Gray v. Prudential Insurance
October 5, 2015
Home Renovations Arm Medical Aids Medical Expenses § 206(8)
Summary from the Troubh Heisler Attorneys
Mr. Gray is a paraplegic using a wheelchair at all times. While on a business trip he suffered an arm injury while being transported from his wheelchair to a van. As a result of the injury, Mr. Gray was less mobile transferring to and from his chair and lost some independence in self-care. His physician suggested modifications to Mr. Gray’s home to increase its level of accessibility.
Mr. Gray sought reimbursement from Prudential for the home renovations. Prudential declined, arguing they were neither reasonable for proper medical nor mechanical aids under Section 206. Judge Collier granted Mr. Gray’s petition but reduced the amount to account for certain high-end materials. Prudential appealed, arguing that the plain language of Section 206’s preamble makes home renovations not compensable because they are not medical in nature.
The panel affirmed Judge Collier’s decision citing Brawn v. Gloria’s Country Inn, 1997 ME 191. In Brawn, the Law Court reversed a hearing officer’s decision that an employer was only required to pay for adaptations to a van that transported an employee’s wheelchair and was not required to pay for the van itself. The Law Court reasoned that Section 206, “is not limited to medical apparatus or aids, but extends to all ‘reasonable and proper . . . mechanical. . . aids’ and ‘physical aids made necessary by the injury.’ 39-A M.R.S.A. § 206 (emphasis added). Judge Collier’s decision correctly determined that the home renovations satisfied this definition because they were physical aids made necessary by the injury.
Furthermore, the panel rejected Prudential’s argument that the renovations were not reasonable and proper pursuant to Section 206(8). Whether something is reasonable and proper requires a fact-based inquiry to determine if the statute’s ultimate purpose of providing reasonable relief from the effects of a work-related injury is met. Judge Collier engaged in a careful review of each modification and its relation to injury. The panel affirmed his decision.