Home maintenance allowance

This step is completed by the serious or severe injury case managerSerious injury case manager on a physical injury team or a severe injury case manager on a physical injury team or Special Care Services. responsible for managing the claim.

If HMA benefits were previously approved and a review is required to determine if benefits can be extended, continue to the Monitor home maintenance allowance eligibility section.

Assess the injury status

Determine if the worker meets the criteria for a seriouslySerious injuries include rotator cuff tears, ruptured discs, severe ankle/wrist fractures, severe knee injuries [e.g., torn anterior cruciate ligament (ACL)]. Soft tissue injuries are not considered serious, unless there is unusual severity (e.g., bilateral epicondylitis, hernia repairs).  Serious injuries include rotator cuff tears, ruptured discs, severe ankle/wrist fractures, severe knee injuries [e.g., torn anterior cruciate ligament (ACL)]. Soft tissue injuries are not considered serious, unless there is unusual severity (e.g., bilateral epicondylitis, hernia repairs).or severelyA 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. Severe injuries include such injuries as spinal cord injuries, severe burns, moderate to severe brain injuries, major amputations, significant respiratory conditions, total loss of vision, terminal cancers, bilateral arm or bilateral leg fractures, and any other injuries of similar severity. injured worker as outlined out in Policy 04-10, Part I and Policy 04-07, Part I Services for Workers with Severe Injuries. If the worker:

• is not seriously or severely injured, they do not qualify for HMA. Continue to step 8 to communicate the decision.
• is seriously or severely injured, continue this step to confirm where they are at in their recovery.

Identify the phase of recovery

Review medical reports to determine what phase of medical recovery the worker is in and whether the worker has or is expected to have permanent limitations that prevent them from completing exterior home maintenance tasks (e.g., lawn maintenance, snow removal, interior/exterior painting, etc.).

Medical reports that may be helpful in confirming this information include return-to-work program discharge reports, independent medical exam (IME) reports, Functional Capacity Examination (FCE) reports, treating specialist reports, Disability Duration ReferenceThe Disability Duration Reference may be used to determine if an injury is expected to be permanent. In the case of a claim with multiple injuries or if the injury is not addressed in the Disability Duration Reference, consider a discussion with the Medical Consultant or Clinical Consultant to assist in determining if the worker has or will have a permanent restrictions. , medical consultant opinion, etc. 

If restrictions are expected to be permanent, confirm if the worker is close to a medical plateau (i.e. a significant increase in function is not expected) and that their limitations will impact their ability to perform exterior home maintenance tasks. For example, a worker may be fit to work their full duties in a sedentary job but still have functional limitations that prevent them from completing home maintenance tasks.

If the worker is in the acute phase of medical recoveryThe acute phase of recovery starts immediately after injury and may last between 1 to 12 weeks depending on the injury severity and required treatments such as hospitalization, surgery or complication management. from a compensable injury and/or further improvement in function is anticipated, they are not eligible for HMA.  For serious injuries, assess the worker's eligibility for short-term home assistance as outlined in in Policy 04-10, Part II, Application 1, Question 2. For severe injuries in the acute phase of recovery, continue to review the worker's eligibility for HMA. 

If the worker does not have or will not have permanent work restrictions, they are not eligible for HMA. Continue to step 8 to communicate the decision.

If the worker is beyond the acute phase of medical recovery and permanent work restrictions have been confirmed or are expected to become permanent (i.e. further improvement in function is not anticipated) continue to the next step to gather information for the HMA review. Additionally, consider if the worker may be eligible for other allowances such as HKA or a personal care allowance (PCA)

This step is completed by the serious or severe injury case managerSerious injury case manager on a physical injury team or a severe injury case manager on a physical injury team or Special Care Services. responsible for managing the claim.

Have a collaborative discussion with the worker to get a better understanding of their current capabilities and any difficulties they are having with completing routine exterior home maintenance tasks. 

When speaking with the worker, listen to their concerns and gather specific details to identify the support they need. Ask focused questions to understand their current needs.

