REIMBURSEMENT FOR TRAVEL EXPENSES IN A WORKERS’ COMPENSATION CASE
Once your workers’ compensation case is accepted by the insurance company or established by the Workers’ Compensation Board, you are entitled to reimbursement for your travel to and from your health care providers (doctors, therapists, etc.) as well as to the insurance company’s “independent medical examiners” or “IMEs.” The rule is that the insurance company must reimburse you for expenses that are reasonable under the circumstances of the case, and the Board has created a set of rules and forms that provide some guidance.
The best way to make sure you are properly reimbursed is to fill out a C-257 form, including as much detail as possible. You can download or print a copy of the form at
http://www.wcb.ny.gov/content/main/forms/Forms_CLAIMANT.jsp#C257
If you drive to the doctor or therapist, you must calculate the distance to and from your home to the medical office. You can use your car’s odometer, but it is probably better to use an internet web site (like Google) because that is what the insurance company will be using when it audits your submission.
Once you have the mileage, you need to calculate your reimbursement based on the rates posted by the Board. The rates for the past three-plus years are:
2017 = 53.5 cents per mile
2018 = 54.5 cents per mile
2019 = 58 cents per mile
Example: You drove to your doctor’s office for treatment on March 1, 2020. The office is 4.2 miles from your house. You would calculate the round-trip mileage as 8.4 miles. With a mileage reimbursement rate of 58 cents per mile, the total reimbursement for that trip is $4.87 (8.4 x .58 = 4.87).
Your C-257 form should include the date and location of each medical visit (including the provider’s name), the round-trip mileage, and the dollar amount of reimbursement for that visit. Although each individual trip may only be a few dollars, the amounts can add up quickly over the course of a case. If you have past visits that you have not submitted for reimbursement, your doctor or therapist’s office can usually provide you with a printout of all of your appointment dates.
The insurance company will “audit” your reimbursement request when it is submitted. The Workers’ Compensation Law does not include any specific time limitation for such an audit, and it does not require the insurance company to give you an explanation of its payments. As a result, it often takes a month or two for an insurance company to respond and the payment amount is often less than what you submitted.
If the insurance company does not respond, or does not pay you properly, then we can ask the Board to take action. The Board will usually give the insurance company additional time to audit your request and direct it to provide you with an explanation of any items or amounts it disputes. You are more likely to be win any disputes about mileage reimbursement if your C-257 was fully completed with all of the necessary details about the date, time, place, mileage and how you calculated the reimbursement amount – that is what Judge will be looking for to see if your request was valid or if the insurance company’s denial is justified.
If you take public transportation, you are entitled to reimbursement for the fare you paid (in most cases a Metrocard fare). If possible, you should buy a round-trip Metrocard for each visit, keep a copy of the receipt, and attach it to your C-257 form.
Whether your travel reimbursement is for mileage or public transportation, you should be sure to (1) add up each expense on a page, (2) write the total for that page at the bottom of the page, (3) add up all of the pages, and (4) write the grand total clearly. That way you will know exactly how much you submitted, how much the insurance company paid, and how much is in dispute.
You can also use the C-257 form to request reimbursement for medical items you paid for out of pocket, such as bandages, ice packs, crutches, a cane, etc. It is important to attach a copy of the receipt for each item as well as a copy of the prescription or doctor’s report saying that it was necessary.
The Board now has a formulary and other processes that insurance companies use to pay for prescription medication directly. However, if for some reason you have paid for a prescription medication, or if you are using over-the-counter pain relievers (like Tylenol, Motrin, etc), you can attach the receipts to the C-257 form for reimbursement.