The story is all too familiar: you’re handling the claim of an employee who sustained catastrophic injuries that will result in significant permanent disabilities.  Because the medical costs are so high the pressure is on to get him out of the hospital or rehab setting and get him home.  However, in order for the patient to be discharged, the home will require modifications to meet his specific needs. The register is rolling, the clock is ticking, and it’s up to you to make it all happen.

I get anxious just thinking about it, and I’ll bet you do, too.  Your anxiety is well founded when you consider just how out of your element you are when trying to arrange for this service.

You’ve been trained as a claims adjuster or nurse case manager, not a contractor.  You’re schooled and practiced in the art of investigating and analyzing issues of compensability and the calculation and delivery of various benefits, not in the design and creation of home modifications. You may be an expert in reading and interpreting medical reports, but blueprints may as well be written in Greek.  You know exactly what to do to negotiate the settlement of a disputed issue, and you’re skilled in the vagaries of medical billing and adjustment, but making sense out of a contractor’s estimate is totally confusing.  You may or may not even know one end of a hammer from another, yet it is your responsibility to see to the timely and cost-effective modification of the claimant’s home in accordance with the needs of his injury. So this you usually do by the seat of your pants.

Home Modification 101-A:
When dealing with home modifications, whether time is of the essence or not, there are a few things that you can do to make the job easier for yourself.  Here are the ABC’s of home modifications:

A) …is for appropriate assessment and accurate scope.  Knowing your claimant, his injury, and the outcomes you are seeking sets the foundation for a successful modification process.

1. In the vast majority of the cases, you should start with a detailed home assessment completed by a skilled Physical or Occupational Therapist.  Since the claimant is seldom present during the home assessment, you should provide the home therapist with a functional and physical assessment completed by the rehab team in the hospital.

2. When at all possible, have the contractor on site during the therapist’s assessment. This is a tremendous time saver and it provides the contractor with a specific scope from which to create his pricing. Far too often the contractor is assigned after the home assessment and it takes several days for him to complete the site visit and create an estimate based on his interpretation of the therapist’s report. When this is done, you’ll frequently find the contractors estimate to be quite different from the recommended scope.  You then have to start the process of first trying to understand his estimate, explaining the differences in the two assessments, and negotiating an understanding of what needs to be done to arrive at an agreed price and timetable for completion.

The majority of this can be avoided by developing a unity of purpose that can be accomplished through a joint site visit at the time of the home assessment.

B) …is for building relationships with contractors and service providers in your area. If you want a responsive contractor that you can trust to complete quality work for a fair price and in a timely manner, you need to take the time to find them and get to know them. Once you are confident in who they are and their abilities, you need to let them know that they are trusted allies.  You can do this by treating them fairly, communicating well, by providing a good volume of assignments and paying them quickly. If you can’t provide volume, at least make them aware that they are your vendor of choice and that you will use them when jobs are required.  It is also a good idea to have a couple of contractors that you can build such a relationship with.  Consider developing one with a large contractor capable of building a site built home and maybe a second one who is better with interior modifications or room additions.

C)…means to consider long term objectives and complete as many as you possibly can NOW! When you are confident that the needs will be greater in the future, constructing modifications now is always less expensive than later.  Material costs seldom go down, and labor costs never do.  By taking care of the necessary modifications now, you can dramatically reduce overall costs as well as the time, focus and energy required to manage the claim.

Although home modifications can be a challenging process, a tremendous amount of frustration can be reduced, and the job simplified, by incorporating simple and sometimes obvious steps. Remember, start with a good and accurate scope and include the contractor from the beginning. Make him acutely aware of the desired outcomes and objectives by inviting him to attend the home assessment site visit.  By doing so, you can build trusting business relationships that can expedite the construction process.  And finally, consider completing modifications now that will be required in the future.  Ultimately each of these steps not only makes life easier for you, but they help contain costs while improving results for the injured employee.

Home Modification 101-B: Get Professional Help!
When it comes to complicated issues, nothing beats specialized knowledge.  But don’t feel that you necessarily have to be the one who has it.  By working with professional companies or individuals who specialize with home modifications, you can save time and money while maintaining your sanity. Although these services should be retained as early in the process as possible, they can be a benefit at any point during the modification process. Here is an example:

The David Corey Company was recently asked to provide a second opinion on a modification that was about to be authorized.  A therapist had recommended a modification that would provide a safe wheelchair exit from a down-stairs back door.  Unfortunately, the house was located on a hill, thus requiring expensive excavation.  A contractor had visited the house, had spoken with the homeowner and the son-in-law about the requested modification, and had considered what would be required to modify the exit.  His final estimate included retaining walls, drainage systems, pavers and landscaping, the estimate exceeded $30,000.00.

Believe it or not, the contractor’s pricing was actually very reasonable and customary for the scope of work he had estimated.  However, because of a lack of skilled involvement, the scope of work was greater than necessary. 

After the Company’s review, we were able to create an appropriate scope of work and the job was completed for under $4,000.00. Although this is a unique example, similar scoping irregularities and overpayments frequently happen on a smaller scale, and issues like these can be avoided by securing the services of home modification specialist as early in the process as possible.

When seeking a skilled professional in home modification, make sure they:

• are licensed in the appropriate profession;
• are insured;
• understand both the medical profession and construction practices;
• understand contractor estimating and pricing practices;
• provide you with transparent line item estimates (showing their fees);
• understand insurance practices;
• provide construction project management;
• can involve appropriate and skilled contractors;
• have e-commerce capabilities;
• can provide a customer service program during the process.

Although these professional services do involve an additional fee, these costs can easily be offset by the surety of scope and accuracy of price you’ll receive, not to mention an invaluable reduction of time and energy that you will be required to spend on the modification process.  Remember…it would be silly to expect a contractor to be able to do what you do with confidence. Likewise, unless you truly understand home modifications and construction, and have the time and inclination to be deeply involved in the process, your best bet might be to work with someone who does.

Corey Staver
The David Corey Company, Inc.
(877) 261-1766 x102