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OhioBWC - Basics: (Policy library) - File

Policy Name:

Travel Reimbursement

Policy #:

CP-20-01

Code/Rule Reference:

O.A.C 4123-6-40

Effective Date:

03/30/17

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance

Origin:

Claims Policy

Supersedes:

Policy CP-20-01, effective 05/09/2014

History:

Rev. 12/01/15; 05/09/14, 01/01/14, 08/01/13, 07/08/13; New 11/21/12

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure consistent and efficient reimbursement to the injured worker (IW) for allowable travel expenses.

 

II. APPLICABILITY

 

This policy applies to managed care organization (MCO) staff and BWC Field Operations staff.

 

III. DEFINITIONS

 

None

 

IV. POLICY

 

A.    BWC shall reimburse an IW  for reasonable and necessary travel expenses, upon the filing of a proper request, (excepting sections IV.B and C) when:

1.    The IW has been ordered or authorized by BWC or the IC to undergo a medical examination outside the community where he or she lives and the travel distance exceeds the mileage distance determined by BWC in the Injured Worker Reimbursement Rates for Travel Expense (C-60A).

2.    When medical treatment, including a service contained in an approved vocational rehabilitation plan, is necessary for the allowed condition, cannot be obtained within the IW’s community, the treatment has been pre-authorized and approved by the MCO, and the travel distance exceeds the mileage distance determined by BWC in the C-60A.

3.    The IW’s allowed conditions require the use of taxi or other special  transportation for treatment or examination on account of  an allowed injury or occupational disease.

 

B.    The employer is responsible for the reimbursement of travel expenses when the travel is related to a request for a medical examination by a physician of the employer’s choice. Reimbursement of travel expenses under this provision shall not require an order of BWC or the IC, unless there is a dispute. Reimbursement by the employer under this provision is not subject to the minimum mileage requirement applicable to BWC reimbursed travel.

 

C.   The self-insuring employer is responsible for reimbursement of travel expenses if related to a self-insured claim, unless the travel is for:

1.    an exam prior to a determination for percentage permanent partial disability; or

2.    the provision of a prosthetic device pursuant to the Artificial Appliance Requests policy.

 

D.   If a claim is enrolled in the FifteenThousand Dollar Medical Only program, refer to the FifteenThousand Dollar Medical Only Program policy.

 

E.    To obtain reimbursement, the  IW must, as soon as possible, complete and submit an Injured Worker Statement for Reimbursement of Travel Expense (C-60), or an equivalent documented travel reimbursement request to the responsible party reflected in sections IV.A-D.

 

F.    BWC will deny travel expenses submitted more than two years after the IW’s date of travel.

 

G.   It is the policy of BWC that the following types of travel expenses must be pre-authorized by BWC to be reimbursable:

1.    Lodging;

2.    Travel in excess of 400 miles round trip;

3.    Companion travel;

4.    Travel by taxicabs, bus, train, air, or other special transportation; and

5.    Any other expenses identified on the C-60A as requiring pre-authorization.

 

H.    Rates of Reimbursement:

1.    BWC shall publish the C-60A that details the criteria and rates used to compute reimbursement of travel expenses.

2.    Travel by automobile shall be reimbursed on a per mile basis, portal to portal, using the most direct and practical route.

3.    Meals shall be reimbursed at the rate reflected on the C-60A only when an overnight stay is required and pre-authorized by BWC, or when the travel day exceeds twelve (12) hours. .

4.    Travel by airplane, railroad, bus, taxi, or other special transportation shall be reimbursed at the actual and necessary cost of such fare; receipts are required.

5.    Lodging shall be reimbursed at reasonable actual cost, up to the maximum amount reflected on the C-60A; receipts are required.

6.    Miscellaneous expenses, such as tolls and parking, shall be reimbursed at actual and necessary cost; receipts are required.

 

I.      BWC Pre-Pay Travel Program

1.    BWC may, in its sole discretion, assist an IW by pre-paying allowable lodging and/or transportation expenses, such as airplane or railroad fares. Such assistance is not mandated by statute or rule.

