After an administrative law judge ordered them to buy an injuredwoman a hot tub, Workers' Compensation officials worry their fundswill go whirling away, like water down the drain.
It may be a first-ever for the division that provides healthbenefits and compensation to those injured on the job, said SteveCavender, program manager at the agency's Office of Medical Service.
'It's the first request of this nature I'm aware of,' Cavendersaid. 'It's the only one I'm aware of in the state, although now I'ma little afraid of copycat requests.'
Private and public insurers in West Virginia said they don't payfor hot tubs, either.
An unidentified woman with a work-related back injury submittedthe claim for a tub with whirlpool jets. Although the woman'sphysician said the bath was part of her therapy, a Workers'Compensation claims person turned it down.
'She quite rightfully turned it down,' Cavender said. 'Workers'Compensation has a schedule of equipment we pay for. Certainly, aJacuzzi is not one of the things we cover.'
The items the division pays for are taken from a standard list ofequipment used by insurers nationwide, he said.
The woman protested the division's decision, and the case endedup in the lap of an administrative law judge. He reversed the order.
Even after Judge Alan Drescher's ruling, the case wasn't over.
The division was ordered to pay for a stand-alone tub withwhirlpool jets, but Cavender says they tried to settle for somethingless. Less elaborate, less expensive.
'We tried to get away with buying an insert to the existingbathtub, but it was not acceptable,' Cavender said. 'It was notliving up to the spirit of the administrative law judge's order.'
An insert costs $300 to $400, Cavender said.
Workers' Compensation also unsuccessfully offered to buy thewoman a health club membership or to pay for visits to a physicaltherapist, where she would have access to a bath with whirlpooljets.
The claimant, on the other hand, selected a $5,000 hot tub,Cavender said.
In the end, the two groups settled on a $2,000 model. But justbefore installation, Workers' Compensation officials realized therewas no place to put the tub in the woman's house. They spent $600 topour a concrete pad outside of the house on which to place the tub.
Other local insurers, including the Public Employees InsuranceAgency and Mountain State Blue Cross-Blue Shield, said they wouldbalk at paying for a hot tub, too.
'I cannot believe they had to pay for that,' said Ann Carpenterof Benefit Services, a third party administrator for claims. 'That'sthe first I've ever heard of someone having to pay that kind ofclaim.'
Hot tubs are specifically excluded from his company's plan, saidDavid Mathieu of Health Plan of the Upper Ohio Valley.
'The cold hard fact is this: If someone needs to get a whirlpoolthree times a day, then it's their nickel,' Mathieu said. 'It's apersonal comfort item. If insurers were to cover those kinds ofthings, our insurees - who already think they're paying too much -would wake up and ask what had happened to their premiums.'
'Whirlpool pumps and equipment' are not covered by the PublicEmployees Insurance Agency, although director Bob Ayers said thereis an appeals process.
While whirlpool baths might soothe the pain of a back injury, itdoesn't have a real medical benefit. That's what insurance pays for.
'It's of comfort, not of therapeutic need,' Ayers said. 'We don'tprovide comfort-based health care.'
Writer Karin Fischer can be reached at 348-5149.
