New York Workers’ Compensation Law (WCL) dictates that an injured worker is entitled to reimbursement for certain expenses relating to an established compensable claim. WCL Section 13(a) provides that an employer is obligated to provide an injured employee with such medical, surgical, or other attendance or treatment as the nature of the injury or the process for recovery may require. In kind, courts have ruled that transportation costs incurred in connection with medical treatment are compensable if reasonable, and that the statute should be interpreted liberally so as to effectuate the economic and humanitarian objects of the act, including access to treatment and the means to travel to the area where services are available [so as not to] result in a frustration of the purpose of the legislation. Simpson v. Glen Aubrey Fire Co., 86 A.D.2D 909, 910, 448 N.Y.S.2d 261, 261 – 262 (3d Dept. 1982).
An injured worker can seek reimbursement of expenses incurred for travel to medical professionals other than doctors. Expenses related to treatment by a podiatrist, psychologist, chiropractor, physician’s assistant, and physical therapist are all eligible for reimbursement.
With this framework in mind, a comprehensive list of eligible and non-eligible expenses has emerged. Round trip mileage for medical treatment, testing, evaluation, and independent medical examinations, within Board guidelines, is compensable. Necessary prescription and over-the-counter medications, medical supplies, hospital parking, and tolls are also reimbursable if an original receipt is provided. Transportation costs incurred when an injured worker moves to a region where the climate will aid in curing their ailment are compensable if prescribed by a treating physician, though a carrier should be careful not to pay for living expenses in the new climate and limit reimbursement to only the travel expenses to relocate temporarily. Mileage to hearings, pharmacies, unapproved out-of-state medical treatment, ACCESS-VR/One Stop Shop/vocational training sites, and non-causally related travel or treatment, are not eligible for reimbursement.
There is no statutory limit on the amount of time a carrier may use to audit and pay Medication and Transportation (M&T) reimbursement requests. A recommended best practice is audit and payment or denial of all M&T reimbursement requests within four to six weeks, though there is no statutory penalty that can be assessed for failure to timely pay these reimbursement requests. The only exception to this is if M&T is ordered to be audited and paid by a Workers’ Compensation Law Judge within a certain amount of time. If a carrier does not comply with this direction, they open themselves up to penalties under WCL Section 25-3(c) for dilatory tactics.
A carrier reviewing M&T reimbursement requests should be careful to ensure that they have been provided with sufficient detail to substantiate the reimbursement. Missing information may be a valid reason for reimbursement denial. Mileage reimbursement requests should include a date, name of the medical professional visited, and round trip mileage from the injured worker’s home. Reimbursement of tolls or paid parking require original receipts.