Home modification services policy

What WorkSafe will pay for

WorkSafe can pay the reasonable costs of modifications to a home in which a worker resides in Australia where the modifications are reasonably required as a result of a work-related injury or illness and will impact on an injured worker's access to and function within the home.

If an injured worker's home cannot be reasonably modified for any reason WorkSafe may contribute a reasonable amount to the purchase costs of a semi-detached portable unit or to the costs of relocating the worker to another home that is suitable for the worker or is capable of being reasonably modified.

Before commencing any modifications to a home it is a legislative requirement that a worker obtain prior written approval from the WorkSafe agent or self-insurer for the payment of the reasonable costs of modifying the home.

If the house is not capable of being modified, prior written approval of the reasonable amount that the WorkSafe agent or self-insurer will contribute to the purchase costs of a semi-detachable portable unit or to the costs of relocating the worker to another home that is suitable or capable of being reasonably modified, if required. A worker is also required to sign a Capital Service Agreement (CSA) if the payment or contribution is more than $10,000.

Background

WorkSafe recognise that some injured workers may require home modifications in order to access or function within their homes. WorkSafe can pay for home modifications following:

• written advice on all housing/residential options from an occupational therapist
• prior written approval by WorkSafe including costings

WorkSafe will consider all reasonable options when addressing a request for home modifications inclusive of installation and provision of equipment, structural alterations and relocation. WorkSafe will also be mindful of Australian standards for home modifications when considering requests for work to be undertaken.

Definitions

In this policy:

• 'Home' – refers to a domestic structure in which an injured worker resides, eg. house, home unit or flat.
• 'Home modifications' – refers to an alteration made to an injured worker's home.
• 'Major home modifications' – refers to any modification/contribution made by the agent for an amount greater than $50,000 where structural changes are necessary (e.g. moving internal walls or enlarging existing rooms) and/or extensive modifications in and around the house e.g. ramps, carports, bathroom and/or bedroom.
• 'Minor home modifications' – refers to an alteration made to an injured worker's home costing $50,000 or less.
• 'Building Modification Project Manager' – refers to a third party provider engaged by WorkSafe to oversee major modifications to an injured worker's home.
• 'Relocation costs' – refers to the reasonable costs directly related to moving from one home to another:
  • Relocation costs for a worker relocating to a suitable home (or home that is capable of being reasonably modified) as a result of a work-related injury or illness include the reasonable costs that may relate to a house sale such as real estate agent fees, stamp duty, advertising costs, legal services, bank fees limited to the relocation process, furniture removal, interim rental accommodation as well as the costs of an assessment and report to locate an appropriate home by an appropriately qualified third party approved by WorkSafe or selfinsurer (e.g. occupational therapist, building modifications project manager).
  • Relocation costs for a worker who is relocating from a rental property to another rental property include reasonable costs payable for the requirement to breaking the tenancy agreement early, furniture removal and the cost of an assessment and report to locate an appropriate rental property by an appropriately qualified third party approved by WorkSafe or self-insurer.
  • 'Rental property' – refers to a home lived in by an injured worker whereby rent is paid to a private owner, the Ministry of Housing or a statutory organisation.
  • 'Semi-detachable portable unit' – A semi-detached portable unit is a stand alone unit/granny flat/bungalow constructed on vacant land close to the main home. It only includes facilities specifically utilised by the injured worker which cannot be accessed or modified within the home. A semi-detached portable unit may only be considered in cases where a worker's home cannot be reasonably modified to suit their needs.

Guidelines

How is eligibility for home modifications determined?

Eligibility for home modifications is determined by the injured worker's need to reasonably access and complete functional activities within his/her home as a result of the workplace injury or illness.

Factors for consideration may include:

• whether the home in which the worker resides is structurally suitable for modification
• the nature of the worker's work-related or illness
• how the worker's work-related injury or illness restricts or is likely to restrict the worker's ability to:
  • enter and leave the home in which the worker resides
  • move about the home for necessary purposes
• the extent of the modifications that will be needed to address those restrictions or likely restrictions, and
• whether the cost of the modifications is likely to exceed the value of the home in which the worker resides

What home modifications can the WorkSafe agent or self insurer consider paying for a worker who has sustained permanent loss or severe restriction in physical functioning?

Before commencing any home modifications, it is a legislative requirement that the worker obtain the WorkSafe agent or self-insurer's written prior approval of the payment of the reasonable costs of modifying the home.

