Home and workplace modifications

Review the claim information to determine if the worker meets the eligibility criteriaPolicy 04-07 states a worker must be considered severely injured to be eligible for home and/or workplace modifications. of a severely injuredA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. worker. Refer to Policy 04-07, Part I; Services for Workers with Severe Injuries,  Policy 04-07, Part II; Services For Workers With Severe Injuries, Application 2 - Mobility for home modifications and Policy 04-05, Part II, Application 1 for workplace modifications.  

Confirm if an occupational therapy (OT) assessment was completed; if no, continue to the next step. 

If yes, determine whether the assessment included recommendations for home or workplace modifications, and if the recommendations are reasonably required as a result of the compensable injury.

When the recommendations are for medical aid equipment (e.g., ergonomic equipment, etc.) and/or assistive devices that do not require home or workplace modifications, follow the 4-6 Special services and equipment procedure. 

Note: Some modifications to the home or workplace may be required in order to install certain medical aids/equipment (e.g., hand/stair rails, grab bars, bidets or raised toilets, stair or porch lifts, temporary ramps, etc.). If non-structural modifications are needed, consult with an HMS when installation involves significant costs and/or construction. 

Call the worker to discuss whether they meet the eligibility criteria of a severely injured worker. Explain what information was considered in the decision. 

When the worker does not meet the eligibility criteria, discuss what other supports may be available (e.g., medical aid, assistive devices, etc.) and arrange other recommended medical equipment as appropriate. Communicate the decision in writing and end this procedure.  

When the worker does meets the eligibility criteria, discuss the next steps to determine if home and/or workplace modifications can be considered. Include the employer in the call if workplace modifications are being considered.

Home modifications

Confirm the worker owns their home. Ask them to complete and sign the home ownership form, and submit proof of home ownership (e.g., land title, purchase agreement, property tax assessment, etc.), 

If the worker is not the homeowner (e.g., either rents, leases or shares accommodations with the homeowner), explain that modifications cannot be completed. Some modifications (e.g., grab bars, stair lifts, exterior temporary ramps, etc.) may be considered with proof of home ownership and written agreementA written agreement is required detailing what the expectations are for the owner and what the WCB will authorize for removal and repairs, when these devices or equipment are removed.  We must have a written agreement detailing what the expectations are for the owner and what the WCB will authorize for removal and repairs, when these devices or equipment are removed.from the registered homeowner and/or condominium entity that outlines the permanency or equipment removal criteria for the home modification. 

When written agreement from the registered homeowner cannot be obtained, explain that an occupational therapy assessment for medical aids/equipment may be completed. The assessment may identify other medical aid equipment or devices which do not require installation or modifications to the home (e.g. bath lift, sask pole, raised toilet seats, etc.). Consult with a HMS to discuss alternative solutions. 

Workplace modifications

Confirm that the employer owns the premises and, if so, ask the employer to submit proof of ownership and written agreement that outlines the permanency or equipment removal criteria for the workplace modification. If the employer does not own the premises, ask them to provide written consent from the building's owner for the proposed modifications. 

When the employer is not able to obtain written consent from the building's owner for the proposed workplace modifications, consider other medical aid equipment or devices which do not require installation or modifications to the workplace (e.g., ergonomic equipment, sit/stand desks, etc.). Communicate the decision and end the procedure.

Note: WCB provides workplace modifications (i.e. structural and/or non-structural) when the worker has permanent work restrictions and there is confirmed employment. When the worker has temporary work restrictions, non-structural aids (e.g., ergonomic chair) may be provided. Structural modifications are considered on a one-time only basis. 

Explain the next steps and make the referral(s)

• Discuss the role of the decision maker, worker, HMSThe HMS will oversee all home and workplace modifications (including all out-of-province home and workplace modifications), and requests the appropriate service (general contractor or consultant) regardless of the cost and duration of the project. and, if applicable, the employer, in the home and/or workplace modification process.
• Review the types of home or workplace modifications that may be considered.
• Discuss the referralsThe OT assessment (e.g., home modification, workplace modification and/or ergonomic assessment, etc.) will identify the worker's functional needs, the type of modifications required and the benefits or limitations of the modification. required for a modification project.
• Make the appropriate referral(s). If an OT assessment for home or workplace modifications has already been completed, continue to the next step.