• How are they managing with exterior home upkeep tasks?
• What home maintenance tasks are they struggling with (i.e., lawn care, snow removal, other yard work, interior/exterior painting etc.).
• Were they responsible for these tasks before their injury? If they were, how are they managing now? If they were not, confirm any changes to their living situation and what additional costs they are incurring.

Consider any changes to the worker's living situation since their work injury. If the worker was not responsible for home maintenance tasks prior to their injury and their living situation:

• has not changed, explain to the worker that they are not eligible for HMA as they are not incurring any additional costs. Continue to step 8 to communicate the decision in writing.
  • Example: A worker was living with someone who completed all home maintenance tasks prior to the injury. Their living arrangement has not changed, and this individual continues to be capable of completing the home maintenance tasks post-accident. As no additional costs are incurred post-accident, HMA is not payable.
• has changed, ask the worker to submit information to support the change in their living situations (e.g., address change, copy of rental agreement, etc.). Once the information is received, continue with the HMA review.
  • Example 1: At the time of the accident, the worker lived in a place where they were not responsible for any home maintenance, so the worker would not be eligible for HMA after the accident. However, if the worker moves to a place that requires home maintenance that they are unable to do and they incur additional costs to complete the tasks, HMA may apply.
  • Example 2: At the time of the accident, the worker's spouse managed all home maintenance tasks before and after the accident, so the worker was not eligible for HMA. However, life circumstances changed, and the worker no longer resides with their spouse, HMA may apply.

Note: If the worker was responsible for all home maintenance tasks before the injury, and the person they live with did not perform these tasks previously, it is not an expectation that this individual now assumes these responsibilities. Home Maintenance Assistance (HMA) should be considered.

If the worker confirms they are living with another injured worker who is receiving HMA, explain to the worker the allowance amount will be equally split between them. Refer to the Benefit allocation for multiple claims or shared household section.

If the worker is requesting approval for retroactive HMA benefits, confirm the time period they are requesting HMA benefits for and ask them to submit independent evidence (i.e. receipts, invoices) for their out-of-pocket expenses for review. Refer to the Retroactive home maintenance allowance section.

For serious injuries

Explain that a referral will be made to the Home Assistance Team (HAT) to complete the review. Continue to next step.

For severe injuries

Consider if a referral for an OT assessment is needed. When:

• an OT assessment was previously completed and there are no changes in the worker's restrictions or their living situation, explain to the worker the review for HMA eligibility will be completed and they will be notified of the decision. Continue to step 6.
• no OT assessment previously completed, discuss with the worker that a referral for an Occupational Therapy (OT) assessment to visit them in their home and assess their ability to manage exterior home maintenance tasks. Explain that medical information will be provided to the OT to help them understand the injury(s) accepted and that aids, equipment, supports or strategies may be recommended to help them remain independent. Make the referral and continue to step 5.

This step is completed by the serious injury case manager. 

Note: For severe injuries, a referral to the Home Assistance Team (HAT) is not required as eligibility for HMA is determined by the severe-injury case managerThe case manager on a physical injury team responsible for managing the severe injury or a Special Care Services case manager..

Send a referral to the Home Assistance Team (HAT) to complete the HMA eligibility review. Include the following information in the referral:

• The rationale to support the worker meets the criteria for a serious injury as outlined in Policy 04-10, Part I and Policy 04-07, Part I Services for Workers with Severe Injuries.
• Medical reports that confirm the worker's fitness for work and the letter communicating the confirmed or anticipated permanent functional limitations.
• Tasks the worker has difficulty performing.
• Any other relevant information (i.e. if retroactive HMA is being requested, if the worker has multiple claims and HMA is already paid on one of them, the worker lives with another worker in receipt of HMA, etc.)

This step is completed by the Home Assistance Team (HAT) for serious injuries only.

Review the reason for the HMA referral and confirm the information supports that the worker has a serious or severe injury with confirmed or anticipated permanent functional limitations.

