WorkCover home modifications

WorkCover can in certain instances contribute to, or cover the cost of reasonable modifications to a home.

This page will look at the circumstances in which this can be done and what the restrictions are to claiming home modifications.

As always, this article only applies to Victorian WorkCover Authority and is not applicable to claims in any other state or territory.

What home modifications will WorkCover consider?

WorkCover will consider paying the reasonable cost of home modifications when the worker resides in Australia, the modifications are reasonably required as a result of a work related injury or illness, and they will impact (presumably improve) on a workers access to and function within the home.

Given WorkCover  scrutinizes all invoices that are potentially payable by them, and the potential cost of building works in 2025 onwards, you can expect there to be very close scrutiny of any request for home modifications.

It is also important to note the difference between home modification, and home renovation.

WorkCover will not pay for any renovation of a home which they described as “to make new again, repair, restore to good condition”. They will only pay for modification, which is to “make a change, alteration, or a variation”.

Starting the process

Requests for home modifications can be initiated by anyone involved which includes the injured worker, their family, their medical or health practitioners, or a hospital. However, in the end, the actual home modification recommendations must be submitted by an occupational therapist.

WorkCover notes that home modification requests should be received from hospital occupational therapists (prior to discharge from rehabilitation hospital) or community occupational therapists (post discharge from rehabilitation or other hospital).

Minor and major works

There are two different classifications that WorkCover apply to home modifications, which are ‘minor’ and ‘major’.

Minor home modifications are for amounts less than or equal to $50,000 and major is considered to be above that figure.

The different classifications have different rules surrounding them in terms of the documentation required to establish an entitlement to home modifications. 

For major home modifications, WorkCover is going to engage a building project manager, as well as obtain at least three written quotations to assess the cost of the proposed works.

For minor home modifications no building project manager is required and the number of quotations is reduced to ‘at least’ one.

What about when the home isn’t suitable for modification?

In circumstances where the workers home cannot be reasonably modified for any reason WorkCover, may also contribute a reasonable amount to the purchase cost of a semi detached portable unit or to the costs of relocating the worker to another home that is suitable for the worker or is capable of being reasonably modified.

We would expect these sorts of arrangements only to be agreed to by WorkCover  where there is very significant injury, for example, where the injured worker is wheelchair bound or has lost a leg or arm in a work accident.

The process

Workers will also be required to sign a capital service agreement if the payment or contribution made by WorkCover is more than $10,000. This is like a contract between the injured worker and WorkCover, setting out the rules regarding the modifications, like ownership and maintenance of the home modifications, subsequent modifications, changes of ownership and frequency of modifications.

One major term will likely by that the worker must stay at that home for at least 8 years unless there are exceptionally circumstances.

This is to make sure the worker uses the modifications that WorkCover has spent money on.

If a WorkCover insurer accepts major Modification plans, the building project manager must prepare and submit schematic plans to the insurer within 20 business days.

This can be after a potential home visit, including a representative of the WorkCover  insurer, and potentially an occupational therapist, the building project manager and an architecture (if required), and obviously the injured worker.

The building project manager can revise the plans if needed after this meeting. The WorkCover insurer will accept or reject the plans. If accepted, a copy of the plans must be sent to the worker and the occupational therapist. Further meetings can take place if agreement can’t be reached.

Ultimately written agreement of the worker and an occupational therapist are likely to be required. If those parties can’t reach agreement on suitable modifications, further meetings can be held to try and reach agreement on the plans. Workers have appeal rights if they do not agree with the insurers decision in relation to home modifications.

The next step is the design and development plan stage. The building project manager must prepare detailed design and development plans and submit a copy to the WorkCover insurer. Those plans are then reviewed by the WorkCover insurer. Plans can be reviewed if not agreed on.

After this process is completed the WorkCover insurer will send a written outcome summary letter to all of the parties detailing what will occur and any timelines involved. Again, the worker has the usual appeal options (Conciliation being the first step) if they do not agree with the plans.

Once the plans are signed off, the building project manager will obtain quotes from builders to complete the home modification works, and the WorkCover insurer will draft the capital services agreement.

The building project manager reports back to the WorkCover insurer and recommends a builder based on the quotes.

If a worker is legally represented, the lawyers can review the proposed capital service agreement, and will contribute up to $250 in legal costs. Once the service agreement is finalised and signed, the building process can commence.

WorkCover notes: “a residential Building Contract must be signed for all modifications over $10,000, in accordance with the Domestic Building Contracts Act 1995 and Domestic Building Contracts Regulations 2017. This contract is between the builder and the home owner and does not involve the [WorkCover insurer]”.

Changes during the modification process

Anyone who has built or renovated a home knows that there can be unforeseen issues that need attention, and inevitably more money. The building project manager can at any time during the work request a variation or addition to the plans. The variation request can be to the overall modifications or a variation in price only.

The insurer has to consider whether the request for a variation or addition is reasonable, as well as whether it complies with Australian standards and/or building regulations.

Final processes, paperwork and later issues

The building project manager will liaise with the occupational therapist regarding a final inspection of the modified home. The manager will also fill out and return a ‘Home Modifications: Final Inspection Summary Form’ to the WorkCover insurer. The builder will not receive final payment until that form is completed.

The worker/home owner is responsible for normal home maintenance and repairs.

If there are issues relating to building workmanship, the injured worker has to discuss it with the builder directly.

The WorkCover insurer is not responsible for engaging builders directly and any poor workmanship. Maintenance or repairs issues need to be taken up by the homeowner with the builder directly.

Conclusion

Home modifications are potentially available to injured workers, but given the amount of money involved in most home modifications, the process is likely to be time consuming, with WorkCover requiring significant support and paperwork establishing the need for modifications.