In order to consider payment of the reasonable costs of home modifications for a worker residing in Australia which he/she reasonably requires as a result of work-related injury or illness, the WorkSafe agent or self-insurer requires the following information:

• submission by a medical practitioner to a WorkSafe agent, who will arrange for an assessment by an approved WorkSafe occupational therapist
• completion of an occupational assessment and report by an approved WorkSafe occupational therapists
• in the case of major home modifications, a report prepared by a WorkSafe approved building modifications project manager appointed by the agent or self-insurer
• signed Capital Service Agreement (where required)
• written approval from their WorkSafe agent or self-insurer

The worker must also provide the following to the WorkSafe agent:

• a current complete copy of the house title or rates notice
• if the property is leased, a copy of the lease and if the original lease has expired, written confirmation from the owner as to the likely length of the ongoing tenancy plus written approval for the home modifications to be undertaken. Where possible, recommendations should be provided for portable aids and equipment that can be moved from home to home, and
• drawing and job specifications are to be prepared following final agreement on design after discussions with the OT and family

The report from the occupational therapist and, where applicable, the building modification project manager must take into account:

• clinical justification for the modifications considering all options available
• Australian standards for disability and access (refer to the Australian Building Codes Board website)
• current building regulations, and
• consultations undertaken with the injured worker and/or his/her authorised representative

Reasonable home modifications are those that allow the injured worker access to the following areas of the home:

• the physical dwelling
• a bathroom
• a bedroom
• a living/dining area
• a kitchen or basic cooking facilities (injured workers who fully or partially prepare his/her own food or beverages)

Other examples of home modifications that can be considered include:

• structural modifications, e.g. door widening, bathroom modification. Where possible, existing materials will be re-used and replacement of items, where appropriate, will be with equivalent materials, and
• changes to fittings or layout, e.g. installation of rails, installation of portable ramps, provision of equipment

WorkSafe may consider paying the reasonable costs of home modifications as a multi-step process.

Initial home modifications may be undertaken to facilitate reasonable access to assist the injured worker to enter and leave the home to facilitate discharge from hospital, while the remainder of recommended home modifications may be undertaken post discharge.

Proposed modifications must be approved in detail and in writing by the agent prior to any work being commenced or payment made.

The work undertaken must be:

• in accordance with the approved quotation
• in accordance with the plans and job specifications submitted to the value of the approved quotation, and
• carried out by an appropriately qualified builder and/or trades person

What can WorkSafe consider paying for if a work related injury or illness is not a significant long term physical, sensory or a cognitive disability?

WorkSafe can pay the reasonable costs of minor modifications or the provision of equipment and/or aids to enable an injured worker to access his/her home based on the recommendation of an occupational therapist as agreed to by WorkSafe.

What factors impact on the reasonable costs of home modifications?

An occupational therapist and/or building modifications project manager appointed by WorkSafe will assess and make recommendations regarding the suitability of a home to be modified having regard to the following factors:

Person related:

• the nature of the work related injury or illness
• how the worker's injuries restrict or are likely to restrict the worker's ability to enter and leave the home, to move about the home for necessary purposes and complete functional activities
• ownership of the property
• length of lease of a rental property (usually a minimum of 12 months)
• anticipated period of occupancy in the dwelling to be modified, and
• the scale of the proposed modifications when considered in conjunction with alternative residential options

Building related:

• the structural suitability of the home to be modified including size, age, design, surrounding terrain and condition of the dwelling
• the extent of the modifications needed to address the worker's restrictions
• whether the costs of the modifications is likely to exceed the value of the home in which the worker resides
• building materials required for the modifications
• local planning regulations/building permits
• the ability of the WorkSafe agent or self-insurer to negotiate any necessary agreement or consent required on modifications with the owners or the Body Corporate. Other negotiations may need to take place with Department of Housing or the Senior Master's Office
• any complex, unique or unusual circumstances associated with the modifications
• relevant National Trust building regulations
• relevant Australian Standards including Australian Standards for disability and access (refer to the Australian Building Codes Board website), and
• permission of the owner, the Department of Housing or the body corporate to temporarily or permanently undertake modifications to the dwelling

Please note in cases of late claim acceptance the WorkSafe agent or self insurer will consider these factors to reimburse the reasonable costs of home modifications if already completed.

What can WorkSafe pay for if the worker's home cannot be reasonably modified?

If for any reason a worker does not reside in a home that can be reasonably modified WorkSafe can contribute a reasonable amount towards an alternative housing option to purchase a semi-detachable portable unit.

The semi-detachable portable unit will only include facilities specifically utilised by the worker which cannot be accessed or modified within the main dwelling. WorkSafe can also contribute a reasonable amount towards a worker's relocation costs to another suitable home or home that is capable of being reasonably modified.

If relocation is considered the most appropriate option, WorkSafe can consider paying the reasonable costs of:

• assistance to locate a suitable home, which may include an assessment and report by an occupational therapist or a building modification project manager approved by WorkSafe
• real estate agent fees
• bank fees relating to relocation costs
• stamp duty, and
• furniture removal

WorkSafe can pay for minor home modifications to enable an injured worker to have reasonable access to the home.

What can WorkSafe consider paying for if the worker's home is a rental property and cannot be reasonably modified?

