Attendant Care Benefits - How to Get The Insurance Company to Pay
This guide discusses attendant care - what it is, what kind of activities it includes, and how to get the insurance company to pay.
What is attendant care?Attendant care is a service provided to a person who is injured or disabled. Attendant care is similar to nursing care. Attendant care includes activities such as helping the injured person get dressed, bathe, transfer on/off the toilet, and administering medications.
Attendant care also includes supervision time, simply being with the injured person to provide supervision so that they do not do something they shouldn't. Many people who suffer traumatic brain injuries require a lot of attendant care.
Attendant care can be provided by professionals. Often, however, attendant care is provided by family members who live with the injured person. This includes a spouse, sibling, son, daughter, or parent.
Attendant care is an extraordinary benefit: it often allows the injured person to be cared for by a loved one rather than having to live in an institution.
Who pays for attendant care?Attendant care is required under Michigan law in both car accident and workers compensation cases. That is to say, attendant care benefits are included in every single auto and workers compensation insurance policy sold in the State of Michigan. The auto or workers compensation insurance company must pay the attendant care benefits.
How much must the insurance company pay?The insurance company must pay the person providing the attendant care benefits an hourly wage. The amount is calculated by the number of attendant hours performed per day times a reasonable hourly rate.
What hourly rate is reasonable? That depends on a number of factors, including the geographical area in which the injured person lives, as well as the skill level of the care required. Most insurance companies pay unskilled family-provided attendant care at a rate of $10 - $14 per hour. That rate isn't necessarily reasonable. But to get the insurance company to pay more will generally require a lawsuit.
Almost all insurance companies require a doctor's note verifying the number of hours of attendant care needed. This is not specifically mandated by law. However, I strongly recommend getting a doctor's note for two reasons. First, it will often get the benefits paid quickly without a fight. Second, a letter from your treating doctor stating that you require ___ hours of attendant care per day will be a great piece of evidence if you ever have to sue the insurance company.
How can I increase the chances of my attendant care getting paid?First, keep a log for each day that you provide the attendant care. In the log write down what activities you do - helping the injured person bathe, get dressed, supervising him, etc - and the number of hours you spend providing attendant care each day.
Second, have the injured person's treating doctor write a short letter stating that the injured person needs ___ hours of attendant care per day because of his accident-related injuries. Under Michigan law, auto insurance reimburses family provided attendant care up to 24 hours per day. In workers compensation cases that number is limited to 56 hours per week, meaning the workers compensation insurance carrier is required to pay up to 56 hours of care per week, even if you provide more.
Make sure the doctor's letter states that the attendant care is required because of the injured person's accident related injuries. It helps even more if the doctor's note specifies the activities needed - for example, help bathing, dressing, supervision, etc.
Each month submit to the insurance company your attendant care logs along with the doctor's note. Following this procedure will greatly increase the chances of getting the attendant care paid.
Attendant care vs. Replacement services - what is the difference?No-fault auto insurance also provides a benefit called "replacement services," also referred to as "household services." Replacement services are different than attendant care.
Replacement services are services the injured person used to do for himself or his dependents but can no longer do because of accident injuries. Replacement services include cleaning the house, laundry, babysitting, lawn care, snow shoveling, taking out the garbage, and grocery shopping.
Attendant care is a service provide to the injured person as a result of the injury. Attendant care is more like nursing care than replacement services. Attendant care includes assisting the injured person with bathing, getting dressed, doing transfers, and supervising the injured person.
Replacement services are reimbursed at a flat rate up to $20 per day. Attendant care is paid by the hour.