24/7 home health care not medically necessary: Appeals court

An injured worker is not entitled to full-time home health care, a three-judge appellate court held in a unanimous decision on Tuesday.

In Dawson v. County of Henrico, a man who became disabled in a work-related vehicle accident failed to convince the Court of Appeals of Virginia in Richmond that he required 24-hour a day, seven days a week home health care provided by his fiancée or at her direction.

On May 22, 2015, Tom Dawson was injured in a traffic accident that resulted in brain damage. He was awarded benefits by the Virginia Workers Compensation Commission for a "reasonable, necessary, causally-related, and authorized medical treatment" for his resulting injuries.

In November 2017, he sought benefits for 24-hour a day, seven-days-a-week home health care, which his employer said was neither reasonable nor causally related to his work accident.

Mr. Dawson’s treating psychiatrist said Mr. Dawson suffered from depression, fatigue, headaches, memory impairment, aggression, difficulty regulating emotions and cognitive difficulties as a result of his brain injury and that he failed to “understand what he needs to do to take care of himself.” The psychiatrist recommended he receive the home health care for “medical well-being and safety,” but later indicated that he probably didn’t need care every hour, but needed supervision during his waking hours.

His fiancée testified that Mr. Dawson barricaded himself in a room when she went to work and was unable to drive, handle money, manage medications or prepare his own meals.

The deputy commissioner denied the home health request, and the commission affirmed the decision in a split decision. Mr. Dawson appealed.

The appellate court affirmed the denial, holding that that the testimony of the psychiatrist that Mr. Dawson “probably” did not need care “every hour” supports the commission’s decision.

Although Mr. Dawson argued that the commission erred in failing to consider the differences between whether his home health care was compensable and whether his fiancée could be paid to provide the care, the court held that because Mr. Dawson could not prove he needed 24-hour care in the first place, the commission’s evaluation of whether payment for care provided by the fiancée was allowable “was unnecessary.”

The appellate court held that the record supported the commission’s conclusion that 24-hour home health care was not medically necessary, and affirmed the denial of the care.