The short answer.
The Longshore and Harbor Workers’ Compensation Act requires treatment for as long as the nature of the injury requires. That standard is not limited to hospitals and clinics. When a treating physician prescribes nursing or attendant care in your home, the responsible carrier is responsible for that care too.
There is no cap. There is no episode limit. It does not run out after a set number of visits or months. If the injury still requires the care, the care is still owed.
Who the Act reaches.
Longshoremen, crane operators, ship repairers, terminal and harbor workers — people injured loading, unloading, building or repairing vessels, or working the docks and terminals that serve them. Serious waterfront injuries come under the Longshore Act rather than state comp.
Its extensions reach further. The Defense Base Act extends the same rules to civilians working overseas on U.S. government contracts. NAFIA extends them to civilian employees of base exchanges, commissaries, clubs and MWR programs — covered in the article for base workers. One rulebook, three doors.
Two things live under “home care.”
- Attendant care is hands-on help with daily living: bathing, dressing, grooming, moving safely, getting to the bathroom, eating.
- Nursing care is skilled clinical work: wound care, medication management, watching a condition that changes and reporting what changed.
Many injured workers need some of each, and the mix shifts over time. A crush injury can mean months of skilled nursing and years of attendant help afterward.
Three things have to line up.
- Your claim is accepted, and medical benefits are still open.
- Your treating physician prescribes the care and describes what you need help with.
- The carrier authorizes it in writing, for a stated number of hours.
The third step is where care stalls. Vague orders get slow answers; specific orders get authorizations. Everything downstream traces back to what one physician wrote in one document. The Longshore and base worker guide →
What a useful prescription says.
The strongest ones name the accepted injury. They name the tasks you cannot do without help. They state hours per day and days per week, so there is a number to authorize. They say how long the need is expected to last, and whether it is expected to be permanent. And they are rewritten when your needs change, instead of a year-old order sitting in the file.
You choose the doctor who writes it.
The Act gives the injured worker free choice of treating physician. The carrier does not assign your doctor. If an adjuster arranged your first appointment and nobody mentioned you had a choice, that choice was still yours. How to change treating physicians properly within your claim is a question for your attorney.
Maximum medical improvement does not end it.
This is the most common misunderstanding, and it usually arrives by phone. MMI is a milestone about wage benefits: it means your condition is not expected to improve further with treatment. It does not close your medical benefits. Care that maintains your condition — that keeps you safe, clean, fed and out of the hospital — continues for as long as the injury requires it.
A family member can often be paid to give it.
When attendant care is prescribed, a family member can frequently be employed through a licensed home care agency: trained for the tasks in the plan of care, supervised by a nurse, and on payroll for work they have been doing unpaid.
Before any settlement conversation.
Some settlements trade lifetime medical care for a one-time payment, and that closure is permanent. Whether it is the right decision belongs to you and your attorney — but it cannot be judged until the cost of your future care has been documented rather than estimated. We prepare those lifetime attendant-care cost projections free, for families and attorneys anywhere in the country.
What it costs you.
Authorized care for the accepted injury comes at no cost to you; it is billed to the responsible carrier under the written authorization. Hands-on care is delivered in Nevada. Guidance and cost projections are free anywhere.
If you are not sure which program covers you, start with a few questions about your work and your care.
Common questions.
Does the Longshore Act cover home care?
Yes. The Act requires treatment for as long as the nature of the injury requires, and when a treating physician prescribes attendant or nursing care at home, the responsible carrier is responsible for it once it is authorized.
Does my care end at maximum medical improvement?
No. MMI affects wage benefits, not medical care. Treatment and attendant care that maintain your condition continue for as long as the injury requires.
Who picks my doctor in a Longshore claim?
You do. The law gives the injured worker free choice of treating physician. The carrier does not assign your doctor.
Can a family member be paid to care for me?
Often, yes. When attendant care is prescribed by your physician, a family member can frequently be employed through a licensed home care agency — trained, nurse-supervised, and paid for the care they already provide.
Sources: U.S. Department of Labor, Division of Longshore and Harbor Workers' Compensation.