• In the case of a worker residing in a rental property which cannot be reasonably modified, WorkSafe can pay for assistance in finding another more suitable rental property.
• Assistance to locate a suitable home may include the reasonable costs of an assessment and report by an occupational therapist. WorkSafe can also pay for reasonable real estate agent fees and removalist costs.
• If a more suitable rental property cannot be located, WorkSafe can consider the reasonable costs of home modification to a new home.
• In such cases, an occupational therapist must review the selected property in order to identify suitable residential options.

What can WorkSafe consider paying for if an injured worker chooses to build a new home or move into another home?

If a worker chooses to build a new home, WorkSafe can consider paying the reasonable costs difference between building the home and the costs of the disability specific building costs.

For example, WorkSafe can pay the cost difference between a standard bathroom and a disability accessible bathroom if required. If a worker chooses to move into another home, he/she would need to take into consideration the requirements.

It would not be considered reasonable for a worker with significant functional limitations to move to a home where substantial modifications needed to be undertaken to allow reasonable access to the home. In such cases, an occupational therapist must review the selected property in order to identify suitable residential options.

Can WorkSafe pay for home modifications for a secondary home which the worker concurrently resides in?

If modifications to a secondary residence are requested, WorkSafe can consider:

• the nature and extent of home modifications to the primary residence or any other previous home modifications approved by them
• the anticipated amount of time that the worker is expected to spend in the secondary residence
• the suitability of the home to be modified

Can WorkSafe pay for more than one home modification?

When considering a request to pay for subsequent home modifications, WorkSafe must have regard to the appropriateness of the next home for modifications and the:

• amount of time the worker occupied his/her previous residence
• cost and extent of all prior home modifications paid for, and
• financial impact on the worker as a consequence of selling his/her previously modified home

WorkSafe can consider paying for more than one home modification if:

• the worker is required to move location to access employment
• the worker is required to move location to access services more readily
• deterioration occurs in the worker's health as a result of the work related injuries or illness, and
• other circumstances occur which are consistent with community standards

Whilst a worker's housing choice and the need to change residences from time to time is acknowledged, it would not be considered reasonable for a worker with significant functional limitations to move to a home where substantial modifications needed to be undertaken to allow reasonable access.

WorkSafe requires an occupational therapist to review the selected property to identify suitable residential options.

Can WorkSafe consider assisting with the provision of short-term alternative housing costs whilst home modifications are underway?

• WorkSafe can assist with the provision of the reasonable costs of short-term alternative housing if the worker is unable to access his/her usual home during the modification process.
• Examples of short-term housing costs may include a short-term stay in an accessible rental property, hotel, motel or serviced apartment.

Can WorkSafe consider paying for air-conditioning/evaporative cooling and heating?

WorkSafe can pay the reasonable costs of room temperature control equipment for an injured worker with permanent impaired thermoregulation, in line with the criteria outlined in the Equipment and related services policy.

When is a Capital Services Agreement required?

A Capital Service Agreement is required where the costs of a building modification are greater than $10,000 in accordance with Victorian workers compensation legislation.

An injured worker must enter into an agreement with the WorkSafe agent in relation to ownership and maintenance of the home modifications, subsequent modifications, changes of ownership and frequency of modifications and changes of ownership.

It is considered reasonable that a worker stay in the modified home for at least 8 years unless there are exceptional circumstances.

Can WorkSafe pay for maintenance/repair costs for completed home modifications?

WorkSafe can pay for the reasonable costs of maintenance and repair of the home modifications completed in relation to an injured worker's work-related injuries or illnesses only, e.g. for maintenance/replacement of a ramp or hand rail.

In such cases, faulty workmanship of any maintenance/repairs completed will remain the responsibility of the tradesperson or company and not the WorkSafe agent or self insurer.

WorkSafe can pay for maintenance and repairs of home modifications required as a result of the work related injury or illness related issues, e.g. for painting or wall damage caused by wheelchair use. However WorkSafe will not pay for general repairs or enhancements that the worker would incur regardless of the work related injury or illness, e.g. replacement of carpet, bathroom tiles or re-painting of the house.

In relation to home modifications what can WorkSafe not pay?

WorkSafe can not pay for:

• home modifications for a person other than the injured worker
• home modifications unrelated to the worker's needs arising from the work-related injury or illness
• home modifications required as a result of a condition that existed before a work-related injury or illness or that are not a direct result of a work-related injury or illness
• home modifications where the owner, a body corporate or other responsible authority has not given permission for the modifications
• home modifications over $10,000 where the Capital Service Agreement (CSA) is not signed by the worker and/or owner
• contribution to or the purchase price of a residence
• upgrades of any materials requested for home modifications
• any space that does not directly contribute to the worker's medical needs, e.g. a carer's room or a quiet room for a worker to spend time away from family
• new items where the original items are suitable for recycling
• furnishings
• rent, with the exception of short-term rent whilst home modifications are under way
• items or labour not included in the final contract for modifications agreed to by the WorkSafe agent or self insurer unless prior approval has been obtained
• home modifications for a house outside the Commonwealth of Australia
• home modifications to a dwelling that is not structurally suitable to be modified
• the unreasonable costs of home modifications