In a recent decision of the Delaware Industrial Accident Board, the novel issue of mileage reimbursement for long-distance medical treatment was addressed. The claimant in Barbara Paul-White v. Christiana Care, IAB Hrg. # 1268615 (10/29/09) sustained a work-related neck injury in 2005 while residing in
Delaware. She submitted to surgery with a neurosurgeon in
Delaware in 2008 and at the time of a hearing on the issue of mileage reimbursement in June 2009, was residing in Georgia.
Following the work accident, the claimant had relocated several times, primarily in response to job transfers on the part of her husband. The first move after the work event was to
West Chester, Pennsylvania. The claimant then resided in
from 2006 until July 2007. This was followed by a move to Tampa, Florida where claimant remained there until January 2008, at which time her husband sustained an injury and was unable to work, prompting the couple to move briefly to Asbury Park, New Jersey to reside with claimant's parents. At that juncture claimant's husband found a job in Georgia and the claimant moved back there in mid-2008.
This matter came to the Board on the carrier's challenge to the claimant's application for mileage reimbursement for medical treatment-related travel and the argument that such mileage claim should be based not on the actual distance traveled, but on claimant's original Delaware address at the time of the work injury.
Mileage for medical travel to include trips to the doctor's office, to physical therapy, for diagnostics, and other treatment modalities is compensable pursuant to 19 Del. Code Section 2322(g). The claimant submitted a request for reimbursement for 24,328.08 miles in travel. In addition to calculating miles based on her vehicle's odometer she used programs such as MapQuest and Yahoo Maps. The staggering amount of mileage claimed was precipitated by the fact that claimant retained as her physician of first resort Dr. Yalamanchili, the Delaware neurosurgeon, even after she relocated to Georgia, Pennsylvania, and New Jersey. The carrier challenged the mileage reimbursement claim based on the proposition that while the statute would allow mileage reimbursement for the medical treatment as "necessary", it was not necessarily "reasonable" to receive such care at such a great distance when similar local treatment is available.
In analyzing the issue of whether there should be any constraints on medical mileage reimbursement, the Chief Hearing Officer who penned the Board's decision observed that the statute involved contains no suggestion that the legislature intended anything other than that an injured worker's actual mileage should be reimbursed, and as such, he rejected the carrier's proposition that the claimant's local home address at the time of the work accident should control as a starting point for the mileage calculation for future medical treatment claims.
On the other hand, the Hearing Officer agreed that reasonableness must govern as the litmus test for any long-distance mileage claims in a case such as this one, commenting that the number of miles should not be the sole factor under scrutiny. As such, he noted that in this case the claimant had moved several times for reasons relating to her husband's employment or lack thereof. Two of her moves were to the surrounding states of Pennsylvania and New Jersey, and in those instances, retaining her providers in Delaware was not unreasonable in terms of the mileage involved.
As for the claimant's period of time in
Florida, she did in fact engage local physicians for her care. There were no mileage claims for travel from Florida back to
Delaware. This observation thus impacted the claim for medical travel from to Delaware; the claimant testified that during her residency in Georgia, she made a good faith attempt but was unsuccessful in finding local medical treatment as the physicians were wary of accepting a
Delaware workers compensation claim or turned her away due to the complexity of her case. The Board also entertained testimony from a claims adjuster that the carrier had difficulty finding a physician willing to take over the claimant's pain management, thus bolstering the claimant's position that she had little choice but to retain to her doctor in
Delaware for adequate treatment.
Editor's comments: This appears to be an issue of first impression and what our Chief Hearing Officer Christopher Baum offered up to me as one of the more novel cases of 2009. One of those irksome little issues that seems to pop up now and again as a matter of dispute that often resolves itself grudgingly short of a hearing, this is likely to be deemed a victory for the injured worker, as long as there is a showing in good faith of the attempt to secure treatment of a comparable nature locally – or a compelling reason to travel the distance in question for the treatment of choice.
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