Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-1-15 - Travel Expenses-Medical Examination and Treatment15.1. General. Claimants are entitled to reasonable travel, meals and lodging expenses actually incurred in connection with an authorized medical examination or treatment. In determining the reasonableness of such expenses, the responsible party shall utilize the travel regulations for State employees as a guide, unless specific provisions to the contrary are otherwise contained herein.
15.2. For purposes of this rule, authorized medical examination or treatment includes medical examination or treatment provided by the claimant's authorized treating physician. If a claimant is required to travel in a personal vehicle for medical examinations or treatment, the mileage reimbursement rate provided for in the West Virginia Department of Administration's Purchasing Division Travel Rules as authorized by W. Va. Code § 12-3-11 shall apply. For purposes of reimbursement rates pursuant to this subsection, all examinations or treatment provided to the claimant shall be considered to have been authorized on the date of the examination or treatment, regardless of whether the treatment was provided by the claimant's authorized treating physician or whether prior authorization was required. The reimbursement rate shall be the rate in effect on the date of the examination or treatment.15.3. Mileage reimbursement as described in subsection 15.2. of this section shall be determined based upon the shortest practicable route between the claimant's residence and the provider.15.4. A responsible party is not required to reimburse a claimant for travel expenses more frequently than once every three (3) months, unless: 15.4.a. An amount in excess of $ 100 in total reimbursement owed is involved; or15.4.b. Action is taken to administratively close the claim.15.5. Physical limitations. Where a medical vendor certifies that a claimant, because of the state of his or her health, requires special travel arrangements in order to report for an authorized examination, the claimant shall be reimbursed for the cost of such arrangements.
15.6. Claimant's residence. The responsible party shall arrange for examination as near as practicable to the claimant's residence. If the claimant changes his residence after his or her date of injury to a location outside of West Virginia or to a location substantially fiarther from the state than the residence on the date of injury, the following limitations shall be observed:
15.6.a. Where the change of residence is necessitated by reason of health or financial hardship, as determined by the responsible party upon a proper showing of such reasons, the responsible party shall, in writing, endorse the change of residence and direct payment of meal and lodging expenses in the following manner: 15.6.a.1. Where the distance between the residence and the situs of the examination is less than four hundred (400) miles, meal and lodging expenses are payable as provided in subsections 15.1. and 15.2. of this section;15.6.a.2. Where the distance between the residence and the situs of the examination is greater than four hundred (400) miles, expenses actually incurred en route shall be payable, up to the cost of round trip air fare, economy class, between the closest airports offering scheduled commercial passenger service, as of the date the examination was scheduled;15.6.a.3. Where the claimant objects to any decision or finding, and the employer does not object thereto, and the claimant is subsequently directed to report for examination upon request of the employer, the claimant is entitled to reimbursement of expenses from point of entry into West Virginia;15.6.b. Where the claimant's change of residence is not necessitated by reason of health or financial hardship, expenses are payable only from point of entry into West Virginia.