Refer to the HMS role section for further details about their role.

Note: Consult with the HMS, as needed, about the required documents and/or modification process. 

Review the occupational therapist's report and assess whether the OT recommendations are reasonably required as a result of the compensable injury.  Call the worker and/or employer to discuss OT assessment results and explain the decision to recommend or not recommend the modification project.

A modification project is not recommended

Explain why they are not eligible for the modification and discuss other recommended supports such as medical aid equipment (e.g., ergonomic equipment, etc.) and/or assistive devices that do not require modifications to the home to install. Communicate the decision in writing and end this procedure.

A modification project is recommended

Discuss the home and/or workplace modifications that may be considered based on the OT recommendations and advise that a site visit is required to determine the scope of work required for the project. Explain a referral to an HMS will be made to arrange the site visit and confirm the worker's and/or employer's agreement. 

If the worker and/or employer are in agreement with a site visit, continue to the next step.

If the worker and/or employer are not in agreement, discuss alternatives and work together to find a solution (e.g., medical assisted devices, equipment, removing barriers, alternate timeframes etc.). Include the HMS in the discussion as appropriate. 

Send a referral to the HMS. Refer to the HMS role section for details about their role. 

The HMS will review the claim and consult with the decision maker to proceed with a site assessment. Once the consent is received, the HMS will arrange a referral to a contractor or consultant who will visit the site to determine the scope of work required based on the occupational therapist's recommendations. 

Once the site visit is completed, the HMS will discuss the outcome of the site visit and recommendations with the decision maker. 

The HMS will arrange a meeting with the decision maker, worker and all other parties to discuss the proposed modifications and to reach a conclusion on the work that will be considered for approval. The HMS will provide the worker with a copy of the quotation report and/or preliminary design report.

If all parties are in agreement with the quotation report, the HMS will submit a proposal to the decision maker requesting approval to proceed with the recommended home or workplace modifications.

Review the proposal from the HMS along with the quotation report. Consider the scope of the work required (including drawings and photos), a breakdown of costs and an estimated timeline to complete the work. Discuss concerns with the HMS and work together to resolve them. Determine whether the decision is to proceed or not proceed with the modifications.

If the decision is to proceed, and the costs:

• exceed the decision maker's level of authority, submit a recommendation to the supervisor requesting approval to proceed with the home and/or workplace modification. Include information from the HMS' proposal in the recommendation and any non-construction related costs (e.g., secondary housing, moving, storage, relocation, real estate expenses, etc.). The supervisor will send the recommendation to the next approval level, if required. See the Levels of Authority manual.
• are within the decision maker's level of authority, notify the HMS of the decision to approve the project.

Each level of authority (i.e., case manager, supervisor, manager, director, vice president) reviews the recommendation, confirms the proposal aligns with policy and documents their decision in a file note. 

Review the supervisor's (or other approvers) decision and address any concerns identified. Resubmit for approval, if required.  

Together with the HMS, call the worker and/or employer (for workplace modifications) to discuss the decision to approve or not approve the modifications project. 

Review any non-construction related costs (e.g., secondary housing, moving, storage, relocation, real estate expenses, etc.) and when arrangements will be made. Consult with the HMS to confirm appropriate timing for these supports.

If the modification project is approved and under $100,000, send two copies of the authorization letter and request that the worker or employer return a signed copy.  Explain that the modification project cannot proceed until the signed agreement letter is on file. Once the signed copy from the worker and/or employer is received, the HMS reviews the document and begins coordinating the modifications project. Continue to step 8. 

If the modification project is approved and over $100,000, explain to the worker and/or employer that the HMS will refer the project for tendering to obtain bids from contractors. Continue to the next step. 

If the modification project is not approved, explain the decision and reason the project will not proceed. Discuss other medical aids, equipment, assistive devices that may be considered to support the worker. This may include a referral for further assessments (e.g., personal care assessment). Consult with the HMS for assistance in identifying alternate solutions, if needed. Communicate the decision in writing and end this procedure. 

