Definitions. Guidelines

Transcription

1 Household Help Guidelines for household help services for injured workers August 2014 The WorkSafe Agent (the Agent) can pay the reasonable costs of household help services when required as a result of a work-related injury or illness under Victorian workers compensation legislation. A written request for household services must be provided from a medical practitioner before the Agent will consider whether or not to approve household services. Prior approval must be given by the Agent before household services can be provided. The Agent will periodically review a worker s entitlement to household help services to ensure that the costs of the services are reasonable and the services are necessary and appropriate for the worker s work-related injury or illness. Background Household help services may be provided to assist with a worker s recovery, rehabilitation and return to work taking into account the worker s: injury or illness stage of recovery, including their physical rehabilitation program domestic circumstances. Household help is provided to replace only the labour component of household tasks. The Agent will not pay for, or reimburse the costs of, any housework, gardening or lawnmowing consumables or equipment. Household help services do not extend to the needs of other independent adults living in the worker s household. There is an expectation that family/household members will contribute to household tasks. The Agent will consider the reasonable contribution of family/household members to household tasks when assessing household help services requests. Household help services are not provided to complete all the tasks the worker undertook pre-injury. Definitions In this policy, household help services means the provision of basic and routine housework and gardening tasks that the worker performed pre-injury or illness and can no longer perform as a direct result of their work-related injury or illness. Household help services consist of: housework tasks lawn mowing tasks gardening tasks provision of firewood. Guidelines What can the Agent pay for in relation to household help services? The Agent can pay the reasonable costs of household help services, up to the maximum amount, that are: required as a result of the work-related injury or illness for the worker only requested by a medical practitioner reasonable, necessary and appropriate in the circumstances approved by WorkSafe under the Act supplied by WorkSafe registered and approved service providers under the Act to replace a worker s labour in the home for routine, common, basic housework, lawn mowing and gardening tasks associated with maintaining themselves in the home i.e. where, prior to the work-related injury or illness, the household tasks were performed by the worker and not by other people such as family members or purchased labour. to replace a worker s labour in providing (collecting, chopping and stacking) firewood where a wood fire is the primary source of heating and/or cooking in the worker s home. Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self-insurer (as the case may be) before the services are provided. WSV1505/03/05.13

2 The Agent can also pay the reasonable costs of household help services where a worker provided housework assistance for a child who: lives in the home was dependent on the worker to perform the tasks preinjury or illness is unable to perform the tasks themselves has no other adults living in the home to undertake the tasks for the child. The household help services required - including the tasks, frequency and for how many hours the services will be provided - will depend on the needs of the individual worker. Household help services available are: HOUSEWORK Please note that the Agent will not pay for, or reimburse the costs of, any housework consumables or equipment e.g. cleaning cloths, cleaning liquids, brooms, mops and vacuum cleaners etc. Housework tasks - Primary Kitchen Clean benches/sink Clean stove top Clean microwave Wipe cupboards Clean wipe/appliances Sweep floor Wipe table Dust furniture Dining Dust furniture Vacuum/seep floor/rugs Bedroom Change bed linen Make bed Dust furniture Vacuum/sweep floor/rugs Bathroom Clean shower Clean bath Vacuum/sweep floor Clean basin Clean mirror Toilet Clean toilet Sweep floor Clean basin Clean mirror Laundry (room) Wipe appliances Clean bench surfaces Vacuum/sweep floor Clean trough Laundry (clothes care) Load washing machine Hand washing Hang washing on line/place in dryer Take in washing/empty dryer Sort/fold clothes Essential ironing. Laundry and ironing tasks must be for the worker only. Housework tasks Exceptional once yearly Heavier tasks

