If you are injured on the job in California and you need to travel to a doctor's office, therapy office, a pharmacy to pick up medication, or to a law office to attend a deposition, the insurance company has to reimburse you for your mileage.
Mileage reimbursement in workers compensation cases requires knowing:
- What can be submitted
- How much is the reimbursement?
- How to get reimbursed?
This article will explain:
- 1. What is mileage reimbursement?
- 2. How much is the mileage reimbursement in California?
- 3. Can you get penalties if you don't receive mileage reimbursement?
- 4. What do I have to submit to get reimbursed?
- 5. How far can I travel and still get mileage paid by the insurance company?
- 6. How mileage reimbursement fits with your overall claim
Any time an employee is examined by a doctor for their California work injury, he or she is entitled to be reimbursed for the miles to and from the examination.1 This applies to all types of medical treatment including physical therapy, chiropractic treatment, and prescriptions.2
These are part of “reasonable transportation fees” and includes parking and tolls.3
You can also be reimbursed for having to attend your deposition.4
The rate for mileage reimbursement for 2018 is 54.5 cents per mile.5 The rate changes every year.6
Once your mileage request has been submitted, your insurance company has sixty days to make the payment.7 8
If they do not, you can get a ten percent penalty.9 If there is further unreasonable delay, you can request a penalty of up to 25%.10
There is a mileage reimbursement form that you can use to submit your request for California mileage reimbursement.
For each trip you should provide:
- traveled from
- traveled to
- round trip miles
- parking fees (if any)
- tolls (if any)
You are required to sign and date the form. It is important to be completely truthful about your mileage reimbursement request, as the form also states that:
“Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison”11 Workers compensation fraud in California is a serious crime and can lead to jail or prison time.
The form is sent to the insurance company that is handling your claim with the claim number listed in the top right corner.
The insurance company may check the dates and visits to determine if the trip you listed relate to your work injury and whether you have calculated the correct mileage. They may also require receipts for any parking or tolls.
Even if you do not completely fill out the form, the insurance company has a duty to investigate your request for mileage reimbursement as opposed to simply rejecting it.12
Example: Kelly goes to her treating doctor's office for an examination. It's six miles from her house. She pays eight dollars to park at the doctor's office. The doctor refers her for physical therapy and she goes for ten visits. The physical therapy center is 9 miles from her house. Kelly also goes to a pharmacy to pick up some medication prescribed by her doctor. The pharmacy is two miles from her house.
Kelly can request mileage reimbursement for the miles to and from all these locations. One visit to the doctor's office is 12 miles roundtrip. Ten visits to her physical therapy is 200 miles (10 x 20) roundtrip. One visit to the pharmacy is 4 miles roundtrip.
At the 2018 rate of 54.5 cents/mile, she will have mileage totaling $117.72. This is for 216 miles (200 + 12 + 4) multiplied by .545. Kelly adds the eight dollars for the parking and attaches the receipt. Her total reimbursement request for this period is $125.72.
Kelly submits her bill on March 20, 2018. After sixty days, the insurance company has still not paid. Kelly can request a penalty of 10% or $12.57. If the delays continue, she can request up to 25% of the reimbursement amount, or $31.43.
If Kelly has months or years of treatment, these amounts can reach thousands of dollars.
Example: Kelly did not fill in all the dates of her trips. She also forgot to list the name of her treating doctor. The insurance company cannot simply refuse to pay the reimbursement. They must make some effort to determine if Kelly's mileage request is correct. If so, they should issue payment.
A California injured worker must be able to obtain medical treatment within a reasonable geographic area. 13 14
Assuming an injured worker wants to be treated by a doctor that is a significant distance from her home, she may still be able to get mileage reimbursement. To avoid having to pay the reimbursement, the insurance company must present evidence showing similar or equally effective treatment in an area closer to the injured worker's home.15
Example: Lee lived in Los Angeles but moved to Nevada while being treated by a doctor in Beverly Hills for his work injury. He continued to be treated by this doctor and later submitted a mileage reimbursement request for $4,236.31. This was for travel from his home in Nevada to his doctor's office in Beverly Hills.
The treatment was reasonable and necessary. But the insurance company refused to reimburse Lee, saying that the travel from Nevada to Beverly Hills was unreasonable and unnecessary.
Though it may have been unreasonable for Lee to travel that far, the insurance company never took any action to find a doctor in Nevada for him. Lee likely would have been able to get similar treatment in Nevada that he got in Beverly Hills. But since the insurance company took no action to change the doctor, Lee was entitled to the mileage reimbursement for out-of-state medical treatment in connection with his workers comp case.
When you are injured, all the cost of your treatment, including mileage reimbursement, should be paid for by the insurance company.
This includes medical benefits, temporary disability benefits, and permanent disability benefits. All these benefits are available when you file a Claim for California Workers' Compensation benefits. You can also appeal any workers comp decision denying you benefits.
Call us for help...
For help with any issues pertaining to workers compensation claims in California, contact us at Shouse Law Group. For cases in Nevada, see our page on mileage and travel expense reimbursement in Las Vegas Nevada workers compensation cases.
Cal. Lab. Code § 4600(e)(2)
Cal. Lab. Code § 5710(b)(1)
Cal. Lab. Code § 4063.2(b)
Avalon Bay Foods v. Workers' Comp. Appeals Bd. (1998) 18 Cal. 4th 1165, 1173, 1180
Cal. Lab. Code § 4063.2(b)
Cal. Lab. Code § 5814
Santa Barbara Metropolitan Transit District v. WCAB (Dominguez) (1997) 62 Cal. Comp. Cases 713
Cal. Code Regs., tit 8, 9767.5
Cal. Code Regs., tit 8, 9780(h)
Braewood Convalescent Hospital et al., v. WCAB (Bolton) (1983) 48 Cal. Comp. Cases 566, 571-572