Calculating Travel Reimbursement
An injured employee may request reimbursement from the insurance carrier if the injured employee has incurred travel expenses when: (1) 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; or (2) the distance traveled to attend a designated doctor examination, required medical examination, or post designated doctor treating or referral doctor examination is greater than 30 miles one-way. The employee must submit a request for reimbursement to the carrier within one year of the date the employee incurred the expenses.
Rule 134.110(d) requires carriers to reimburse injured employees for qualified travel based on the travel rate for state employees on the date travel occurred. From September 1, 2016 to December 31, 2016, the mileage reimbursement rate is 54 cents per mile.
The carrier must reimburse the employee based on the travel rate applicable on the date the travel occurred. The carrier and employee should calculate the mileage owed using the shortest reasonable route. Total reimbursable mileage is based on round trip mileage.
Travel mileage is measured from the actual point of departure to the health care provider’s location when the point of departure is: (A) the employee’s home; or (B) the employee’s place of employment.
If the point of departure is not the employee’s home or place of employment, then travel mileage shall be measured from the health care provider’s location to the nearest of the following locations: (A) the employee’s home; (B) the place of employment; or (C) the actual point of departure.
When an employee’s travel expenses reasonably include food and lodging, the carrier must reimburse the employee for actual food and lodging expenses not to exceed the current food and lodging rate allowed for state employees on the date the expense is incurred.
Rule 134.110 ties the rate of food and lodging reimbursement to the reimbursement rates allowed for state employees. The food and lodging reimbursement rates for state employees are found on the Texas Comptroller’s website at: https://fmx.cpa.texas.gov/fmx/travel/textravel/rates/current.php.
Since 2010, the maximum meal and lodging rates have been tied to the US General Services Administration’s federal domestic maximum per diem rates. Therefore, carriers must check the GSA’s website to determine the maximum meal and lodging rates, based on the county to which the travel takes place.
The GSA’s federal Domestic Maximum Per Diem Rates can be found at: http://www.gsa.gov/portal/content/104877. Note that these rates are considerably different than the $85 $36 rates described below. For September 2016, the daily lodging and meals and incidentals rates for Austin, for example, are $135 and $59. If a partial day (first or last day of the trip) is involved, the meals and incidentals should be apportioned in the manner shown at http://www.gsa.gov/portal/content/101518.
If the city is not listed, but the county is listed; the rate of reimbursement is the rate of the county. For areas not listed (city or county), the maximum rates are:
•Lodging In-State: up to $85
•Meals In-State: up to $36
This rate change is applicable to any qualified travel that occurs within the applicable period. For travel occurring on earlier dates and times, the earlier rates apply.
A carrier shall pay or deny the injured employee’s request for reimbursement within 45 days of receipt.
If the carrier does not reimburse the full amount requested, partial payment or denial of payment shall include a plain language explanation of the reason(s) for the reduction or denial. In that event, the carrier shall inform the employee the he or she has the right to request a benefit review conference in accordance with Rule 141.1 (relating to Requesting and Setting a Benefit Review Conference).
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