The injured employee, a 54-year-old convenience store clerk, suffered a horrific brain injury when stabbed in the skull by an armed robber. After several surgeries and extensive in-patient rehabilitation, he was left with neurological deficits that left him unable to live independently. The injured employee, who was divorced, moved into his elderly father’s home where he was under constant supervision by his father and/or other family members.
A claim was filed on behalf of the father alleging, in essence, that if he did not provide such a living arrangement for his son, then the insurer would be required to pay for him to be housed in a supervised residential setting at substantial cost to it. It was further alleged that the insurer was required to pay for attendant care provided by the father, as it would be unjustly enriched at the father’s expense.
The case was heard at conference when the insurer refused to pay voluntarily. The Administrative Judge ordered the insurer to pay the father 16 hours of attendant care, 365 days of the year at $ 14.50 per hour.
This case illustrates that when an injured employee’s family provides services otherwise required to be provided by a third-party at substantial cost to an insurer, that the insurer cannot pass those costs to the family. Insurers are required to pay family members who provide such services.
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