Mileage Reimbursement in California Workers' Compensation Claims- 2019 Update
The mileage reimbursement rate for medical appointments and medical treatment increased to $0.58 per mile for 2019. The mileage reimbursement rate applies for all dates of injury for medical mileage incurred during 2019. Record keeping by the injured worker is essential.
Injured workers are entitled to reimbursement for mileage for medical treatment appointments.The basic rule in California workers' compensation claims has long been that injured workers are entitled to reimbursement for mileage to attend medical evaluations and treatment appointments. For mileage incurred in calendar year 2019, the mileage reimbursement rate is $0.58 per mile regardless of the date of the injury. For example, if an injured worker is treating in 2019 for an injury that occurred years earlier, the 2019 mileage reimbursement rate applies. An injured worker should maintain a log or spreadsheet of the mileage incurred going to and from medical appointments. Trips to the pharmacy to fill prescriptions are included and parking and toll fees can be added to the reimbursement request.
Often, the insurance administrator will object to portions of the mileage reimbursement request.By law, the insurance company or third party administrator (TPA) only has to timely reimburse authorized medical treatment related mileage. In the current system, medical treatment authorization requests are submitted to a Utilization Review company who often denies treatment authorization even on accepted injury claims. If the mileage is to unauthorized treatment appointments, the defendant has no immediate obligation to reimburse the injured worker for mileage. And it won't.
However, the injured worker should maintain a log or spreadsheet of the mileage and list the medical facility name as well as the purpose of the visit (doctor appointment, physical therapy, pharmacy visit, etc.) At the time of settlement or trial, the issue of reimbursement for the non-authorized appointments can be used by the attorney for the injured worker to request a higher settlement amount, or even for full reimbursement as part of the settlement agreement.
Often, claims are denied, sometimes for over a year while the Qualified Medical Examinations and litigation process plays out before a claim is finally accepted as a job-related injury. At the point that the claim is accepted, the mileage reimbursement request should be submitted. It might take until the time of the final settlement of the claim, via a Compromise & Release that must be approved by a judge, that the mileage reimbursement issue is resolved by some type of agreement.
Mileage and parking for court dates are not reimbursable.Workers' compensation applicants often are disappointed to learn that the parking and mileage expense to attend court dates are not reimbursable. Know that your attorney has to paid parking and mileage expenses to attend court dates with you, and the attorney is never reimbursed for such either. The concept of medical mileage reimbursement stems from the concept that medical treatment expenses should be covered by the defendant insurance carrier or administrator, not by the injured workers. Medical mileage reimbursement can correctly be viewed as a form of medical treatment reimbursement, while court dates are not part of the medical treatment process.
Don't expect your attorney to file for a court hearing over medical mileage reimbursement.While waiting months for medical mileage reimbursement can be aggravating and frustrating, especially for someone out-of-work with little money coming in, injured workers should recognize that the California workers' compensation courts are burdened with heavy court calendars on issues such as whether a work-injured occurred, liability for TTD benefits, permanent disability level disputes, authorization for medical treatment, liability for additional medical-legal examinations, and other issues of great import. Judges are simply too busy to spend their days going over mileage reimbursement requests. However, the reimbursement requests can be added onto the issues on a court hearing set on other issues.
Also, be aware that defendants normally add a mileage waiver clause into most settlement agreements. As such, both the injured worker and her attorney should be aware of any claim for mileage reimbursement and work such into any global settlement. Sometimes, a defendant will agree to reimburse mileage outside of the settlement as an inducement to compromise on other disputed issues.