| (a) 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.
(b) The injured employee shall submit the request for
reimbursement to the insurance carrier within one year of the date
the injured employee incurred the expenses.
(c) The injured employee's request for reimbursement
shall be in the form and manner required by the division and shall
include documentation or evidence (such as itemized receipts) of the
amount of the expense the injured employee incurred.
(d) The insurance carrier shall reimburse the injured
employee based on the travel rate for state employees on the date
travel occurred, using mileage for the shortest reasonable route.
(1) 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.
(2) 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.
(3) Total reimbursable mileage is based on round trip
mileage.
(4) When an injured employee's travel expenses reasonably
include food and lodging, the insurance carrier shall reimburse for
the actual expenses not to exceed the current rate for state employees
on the date the expense is incurred.
(e) The insurance carrier shall pay or deny the injured
employee's request for reimbursement submitted in accordance with
subsection (c) of this section within 45 days of receipt.
(f) If the insurance 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. The insurance carrier shall inform the injured employee
of the injured employee's right to request a benefit review conference
in accordance with §141.1 of this title (relating to Requesting
and Setting a Benefit Review Conference).
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