Authorization of Housekeeping Services as Medical Benefit

Authorization of housekeeping services as a medical benefit.

In Dery, the Industrial Claim Appeals Office (the Panel) affirmed the decision of the ALJ to deny housekeeping services as a medical benefit.

The claimant, proceeding pro se, sustained an injury to her left knee at work on July 3, 1991, and subsequently underwent a meniscectomy. Due to her prolonged use of crutches, the claimant developed additional conditions that included thoracic outlet syndrome and nerve damage under the right arm. The claimant was ultimately diagnosed with Complex Regional Pain Syndrome (CRPS) in her lower left extremity. Respondents admitted and began paying permanent disability benefits in 2001.

The respondents paid for housekeeping services for the claimant for several years thereafter. In October 2021, when respondents declined to authorize any further housekeeping services, the claimant applied for hearing seeking the reauthorization of those services. At the hearing, claimant’s expert, Dr. Sharma, testified that while the housekeeping services were not a medical service claimant needed, the service would allow the claimant to maintain her dignity through having a clean house. The respondents’ expert, Dr. Mathwich, testified that he was skeptical that housekeeping services would achieve any functional gain for the claimant. Dr. Mathwich noted the claimant stated that her condition worsened during the years she did receive housekeeping services, and that physical activity such as housekeeping should be encouraged due to the CRPS diagnosis.

The ALJ held that housekeeping services may be “incidental” to obtaining medical treatment where the claimant is receiving “medically necessary attendant services,” but did not find such a connection in this matter. The claimant appealed, arguing that the recommended housekeeping services were integral to her medical care.

The Panel affirmed the ALJ’s order since the ALJ’s findings were supported by substantial evidence in the record.

Dery v. ABC Nursery School, LTD & Junior Academy and Pinnacol Assurance, W.C. No. 4-104-954 (Aug. 15, 2024).

Want to know more? Contact Katherine Lee at kcarris@pollartmiller.com or 877-259-5693.


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