15.1. 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; or
15.4.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.
