Home-Care Reimbursement: Compare the Agency’s Charge With the Caregiver’s Wage

A quote showing what an agency pays its caregiver is not the same document as an invoice showing what a customer pays the agency. That difference matters when a spouse provides medically necessary home health care after a California work injury and the dispute concerns a reasonable reimbursement rate.

The January 7, 2026 WCAB panel decision in Harvey v. SoCal Machine, Inc., No. ADJ17547374, illustrates a useful evidence task: Compare equivalent services at the same skill level using the employer’s cost of obtaining those services. It is persuasive panel authority, not binding en banc precedent, and does not establish a statewide hourly rate. In the same decision, the panel rescinded a separate order approving permanent-disability stipulations and returned unresolved adjustment and fee issues to the trial level; its amended home-care award is the focus here. Harvey, slip op. at 8–9, 11–12.

Identify what each price actually measures

Before comparing two numbers, label their basis. An employee-wage listing describes compensation paid to a worker. An agency charge describes the price charged to the customer, potentially including the agency’s operating costs. A family caregiver’s earnings from a previous job describe a different employment relationship. These figures cannot be treated as interchangeable proof of the cost of replacement home care. First determine whether an applicable Medicare or official fee schedule governs the service; section 5307.8(a) addresses services outside those existing schedules. The Harvey comparison does not authorize bypassing a governing schedule.

In Harvey, the panel accepted dividing the spouse’s work into ordinary caregiving and nursing-level services. It changed the reimbursement amounts because the appropriate metric on that record was the employer’s cost of equivalent third-party services, supported by provider bills and testimony. It did not reject the distinction between skill levels. Id., slip op. at 8–9.

Build a comparison that matches the service

A useful comparison packet identifies the provider, service location, dates covered, type of care, hourly or other billing unit, and the person responsible for supplying that service. Keep the original quote or invoice alongside the summary so counsel can check qualifications and limitations.

• Service: Describe the actual task and the physician’s explanation of its injury-related need.
• Skill level: Separate ordinary assistance from services requiring nursing-level skill; do not apply the most expensive category to the entire day.
• Price basis: State whether the figure is an agency customer charge, employee wage, negotiated payment, or another measure.
• Comparable period: Identify when and where the service was available and any minimum visit, overnight, or other pricing condition.
• Actual performance: Connect the claimed hours to records of who supplied the care and when.

For example, a customer quote for a nursing visit cannot establish the value of every hour spent preparing meals. Conversely, a general caregiver wage advertisement does not itself establish what the employer would pay an agency for the nursing service actually required. This comparison is an evidence-organizing method, not a substitute for deciding which schedule or reimbursement procedure governs.

Keep hours, skill and price as separate questions

A finding that someone needs help around the clock does not mean every hour involves the same task or skill. The Harvey record distinguished nursing-level work from ordinary caregiving and excluded hours during which the spouse was not supplying care. The panel preserved the two-category approach. Id., slip op. at 5–6, 8–9.

Keep a truthful task record that identifies actual time, interruptions, outside help and overlapping services. Do not count the same period twice simply because two tasks are described. California Labor Code section 5307.8(b) separately excludes payment to the extent services were regularly performed in the same manner and degree before the injury. Explain what changed; ordinary household membership does not turn all household work into compensable care.

A rate dispute does not establish authorization

Under Labor Code section 4600(h), home health care must be reasonably required because of the industrial injury and prescribed by a qualifying physician and surgeon. The statute also limits liability for services supplied more than 14 days before the employer receives the prescription. Preserve the prescription and receipt evidence. A persuasive agency quote does not cure missing medical support or establish every claimed hour.

If approved services were never provided, our guide to documenting undelivered home care addresses that separate problem. The full Harvey case analysis explains the panel’s award and unresolved settlement issues. For a specific rate dispute, bring the care records, authorization documents, original provider bills and competing rate evidence to our workers’ compensation practice.

Sources: Official Harvey decision; Labor Code § 4600; Labor Code § 5307.8.