A life-altering workplace injury can suddenly transform simple mobility into a monumental challenge, making everyday tasks seem insurmountable without assistance. For injured workers in North Dakota, the path to obtaining a necessary power mobility device is not a simple prescription fulfillment but a meticulously regulated journey governed by specific workers’ compensation rules. Understanding this framework is critical, as the process involves a series of stringent evaluations, detailed documentation, and clear limitations designed to ensure that any approved device is medically essential and directly related to the compensable injury. This system dictates everything from the initial request and the type of evaluation required to potential vehicle modifications and the formal appeals process. Navigating these regulations requires careful attention to detail from both the injured employee and their healthcare providers, as each step serves as a critical checkpoint before a power mobility device can be considered for purchase, ensuring that taxpayer and employer funds are used responsibly for legitimate medical needs.
1. The Initial Medical Justification
The journey toward securing a power mobility device begins with a foundational and non-negotiable requirement: a formal order from the primary healthcare provider. This order cannot be a casual recommendation; it must be substantiated by clear, objective medical evidence that unequivocally supports the necessity of the device as a direct result of the compensable work injury. Furthermore, the order must be dated to coincide with an in-person office visit, ensuring the assessment is current and based on a direct examination of the injured employee’s condition. Upon submission of this order, the organization initiates a comprehensive review to determine if the employee is already utilizing the most appropriate assistive device for their functional needs. This review often necessitates a formal mobility assessment conducted by a licensed or certified occupational or physical therapist who has specialized training in rehabilitation mobility. The resulting report is crucial, as it must contain explicit documentation of the employee’s functional limitations in standing and walking, even with other assistive devices, and provide a clear rationale for why simpler tools like a cane, walker, or manual wheelchair are insufficient for completing essential activities of daily living.
2. From Assessment to Approval
Once the mobility assessment confirms that a power mobility device is the most appropriate solution, the process advances to a more specialized evaluation phase. The primary healthcare provider must issue a referral for a comprehensive wheelchair or seating evaluation, which must be performed by a certified assistive technology professional or a similarly qualified expert. This evaluation is far more detailed than the initial mobility assessment, culminating in an itemized list of every component and feature needed for the power mobility device. Each specified element must directly correspond to the functional deficits that were previously identified, ensuring the final device is custom-tailored to the injured employee’s unique medical requirements. Following this, the organization may request at least one, and potentially a second, itemized cost quote from a medical service provider to ensure fiscal responsibility. It is also critical to understand the strict limitations on approval. A device intended primarily for outdoor or recreational use is not considered medically necessary and will not be covered. Similarly, upgrades are generally not approved if they are for luxury or recreational purposes, though exceptions exist for features like power tilt or recline seating if they are proven necessary to prevent additional medical complications, assist with transfers, or help manage the employee’s muscle tone and spasticity.
3. Final Provisions and Recourse
The final stages of the process addressed ancillary needs, long-term device management, and the crucial right to appeal. For an injured employee approved for a power mobility device who did not sustain a catastrophic injury, the organization held the discretion to approve a vehicle modification or adaptation to transport the device. However, this approval did not extend to the purchase of a new vehicle. Furthermore, the regulations established that all requests for a replacement power mobility device would be subject to the same rigorous criteria as the initial request. This ensured that the ongoing medical necessity for the device was continuously validated and that a new device was only provided when it was fully justified under the established standards. Ultimately, the system provided a clear path for recourse. Any decision made by the organization under these rules could be formally appealed, with the adjudication process governed by the procedures outlined in North Dakota Century Code section 65-02-20. This structured appeals process provided a legal framework for resolving disputes and ensured that all parties had access to a formal review of the determination.