If a previous Home Independence Assessment - Home Activity Review (HAR) was completed for short-term home assistance (STHA), review it to confirm if the worker's limitations have changed (e.g., change in restrictions or permanent restrictions have been confirmed). If the worker's functional limitations have changed, a new HAR form is required.

Review and prepare the HAR form. Call the worker and complete the form. Compare the worker's capabilities and medical reports to the physical demands required to complete the exterior home maintenance tasks.

Note: Complete an initial OT assessment within 90 days when home maintenance needs shift from short-term to long-term. The assessment will attempt to identify strategies or assistive aids to support independence and confirm home assistance needs.

If the criteria for HMA:

• has not been met, clearly explain the reason why the worker does not meet the eligibility criteria for HMA. Consider if they qualify for other allowance benefits such as HKA, STHA, PCA or assistance under Medical Aid (agency, assistive aids and equipment), and outline the next steps required to confirm eligibility. Continue to step 8 to communicate the decision in writing.
• has been met, an OT assessment was previously completed and there are no changes to the worker's restrictions or their living situation, continue to step 6 to determine the worker's eligibility for HMA.
• Has been met and there was no OT assessment previously completed, explain to the worker that a referral will be made for an Occupational Therapy (OT) assessment and make the referral. Ensure the worker understands that:
  • An occupational therapist (OT) will arrange a time to visit them in their home to assess their abilities to manage exterior home maintenance tasks based on their accepted injury.
  • The OT will be provided with medical information to help better understand the worker's injury, which will help with the assessment.
  • The goal is to work together to promote and maintain their independence.
  • Once the assessment results are received, the OT's recommendations will be reviewed to see if there are any aids, equipment, supports or strategies that can help them manage home maintenance tasks independently. Recommendations must relate directly to support needed for functional limitations caused by the compensable injury.

This step is completed by the Home Assistance Team (HAT) for serious injuries or severe-injury case managerThe case manager on a physical injury team responsible for managing the severe injury or a Special Care Services case manager..

Review the OT assessment report and any recommendations provided. If there are questions or clarification is needed, follow up with the OT promptly to ensure accuracy while the assessment details are still current.

Evaluate medical aid(s)/equipment recommendations

If medical aid(s)/equipment was recommended, consider the reason for the recommendation(s) and how it will benefit the worker. Ask:

• Will the aid/equipment address a functional limitation resulting from the worker's compensable injury?
• What is the impact on the worker if the aid/equipment is not provided?
• How often will the aid/equipment be used?
• Why a specific brand was recommended (if applicable) and whether there are cost-effective alternatives that will still meet the worker's needs.
• Is the cost for the aid/equipment reasonable given the benefit it provides to the worker?
• Will providing the medical aid/equipment resolve the worker's permanent functional limitations or will the worker still need additional support to maintain their home?  Note: Equipment/aids for tasks that HMA compensates for (e.g., snow blower, lawn mower) should not be approved unless it eliminates the need for HMA.

Consult with the OT and/or the special needs coordinator if there are questions or concerns about the recommended aids/equipment. 

Discuss recommendations with the worker

Call the worker and review the OT recommendations including any aids, equipment, strategies and supports to help them complete exterior household tasks.

When aids/equipment are recommended that does not resolve the permanent limitations, do not approve the recommended home maintenance equipment. Explain to the worker that because the equipment does not fully address their limitations, it cannot be approved at this time and WCB will continue to assess their eligibility for HMA. Continue to the next step.

Provision of aids/equipment

When aids/equipment are recommended that fully resolve the permanent limitations and no further home maintenance assistance is required, discuss the decision not to approve HMA benefits. Explain what aid(s)/equipment have been approved and that arrangements for purchase and delivery will be made through a WCB special needs coordinator. In some circumstances, the worker may be required to purchase the aid/equipment and submit the receipt for reimbursement. 

