GQ Corner

Q. The claimant goes to see a specialist and it is 45 miles one-way so of course I will be paying the mileage but when he turns it in, he also sends in a request for me to pay for two meals and parking. He has presented no receipts for any of them. I can see paying for parking because I know it was in the medical center and you have to pay for parking but do I owe for two meals?

A. You only owe for meals if it is reasonable to expect that the travel and appointment time would necessitate a meal. Reimbursement is based upon the rules that regulate reimbursement for a Texas state employee. A state agency may not reimburse a state employee for a meal or lodging expense the employee incurs while traveling outside the employee’s designated headquarters for less than six consecutive hours. . .  Accordingly, when presented with a request for reimbursement for meals, the adjuster should question the claimant concerning the number of hours that the trip took; the adjuster should also request receipts for all meals and lodging expenses.

Q. I have a claimant who continued to receive his health insurance post injury, where the employer was paying their portion, but the claimant did not pay his portion because he said he couldn’t afford it, so the insurance was cancelled.  Now the claimant is wanting to get additional monies added to their TIBs rate since their employer is no longer paying for insurance, even though the employer would continue to provide if the claimant would have paid his portion of to continue to insurance.  Since the employer would have continued to pay their portion, can we dispute the claimant being owed additional TIBs or do we now have to go back and get an amended DWC-3 with the nonpecuniary section amended and recalculate everything?

A. No. The Appeals Panel has held that if the health insurance is discontinued for any reason (even non-payment of employee’s portion of premiums) the AWW needs to be adjusted upwards as of the date the employer suspends its premiums.