Medical and related services

When is a worker entitled to domestic assistance?

A worker may receive domestic assistance during incapacity to help them complete their activities of daily living including:

• cleaning
• laundry
• gardening, and
• transport not covered as a medical, hospital or rehabilitation expense.

A claim for domestic assistance must be determined within 21 days of the claim being made.

A worker is entitled to domestic assistance if:

• a medical practitioner has certified, based on a functional assessment of the worker, that:
  • the worker would benefit from the assistance
  • the assistance is assessed as reasonably necessary, and
  • the necessity arises directly from the worker’s compensable injury
• the worker did the domestic tasks before the injury happened, and
• the assistance follows a care plan (see ’Creating a domestic assistance care plan’ below) established by the insurer in accordance with the Workers compensation guidelines (the Guidelines).

A claim for domestic assistance cannot be paid for a task that the worker did not perform before the injury.

How much can be claimed?

A worker is entitled to up to six hours a week of domestic assistance, for a cumulative period of three months (whether consecutive or not), unless the compensable injury has resulted in a degree of permanent impairment of at least 15 per cent.

If the injury to the worker has resulted in a degree of permanent impairment of at least 15 per cent, they are entitled to ongoing domestic assistance until:

• they are assessed as functionally capable of completing the duties themselves, or
• they cease to be entitled to compensation, whichever comes first.

As domestic assistance is not covered by a Fees Order, the insurer must negotiate a fee with the provider beforehand, taking into consideration what the community would normally pay for these services. The insurer is to specify these costs when notifying the worker and provider of its approval.

Creating a domestic assistance care plan

In order for a worker to receive domestic assistance, the insurer must create a care plan that sets out and approves the domestic assistance to be paid.

The Guidelines specify the minimum requirements of a care plan as follows:

• task(s) covered
• service provider’s name
• number of hours and frequency of assistance
• start and end dates the assistance is approved for
• cost or rate payable for the assistance
• total cost for the duration of service
• clear explanation of the relationship between the need for the tasks recommended and the worker’s injury.

Gratuitous domestic assistance

Gratuitous domestic assistance is domestic assistance provided to a worker for free, that is, the worker has not paid and is not liable to pay for this service. An example of this might be a relative who provides cleaning for the worker or looks after their children.

People providing gratuitous (free) domestic assistance to a worker are entitled to claim for the cost of such assistance if they have lost income or forgone employment due to providing the assistance. The insurer is to pay the provider of the assistance (not the worker) once it has been verified (see below).

Claiming gratuitous domestic assistance

People providing gratuitous domestic assistance may claim compensation directly from the insurer. To do this, they must provide proof of the domestic assistance provided and demonstrate that they have lost income or foregone employment to provide the assistance.

Information that might demonstrate this includes:

• pay slips showing fewer hours of overtime or of casual work, with a supporting letter from their employer
• evidence that they have moved from full-time to part-time work, or
• a certified copy of the letter of resignation or termination, giving reasons.

The amount of lost income or foregone employment is not relevant to the amount of compensation that may be provided to the person. The provider of gratuitous domestic assistance should be paid a proper and reasonable amount for the services provided.

Providers of gratuitous domestic assistance must submit a log or diary of the assistance they have provided to the worker before the insurer can approve and pay for the services. Both the provider and the worker (if able) must sign the log or diary.

See Part 4 of the Guidelines for more information.