GQ Corner
Q. Please see attached mileage requests for bus trips from Mexico to El Paso for medical treatment. When injured the EE lived in Texas, but has since moved to Mexico, do we owe for these bus trips?
A. There are a couple of points worth discussing here.
First, remember that under Rule 134.110(a)(1), claimant has the burden to show that medical treatment for the compensable injury is not reasonably available within 30 miles from where the injured employee lives and the distance traveled to secure medical treatment is greater than 30 miles one-way. If he cannot prove that, he is not entitled to reimbursement. It appears he is living in Gomez Palacio, Durango, Mexico. If that is correct, a quick Google search reveals that is a city of over 250,000 people. You may be able to search providers within that city and find that medical treatment is in fact available well within 30 miles from where he lives. It seems ridiculous that he has to travel 523 miles to El Paso (according to Google maps) for medical treatment.
Second, there is an older AP decision (981209) that indicates claimant might not be entitled to reimbursement for travel expenses occurred as a result of travel to a doctor in City 1 when the travel is necessitated by the claimant’s move from City 1 to City 2, when such move is not due to the compensable injury. That appears to be what the claimant in your case has done in moving to Mexico.
Third, if you are going to reimburse the claimant, reimbursement is not based on his actual expenses (e.g., his actual bus fare). It can only be based on the actual mileage. See Rule 134.110(d) and AP 951047. Again, his actual mileage is approximately 523 miles each way, according to Google maps.
Q. The claimant is a classroom teacher who was injured on her hire date, 8/9/18. claimant elected to use her leave that had already accrued (we did not know that leave carries over from one ISD to another), and TIBs were never initiated. She will most likely be entitled to IIBs. As there is no 50 weeks of earnings prior to her DOI with our insured, what is the correct procedure to calculate IIBs? We know that she worked for another school district for the ’17-18 years. Do we obtain those earnings with a DWC3-SD or DWC3-ME from her prior employer, check stubs from the claimant, or do we obtain a same/similar employee form our insured?
A. I would try for a same or similar employee first. If no same or similar and the claimant can provide wage info from the prior employer for the prior 12 months, I would use that.
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