Durable Medical Equipment (DME) plays an essential role in a worker’s recovery journey. It’s used to help injured workers maintain or regain their ability to perform daily living activities. In the course of a worker’s compensation claim, it’s common for injured workers to receive correspondence from the insurance company related to DME. This equipment is often prescribed as part of the worker’s treatment, and the insurance company may approve or deny the provision of the equipment depending on the specific circumstances of the case1.
In some cases, DME is required temporarily, while in others, it is needed on a permanent basis. It is especially useful in helping workers recover from surgical procedures and extended hospital stays. For those with chronic medical conditions, DME may be necessary for continuous treatment and medication administration. For severely disabled workers, DME can significantly aid in performing daily living activities23.
Case Study: John’s Journey to Recovery
To illustrate the impact of DME on a worker’s recovery journey, let’s consider the case of John, a construction worker who suffered a severe injury to his lower back while on the job. John’s injury was severe enough to require surgery, after which he was prescribed several pieces of DME to aid his recovery. These included a hospital bed for his home, a wheelchair for mobility, and a lift device to help him move around.
John’s recovery was challenging, but the DME provided much-needed support. The hospital bed offered adjustable positioning, which reduced the pressure on his lower back and improved his comfort while resting. The wheelchair enabled him to move around his home and attend physical therapy sessions. The lift device was particularly helpful, assisting John in getting in and out of bed independently, thus reducing the risk of additional injury.
However, obtaining the necessary DME wasn’t a straightforward process. John’s doctor had to provide a “Request for Authorization” for each piece of equipment, which then had to be approved by the insurance company. Initially, the insurance company denied the request for the lift device, which led to an Independent Medical Review. Fortunately, the decision was overturned, and John was able to receive the lift device, significantly improving his recovery process4.
John’s experience also highlights the impact of DME on a worker’s Whole Person Impairment and Permanent Disability assessment. His use of the wheelchair and lift device factored into his impairment rating, affecting his compensation. The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, provides a framework for this, stating that Whole Person Impairment ratings can be influenced by the use of such equipment5.
John’s case is not unique. Several court cases have considered the issue of DME provision in workers’ compensation claims, often revolving around the injured worker’s entitlement to the DME and the reimbursement for the DME from a provider. For example, in the case of Ocean View School District vs. WCAB (2007), the insurance carrier was ordered to pay for DME that included a rechargeable IPG battery, similar to the process John went through to get his lift device6.
John’s story underscores the pivotal role of DME in a worker’s recovery journey. It not only aids in the physical recovery process but also plays a significant role in the evaluation of a worker’s impairment and the legal aspects of a worker’s compensation claim.