“Can a family member, rather than a health aide, be reimbursed by no-fault for providing nursing services to an auto accident victim?”
Yes, although there are several points to keep in mind. First of all, the injured family member must be hurt severely enough that a doctor recommends the need for home health services, such as changing bandages, helping with bathroom needs, bathing, transfers from bed to chair, and so on. Secondly, the services must be of the skill level that a family member can reasonably perform, as mentioned in the list above. Skilled nursing services such as placing or cleaning catheters, or giving injections of medication, might have to be provided by a licensed or certified health professional, not a layperson.
Next, the type and amount of services must be reasonable, necessary, and related to the injuries from the collision. In other words, the no-fault carrier will certainly question whether 24-hour daycare is necessary for a person with a broken wrist or whether three family members at a time should be reimbursed for helping to change the bandage on a family member’s sprained ankle.
Finally, the rate of pay for providing the care will be negotiable. The insurance company will usually offer an amount around the rate that a health care agency pays the unskilled workers they send to a home to provide the care—not the rate the agency itself charges the insurance company, which includes the overhead that the agency has in addition to paying the worker. However, family members who provide unskilled services that a doctor recommends can argue that they have overhead, too, such as keeping track of the work they do and the time it takes to do it, and for any expenses that they incur as part of giving the care, such as going to the store to purchase health-related items that are part of the care, or for taking classes to learn how to provide more advanced levels of care.
If an agreement is reached between the family and the insurance company for having a family member provide in-home care, please remember that the amount the family member receives is income that must be reported to the IRS and any state and local tax authorities. The insurance company will send a Form 1099 to any caregiver who receives direct reimbursement from the company. The tax considerations are an essential part of the decision whether it makes financial sense for a family member to provide in-home care or to allow an agency to send in a worker who will do the work.