GQ Corner
Q. I have a claim that is within the HCN. The injured worker has selected “Doctor A”, who is 60 miles one way from his home; however, despite HCN, “Doctor B” is 40 miles away and will accept the injured worker’s treatment. Does the carrier have the argument to reimburse mileage for no more than 40 miles one way or would the injured worker prevail in the argument having selected the HCN physician 60 miles one way?
A. According to Rule 134.110, reimbursement for travel for medical treatment is only required where treatment for the compensable injury is not reasonably available within 30 miles (one way) from the claimant’s primary residence. In this case, you would be permitted to deny 20 miles of the reimbursement request (one way) due to the availability of a closer doctor.
Q. I have a claimant that injured his left middle finger on 2/9/20. Per his supervisor, the claimant was popping his knuckles when he cracked his left middle finger and had to be sent to the ER. He was diagnosed with sprain of interphalangeal joint of left middle finger. This was only a one time ER visit and he was released from care. Based on the description given, is this claim compensable or can we deny the claim?
A. Yes, in the absence of a showing that popping one’s knuckles was furthering the affairs of the employer or otherwise arose out of the employment, then this is not a compensable claim.
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