Medical Transportation and Resonableness - What to Pay

Saturday, January 17, 2004 | 0

As is often the case, a dialogue in our Forums essentially take on an educational route by themselves, providing excellent practice article material with a bit of editing for clarity and readability. The following article is a summation of a Professional Forum thread concerning medical transportation expenses.

Q: Is there anything in the Labor Code stating that the client/insured has to provide medical transportation for an injured worker to chiropractic visits? My question is two-fold. First, if it is a matter of no transportation, couldn't they take public transportation? If it is a matter of disability, how do we determine what is reasonable when it comes to transportation? If a doctor prescribes the transportation, but it doesn't seem reasonable, do we have valid grounds to object to bills from a medical transportation company?

A1: The main Labor Code Section is 4600, which refers to the Government Code sec. 19820. The route to the $0.34/mile rate which is "reasonable expenses of transportation" is a bit complicated, but DWCNewsline 02-01 increased the rate 10-1-01 and quoted Title 2 of the Code of Regulations Sec. 599.631(a). The two are connected, per the DWC.

Thus, in answer to your question, per case law, a claims adjuster owes "reasonable expenses of transportation," presumed to be 34 cents a mile, absent other information.

This applies to trips to ANY physician, chiropractor, accupuncturist, physical therapist, or trips to the drug store.

There is nothing to prohibit an injured worker from taking a bus for 5 miles each way on a monthly bus pass and then claiming 34 cents/mile.

I have seen an injured worker take an air ambulance to San Francisco for limb implantation surgery, $10,000 to $12,000. Technically, that is reimbursement for transportation expense.

I recall an injured worker who was sent to see Dr. Lipton in San Francisco from the mountains above Yosemite. She had never driven a car in her life. Her husband was hospitalized. She was in a "halo" neck brace. She took an ambulance 15 years ago or so. The cost then was $700 or so. A WCJ ordered it paid. I think most would have.

The test is what is "reasonable" in order to allow the injured person to obtain treatment. Medical transportation companies are becoming more and more common. Often they are cheaper than a cab or other alternatives.

A2: I would assure the need for medical transportation has been documented in the Primary Treating Physician (PTP) reports as a medical necessity. The applicant not having a vehicle, which we see frequently, is not sufficient reason to support the need for medical transportation. If the report is not substantial in this area, you may object to the PTP's findings per LC 4061/4062 and attempt to resolve the issue that way.

The applicant can take public transportation, again with the reasonability rule applying, you do want to assure it does not aggravate the original injury as you may increase the extent of injury. Lower extremity and some back injuries or recent surgeries are obvious situations where most applicant's should not drive themselves and should a neighbor or family member not be available to assist it may be prudent to provide alternative transportation who is most likely already under contract with the insurance company.

I agree that $.34 per mile is due to the applicant for all medical visits including trips to pharmacies. If a claim is received for mileage over this amount, it is recommended to pay the reasonable mileage due and object to the balance claimed within the 30 days currently provided for objection to medical treatment costs. A valid reason for objection is that the PTP has not provided substantial and continued reporting which documents why the applicant requires transportation as medically reasonable and necessary to cure or relieve the effects of injury.

A3: It sounds as though your question may have to do with what appears to be a burgeoning practice primarily in Southern California where some physicians are providing transportation. You are required to pay reasonable costs of transportation. Some of these "services" charge more for travel than the cost of the medical care and frequently exceed the cost of even a cab.

I would object to costs that exceed the $34 per mile unless you have verification that there is a medical need for more than that. If there is verification that such services are necessary, you should provide the service yourself rather than leave it to the applicant or the especially the doctor to provide the service unless you have some understanding as to the costs etc.

A4: There are many physicians and applicant's attorney's in Southern California that are forming separate transportation companies and are charging $150+ to transport claimants back and forth to therapy and doctor visits. The other problem is that when you take the applicant's depo, you learn that there are 6-10 other applicant's in the medi-van at the same time.

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