In cases where the worker faces financial barriers to obtaining the necessary aids or equipment, an advance may be considered to facilitate access. For larger equipment purchases, ask the worker to send in a couple quotes. Additionally, recommend the worker purchase extended warranty as it will be covered as part of the purchase price. Refer to the Repairs or replacement of aids and equipment section.

Continue to step 8 to communicate the decision in writing.

This step is completed by the Home Assistance Team (HAT) for serious injuries or severe-injury case managerThe case manager on a physical injury team responsible for managing the severe injury or a Special Care Services case manager..

Based on the available medical information and/or OT assessment (if completed), determine if the worker is eligible for HMA. Review each claim on its own merits.

Ensure the worker has a serious or severe injury and the need for support is due to functional limitations related to their compensable injury. If the functional limitations or their relationship to the compensable injury are unclear, consult with a medical or clinical consultant.

Determine the appropriate HMA level

HMA level 1

Consider the flexibility of when the home maintenance task can be performed compared to the worker's functional limitation. Permanent physical restrictions that impact employability may not prevent a worker from doing the physical activities associated with medium level, awkward or heavier home maintenance tasks. For example, a worker who cannot mow the lawn due to a standing restriction may be able mow the lawn if it is done over a couple of days. 

Additionally, HMA level 1 may be considered if the worker:

• is responsible for maintaining the exterior of their condo or house and/or they incur additional costs for exterior maintenance over and above their condo fee or rental agreement.
• rents an apartment, condo or home where they are not responsible for outside maintenance, but they are responsible for interior painting, window washing, and minor repairs, etc.

HMA level 2

Ensure the worker is severely injured and meets the eligibility criteria as outlined in Policy 04-07, Part II, Application 4: Self Care, Questions 7 to 10. Level 2 is not payable for seriously injured workers.

For worker's living in a rented home, reimbursement for their damage deposit may be considered for reasonable wear and tear to the residence if the worker is using a wheelchair or similar mobility aid (i.e., scooter) in the home most of the time. For these circumstances, reimbursement is based on the amount of damage to the home which is paid when the worker moves from the residence. This would eliminate the need for a level 2 yearly HMA.

Identify the HMA effective date

When the worker is eligible for HMA, determine the effective date. HMA is effective the first day of the month the OT assessment was completed. The effective date for a HMA should not be:

• the date of accident. The worker would be in the acute phase of recovery from the injury, the restriction is considered temporary and not confirmed to be permanent. Consider STHA. Refer to the 5-2 Short-term home assistance procedure
• the date of a Medical Consultant memo confirming permanent restriction. The memo may be after the worker has a confirmed permanent restriction according to file information. 

Additionally, if permanent work restrictions were confirmed for a date in the past, the worker may be eligible for retroactive HMA benefits if they can provide support that they incurred additional costs to hire someone to complete home maintenance tasks. Refer to the Retroactive home maintenance allowance section.

This step is completed by the Home Assistance Team (HAT) and their supervisor or by severe-injury case managerThe case manager on a physical injury team responsible for managing the severe injury or a Special Care Services case manager. and their supervisor.

Send a recommendation to the supervisor requesting approval to pay HMA benefits. Include the following information:

• Rationale to support the worker has a serious or severe compensable injury that is permanent.
• Medical reporting that supports the worker has permanent functional limitations impacting their ability to perform home maintenance tasks. Include details on the specific tasks the worker struggles (e.g., snow removal, mowing the lawn, interior/exterior painting, etc.) and the compensable functional limitation that impacts their ability to complete them.
• Date of the OT report and any aid/equipment provided to the worker and how it helps the worker remain independent.
• Details about the worker's living situation (e.g., lives in a condo, rented home, or owns their house) and whether they are responsible for the maintenance and/or maintenance costs.
• The worker's environmental conditions (e.g., lives in a warm climate and does not require help with snow removal but may have other home maintenance needs).
• The level of HMA (either level 1, 2 or both). Refer to step 6.
• For HMA level 2, include an explanation of why the worker qualifies (e.g., worker is in a wheelchair or uses a similar mobility aid for most of the day), which causes wear and tear to the home.
• The effective date for HMA benefits and the information to support the start date.
• If the request includes approval for HMA benefits retroactively, include relevant information related to the retroactive period. Refer to the Retroactive home maintenance allowance section.
• If the worker may be eligible for a clothing allowance (e.g., the worker has a prosthesis, appliance or wheelchair). When the worker may be eligible, but a decision has not been made, refer to Policy 04-07, Part II, Application 4, Question 11 and 12 and the Clothing allowance section in the 4-6 Special services and equipment procedure.
• The review schedule. Depending on the claim circumstance, HMA may be reviewed at a pre-determined date, yearly, every 3-5 years or on another schedule (semi-annual). Refer to the HMA review schedule information in the next step.

