Revised Travel Reimbursement Form Takes Effect in April

The Division of Workers’ Compensation has finalized revisions to DWC Form-048, Request for Travel Reimbursement.

DWC Form-048 incorporates amendments to 28 Texas Administrative Code §134.110(a), effective March 30, 2014, that permit injured employees to request reimbursement from an insurance carrier for travel expenses to attend a designated doctor examination, required medical examination, or post-designated doctor examination. The revisions create a separate Spanish form, add plain language, update the format and style for consistency with other TDI-DWC forms, and add a “Things to Know” section to provide additional information about travel reimbursement.

An injured employee may request reimbursement from an insurance carrier for travel expenses incurred either while seeking medical treatment for a compensable injury not reasonably available within 30 miles one way from where the injured employee lives or while traveling to attend certain examinations if the distance traveled is greater than 30 miles one way. An injured employee must use DWC Form-048 to request travel reimbursement. If the insurance carrier denies or partially denies the request, the insurance carrier must send a plain language explanation to the injured employee explaining the reasons for the denial or partial denial.

TDI-DWC posted an informal working draft of DWC Form-048 to its website on May 18, 2015, with an informal comment period ending on June 1, 2015. To show revisions made after the first comment period, TDI-DWC posted a second informal working draft of DWC Form-048 to its website on December 14, 2015, with an informal comment period ending on December 28, 2015. The finalized DWC Form-048 is available on the TDI-DWC website at http://www.tdi.texas.gov/forms/form20employee.html, and is effective April 11, 2016.

Injured employees and insurance carriers may continue to use the existing DWC Form-048 until the effective date of revised DWC Form-048.