3 Generally referred to as spring cleaning e.g. replacing the labour associated with cleaning an exhaust fan, oven, light fixtures, windows and thorough floor cleaning. LAWNMOWING AND GARDENING Please note that the Agent will not pay for, or reimburse the costs of, any lawnmowing or gardening consumables or equipment e.g. mowers, weeders and fertilizers. Lawn mowing tasks Mow lawn Tidy edges The maximum frequency for lawnmowing tasks is one fortnightly during the summer period (1 October 31 March) and monthly during the winter period (1 April 30 September). A detailed quote for lawnmowing is required which specifies: type of grass size of lawn frequency of lawn mowing and edging. Gardening tasks - Primary Sweep paved areas Weed garden beds Gardening tasks Exceptional once yearly Heavier Garden Tasks Clearing gutters Light pruning of trees In fire prone or regional areas this might include general clearing of the immediate vicinity of the house Provision of firewood WorkSafe can only provide assistance, up to a maximum of three years, with the replacement of labour previously undertaken by a worker to obtain firewood if all the following criteria are met: The worker collected, chopped and stacked the wood themselves prior to their injury The worker and other household members are unable to carry out the task since the worker s injury Wood was the worker s only energy source for heating prior to their injury. In determining the reasonable costs of providing firewood, the Agent will consider the following options: Employing someone to chop, split, deliver and stack the firewood, or Using a commercial firewood supplier to supply and deliver the wood. The worker must have prior written approval for the provision of firewood from the Agent before firewood is provided to the worker. WorkSafe is not liable to pay for: assistance with firewood if a worker relocates gas or electricity associated with the running of any alternative hearing source. WorkSafe recommends that service providers familiarise themselves with the list of available services. Providing assistance for tasks not included on this list and not approved by the Agent for that worker may lead to non-payment. Requests for services that are not on the above lists should be discussed with the approving Agent. Who can provide household help services? The Agent will only pay for household help services by providers who are: registered and approved by WorkSafe to provide household help services able to provide evidence of Australian company or Victorian business registration able to provide evidence of current public liability insurance (minimum $2 million). The registration period is valid for the term of the current public liability insurance. Registration status can be renewed by submitting a copy of the renewed public liability insurance (or certificate of currency) to WorkSafe prior to the expiry date of the current registration. Further information on WorkSafe s required level of public liability insurance can be found on WorkSafe s

4 Application for Registration to Provide Services to Workers. What information does the Agent require to consider paying household help services? WorkSafe considers household help to be a referred service. A medical practitioner must provide a referral for household help services prior to commencement of services. Prior approval from the Agent is required for the Agent to consider paying for household help services. To receive prior approval for household help services, the worker s treating medical practitioner must provide a written request to the Agent for household help services prior to commencement of any services. The household help services request must specify the: relationship between the household help requested and the worker s work-related injury or illness household help tasks required frequency of the household help required the period of time that household help is required and any commencement date, e.g. to undergo and recover from surgery. When will the Agent respond to a request? Within 10 working days of receiving the household help services request, the Agent will advise whether: the request has been approved the request has been denied, or further information is required to make a decision. Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information. What are WorkSafe s invoice requirements? Refer to the How to Invoice WorkSafe guidelines. What fees are payable for household help services? Refer to the Fee Schedule for Household Help Providers. In relation to household help services, what won t the Agent pay for? The Agent will not pay for: services provided by a provider that is not registered and approved by WorkSafe under the Act services subcontracted to, or provided by a nonregistered provider fees associated with cancellation or not being at home when the provider attends services provided outside Australia without prior written approval from the Agent services provided by telephone or other non face to face mediums telephone calls and telephone consultations between providers and workers and between other providers services provided more than once on the same day to the same worker services provided by friends or by family members services that extend to other adults in the home services that are not approved by WorkSafe as household help services and, in particular, the following: the costs of any housework consumables or equipment e.g. cleaning cloths, cleaning liquids, brooms, mops and vacuum cleaners the costs of any lawnmowing or gardening consumables or equipment e.g. mowers, weeders and fertilizers the cost of home maintenance products e.g. gutter guards and synthetic turf food preparation housework equipment or household appliances unless recommended by an Occupational Therapist (OT) as assistive equipment for the worker self-care tasks including bathing, dressing or personal grooming pet care support of hobbies or personal lifestyle interests, for example, hobby farm, animal breeding or showing car care home or furniture maintenance including window washing, cleaning of drapes, blinds or carpets

5 home modifications including painting, renovation or modification property maintenance or repair including painting, watering gardens, gutter cleaning or maintaining paving raw garden materials, e.g. plants or mulch the cost of garden implements unless recommended by an OT as modification or assistive equipment for the worker fees for rubbish or grass removal and/or disposal the cost of State Forest licenses required to collect firewood or the cost of equipment associated with firewood, such as maintenance of fireplaces. Further information Contact the referring Agent, or refer to: Application for Registration to Provide Services to Workers Fee Schedule for Household Help Providers How to Invoice WorkSafe WorkSafe s Online Claims Manual

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