The supervisor reviews the recommendation and approves or does not approve HMA, including the effective date and the proposed review schedule. The supervisor may adjust the recommended effective date and review schedule, if required. 

This step is completed by the Home Assistance Team (HAT) for serious injuries or by severe-injury case managerThe case manager on a physical injury team responsible for managing the severe injury or a Special Care Services case manager. and their supervisor.

Review the supervisor's recommendation to approve or not approve HMA, if applicable.  Action any recommendations as appropriate.

Call the worker to discuss the decision and rationale to approve or not approve HMA.

HMA not approved

If the decision is to not approve HMA, clearly explain why the worker does not qualify if not discussed in an earlier step (e.g., not seriously or severely injured, medical aids or equipment resolved the functional limitation for home maintenance).

If applicable, discuss whether the worker may qualify for another benefit like HKA, STHA or PCA and explain the next steps for the review. Refer to Policy 04-10, Part I for other available allowances for serious injuries or Policy 04-07, Part I Services for Workers with Severe Injuries. 

Communicate the decision in writing and end this procedure. 

HMA approved

If the decision is to approve HMA, discuss the HMA level (level 1, level 2 or both) that is approved, the next review date and the approved amount according to Policy 04-10, Part II, Addendum A for HMA level 1 and Policy 04-07, Part II, Addendum B for HMA level 2. Ensure the worker is aware that HMA is only payable while they are responsible for the maintenance of their residence. Encourage the worker to find a service provider in the area they reside who can assist with the home maintenance tasks they are unable to manage.

Communicate the decision in writing and notify the Medical Aid Team of the approval.

Medical aid requests HMA benefits based on the effective date and the approval period. If HMA is only payable for a partial month (based on the effective date), Medical Aid will process the payment based on a prorated calculation.

Note:  Costs associated with paying HMA level 1 are automatically charged to the employer's industry. The employer receives cost relief for these benefits as outlined in Policy 05-02, Part II, Application: 1, Question #9.

HMA review schedule

Set up the monitoring scheduled to determine the worker's ongoing eligibility for HMA based on the individual claim circumstances. Consider: 

• Reviewing at a pre-determined date (e.g., 30 days, 45 days, 60 days, etc.) for workers who are entitled to a temporary HMA. Monitor closely and end HMA when medical or file information indicates the worker is able to do home maintenance tasks or does not qualify for the HMA.
• Reviewing yearly if changes are anticipated (e.g. a worker is over the age of 65 and rents their home, their living situation is expected to change or a worker is receiving other benefits such as a Housekeeping Allowance or Personal Care Allowance which also may require a yearly review, etc.).
• Reviewing every three to five years if the worker is only receiving HMA or is receiving both HMA and HKA and no changes are anticipated. Supervisor approval is required for this schedule. Consider the following guidelines to determine review frequency. For workers:
  • Under age 65 who rent: every three years.
  • Over age 65 who own: every three years.
  • Under age 65 who own: every five years.

Case manager review is required at a minimum of every 5 years.

Notify the case manager of any monitoring requirements and the next scheduled review date.

Note: If a worker in receipt of HMA benefits updates their address, an auto-task will be triggered for the claim owner to review for any changes to the ongoing benefit entitlement.