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Claims Management

Five Mistakes That Drive Up Home Modification Costs

Without the right experts involved, a home modification can go very wrong. Avoid these common mistakes to achieve cost-effective results while helping to restore a much-needed sense of normalcy for the injured worker.

April 27, 2021

Home modifications for severely-injured workers can be an overwhelming process for adjusters simply because it is an infrequent component of the job. There are many benefits to gaining a broad understanding of the process and, more importantly, the complicated and costly problems that can occur as a result of a poor home remodel. Here are five cost-driving mistakes to avoid when managing a claim that includes a home modification.

1. Using an unreliable third-party vendor to manage the home modification. There are plenty of vendors who promote this service as part of their offerings, but beware. All too often these vendors are not experts in home modifications and do not monitor the quality of the contractors that they use. Many times these vendors contract the home modification out to a construction company that does not specialize in modifying homes for individuals with disabilities. These factors can expose you to a range of problems – from contractors who use faulty materials, to contractors who make illogical modifications that do not match the patient’s disabilities. These third-party vendors are often also building in a nice fee for themselves. They rarely provide an itemized estimate, so you do not have the opportunity to see this added cost. The only way to avoid this is by taking control of the process and overseeing the project yourself.

2. Starting construction before understanding the real capabilities of the patient. Does your contractor understand the substantial difference in mobility related to a C3 versus L4 spinal cord injury? Most do not, so they are going to approach all home modifications as if they are the same. This can drive up costs significantly. In one case, the patient may need a roll-in shower, however, the other only requires a folding shower bench. One may require a roll-under kitchen sink, whereas the other will not be able to prepare their own meals, so more extensive modifications are unnecessary. Approaching home modifications like all injuries are equal can drive up your costs with many unnecessary alterations. It is important to assess the patient’s abilities before any construction begins and instruct the contractor as to what is required based on independence level and provision of care.

3. Using a provider who doesn’t understand both the injury side and construction side of the project. This is not a home redecoration. You need a provider that knows the difference between what is medically necessary for the patient as opposed to what is nice to have. You also need a provider who is not going to make costly construction errors in the process, like removing a necessary load-bearing wall. Utilizing a home modification specialist is a critical factor in not only saving on costs, but also avoiding a lot of preventable aggravations throughout the process. A legitimate home modification specialist’s process usually includes steps like taking photos, measuring, reviewing medical records, designing several options and discussing them with the claims team (carrier and third-party administrator), working with the claims team to determine a final plan, discussing the plan with the family, then utilizing vetted contractors who they have put through specialized training.

4. Not managing the scope of the project during the construction phase. Any good home modification should provide an itemized estimate based on your approved scope. But, once the construction begins, you are not finished. The entire claims team (carrier and third-party administrator) must be part of the entire process and should require ongoing timelines and photos to ensure that the approved scope of work is being followed. In addition, it is important to ask to be notified before the contractor starts on any additional work that was not part of the initial scope to determine options, need and cost. Demand complete transparency so that you can keep tabs on the full project start to finish.

5. Failing to rely on your carrier’s expertise. Your workers’ compensation carrier contacts can be your largest allies in a home modification project for an injured worker. They have seen it all and have a wealth of expertise to share. It is likely that you will encounter unchartered territory that your carrier has probably dealt with in several cases, so do not hesitate to reach out to them for help. Your carrier specializes in helping severely injured employees get the best possible outcomes, so use them as a resource.