Note: In rare cases, if it is not practical to modify the worker's current residence for structural or other reasons, a financial grant towards the purchase of an alternative residence may be considered. The grant will normally be equivalent to the cost for the approved modifications for the worker’s current residence; however, the grant cannot exceed the actual costs to modify the new home (see Policy 04-07, Part II, Application 2 for additional information about these grants). As noted above (see step 2), all grants in lieu must be referred to a HMS. 

Review the outcome from the tendering process. When there is an increase in the construction costs, the HMS will notify the decision maker and the decision maker obtains approval from the appropriate level of authority (i.e., case manager, supervisor, manager, director, vice president) before the project can be awarded. For example, if approval was provided for $150,000 and the favored bid came in at $175,000, approval for the increase in the project costConsulting fees are paid on a percentage of the construction costs so if these costs go up so do the consulting fees. is obtained from the appropriate level of authority. 

Together with the HMS, call the worker and/or employer to discuss the outcome of the tendering process and the contractor selected to complete the modifications. 

Review any non-construction related costs (e.g., secondary housing, moving, storage, relocation, real estate expenses, etc.) and when arrangements will be made. Consult with the HMS to confirm appropriate timing for these supports.

Send two copies of the authorization letter and request that the worker or employer return a signed copy. Explain that the modification project cannot proceed until the signed agreement letter is on file. Once the signed copy from the worker and/or employer is received, the HMS reviews the document and begins coordinating the modifications project.

Continue to manage the claim and ensure the payment of invoices are completed. The HMS will monitor the progress of the home or workplace modifications until the project is completed. 

The Medical Aid team reviews and processes payments for invoicing that aligns with the project plan and budget. If an invoice is not within the approved proposal, a file note is sent to the decision maker indicating the invoice exceeds the approved amount.

Review and, if appropriate, approve change requests, any unforeseen design or structural changes, revised quotes or increased constructions costs as recommended by the HMS. Request approval from the appropriate level of authority, as required. 

Determine ongoing ownership of equipment and property associated with the modification. Explain that a signed security agreementA security agreement is a contract signed between two parties, the borrower and the lender. The security agreement protects the lender by creating a security interest in all or some of the assets of the borrower.  The agreement outlines the terms and conditions of the loan, and lists the assets used for security.  Discharge of the WCB’s security interest takes place when the worker meets the ownership criteria or other criteria imposed by the WCB at the time of purchase.  is required prior to the worker taking occupancy (for home modifications). Refer to Policy 04-07, Part II, Application 2, Question 9; Mobility and procedure 7-9 Tools and equipment. 

For workplace modifications where the worker is still employed with the employer after one year, consider transferring the ownership and maintenance responsibility of the equipment to the employer. If the employment has or is likely to end, WCB retains ownership of the equipment. In these cases, WCB may have the equipment returned and made available for use by the same or a different worker in a future employment opportunity.

Once the HMS confirms the modifications are complete, review any recommendations for a referral for OT reassessment (if required) to determine any changes in the worker's care needsHome modifications do not always result in changes to personal care allowance. In some cases, the modifications are completed to improve a worker's quality of life. (i.e., personal care allowance, home maintenance allowance) following the home modifications. 

Communicate the completion of the project in writing to the worker (home modification) or employer (workplace modification). Include the following information:

• The approved modifications and basis.
• The ongoing responsibilities of all parties. See question 9 of Policy 04-07, Part II-Mobility.
• Details about ownership and maintenance of the WCB-owned equipment (e.g., lifts, temporary ramps, etc.) required for the home modification.
• The employer's responsibility for maintenance of the WCB-owned equipment (e.g., lifts, temporary ramps, etc.) required for the workplace modifications.
• Review and appeal information.

Review the worker's eligibility for allowances (i.e., personal care allowance, home maintenance allowance level 1 and 2) as the worker's level of care may have changed following completion of the modifications.  

Contact the HMS to discuss any project related issues that need to be addressed. 

The HMS coordinates a warranty follow-up inspection with the contractor or consultant to ensure any problems are resolved within the 12-month warranty period. The warranty inspection report will be sent to the decision maker, including the warranty work to be completed by the contractor(s).

Note: Any issues or concerns regarding the service provided by the contractor or consultant should be referred to the health care consultant for the residential and workplace modifications contract.