, his condition is not stable enough to assess whole person impairment, so it’s not clear whether he will reach the 15% WPI threshold.

Mark asks the insurer to pay for someone to come and clean his home and car, to mow his lawn and weed his garden, and for uber costs to take him to and from his appointments. After assessment, the insurer agrees but says that it will need to revisit the agreement in 3 months’ time, when Mark is further along on the road to recovery.

3 months pass, and Mark is now able to drive, and walk without crutches. He can’t however, bend, squat, or kneel on his injured knee, nor can he do any weighted pushing or pulling motion while his knee is still feeling weak. This means he can’t safely clean his bathroom or shower, and he can’t vacuum or mop his floors. The insurer re-assesses his needs and agrees to pay for cleaning for another 3 months.

After this time, Mark is rehabilitated enough to do all of his own cleaning again, and the insurer stops paying for a cleaner.

Ethel is diagnosed with PTSD after being exposed to traumatic incidents as a support worker. She makes a claim for lump sum compensation which is settled with a whole person impairment of 22%. Due to Ethel’s symptoms, she suffers with fatigue, low motivation and is not able to leave her home without assistance.

Fortunately, Ethel’s husband Arthur is retired and can help her when she needs to leave the house. Arthur however has a long standing back injury, and before her own injury, Ethel did all the household cleaning, lawn mowing and gardening, whereas Arthur did the groceries and prepared all meals.

The insurer does an assessment and agrees to pay for a cleaner, as well as a gardener and lawn mowing company to come to the house but won’t agree to pay for Ethel and Arthur to be provided with pre-prepared meals, because Ethel didn’t do meal preparation before she was injured.

The insurer can have Ethel’s entitlement to domestic assistance reassessed in the future and it may increase or decrease depending on her disabilities, but her entitlement to claim is unrestricted because she has a 22% WPI.

How can you get paid Domestic Assistance under a workers compensation claim?

So how do you get the insurer to pay domestic assistance? Follow these simple steps.

Send an email to your case manager stating that you need domestic assistance to complete whatever tasks you previously did yourself, and which you now can’t do because of your injury. Tell your case manager that you want a Functional Assessment to work out what tasks the insurer should be paying for.

Get your doctor to note in your Certificate of Capacity that you need domestic assistance too, and make sure you are submitting those certificates to the insurer as you normally would.

The insurer has 21 days from your request to arrange a Functional Assessment. This involves an Occupational Therapist (an OT) coming to your home and assessing the household tasks that you need help with. The OT will write a report for the insurer, and the insurer will advise you of what help they are prepared to cover.

It’s important to note that the insurer doesn’t arrange the services for you. As an example, if you are told that you can get a cleaner, you will need to find a local cleaner that suits your requirements and arrange for that cleaner to bill the insurer.

What to do if the insurer doesn’t take action

Now we know it’s all too common for case managers to ignore requests from injured workers, or not to give proper attention to requests that are genuine and which an injured worker is entitled to make.

So, here’s the kicker: if you don’t get a response from the insurer, or, the insurer’s response isn’t to take the proper action to arrange an assessment of your domestic assistance needs, or, you don’t agree with the insurer’s decision about your domestic assistance requirements, go straight to IRO and lodge a complaint.

You can do that by phoning 139 476, or by lodging a complaint online here.

If you’ve got a NSW workers compensation claim and you’re frustrated with what’s happening, or you need some guidance, talk to us about how we can help you.