2.    Travel by automobile or taxi, meals, or other miscellaneous travel expenses are not eligible for pre-payment.

3.    An IW seeking to have travel expenses pre-paid shall submit the request to field staff as soon as possible prior to travel. Field staff shall advise the IW on the requirements and process for approval and arrangements.

 

J.     Overpayment of Travel Expenses: If there is an overpayment of travel expenses, BWC shall issue an order indicating the overpayment and that the overpayment will be collected at 100% from any future approved travel expense reimbursement to the IW. The IW may also repay the overpayment amount at any time.

 

BWC staff may refer to the corresponding procedure for this policy entitled “Travel Reimbursement” for further guidance.

 

 

 

Procedure Name:

Procedures for Travel Reimbursement

Procedure #:

CP-20-01.PR1

Policy # Reference:

CP-20-01

Effective Date:

03/30/17

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance

Supersedes:

Procedure CP-20-01.PR1, effective 12/01/15

History:

Rev. 12/01/15; 05/09/14; 01/01/14, 08/01/13, 07/08/13; New 11/21/12

 

 

II.    BWC staff shall refer to the Standard Claim File Documentation policy and procedure for claim-note requirements and shall follow any other specific instructions included in this procedure.

 

II.   General Provisions and Pre-Authorization

 

A.      Field staff may reimburse travel expenses when one of the following occur:

1.    When the Injured worker (IW) is ordered or authorized to appear for a medical examination occurring forty-five (45) miles or more, round trip from the IW’s residence, by:

a.    BWC;

b.    The Industrial Commission (IC);

c.    The managed care organization (MCO);

2.    When the MCO has determined that treatment necessary for the IW’s allowed condition(s), including a service contained in an approved vocational rehabilitation plan, is required and cannot be obtained within 45 miles round trip from the IW’s residence;

3.    When the IW’s allowed condition(s) requires the use of taxi or other special transportation for treatment or examination for the allowed injury or occupational disease.

 

B.      The following travel expenses must be pre-authorized by field staff prior to travel required pursuant to section II.A:

1.    Lodging;

2.    Travel in excess of 400 miles round trip;

3.    Companion travel;

4.    Travel by taxicab, bus, train, air, or other special transportation; and

5.    Any other expenses identified on the Injured Worker Reimbursement Rates for Travel Expenses (C-60A) as requiring pre-authorization. 

 

C.     In cases arising under section II.A.2, the MCO shall identify the closest provider of the service, utilizing the hierarchy of distance (i.e., a provider in the following order of preference: within the local community, regional community, statewide community, or contiguous states where services can be obtained).

1.    The MCO shall staff its provider recommendations and the need for any pre-authorizations with field staff before authorizing treatment.

2.    The MCO and field staff shall document the rationale for the choice of provider(s) in the claim notes and what travel expenses are pre-authorized, if any.

3.    The MCO shall advise the IW to contact BWC for more information regarding requirements and procedures for obtaining reimbursement of travel expenses.

 

D.     Field staff shall staff any questions and/or unusual situations regarding travel pre-authorization and/or reimbursement with the supervisor, and Claims Policy as needed.

 

III.  Submission of a Travel Reimbursement Request

 

A.      The IW must submit a request for travel reimbursement on a current Injured Worker Statement for Reimbursement of Travel Expense (C-60) form or an equivalent document (e.g., email, letter, or outdated C-60).

 

B.      If field staff receives a travel reimbursement request and the reason for travel was for a medical examination scheduled by the IW’s employer, field staff shall return the request to the IW, advising him or her that the request must be submitted to his or her employer for reimbursement.

 

C.     If field staff receives a travel reimbursement request and the IW is employed by a self-insuring employer, field staff shall return the request to the IW, advising him or her that the request must be submitted to his or her employer for reimbursement unless the travel is for:

1.    An exam prior to a determination for percentage permanent partial disability; or

2.    The provision of a prosthetic device pursuant to the Artificial Appliance Requests policy.

 

D.     If field staff receives a travel reimbursement request and the IW’s claim is enrolled in the Fifteen Thousand Dollar Medical Only Program, field staff shall refer to the Fifteen Thousand Dollar Medical Only Program policy and procedure for further information.

 

E.      If field staff receives a travel reimbursement request and the reason for the travel was for a medical examination scheduled by the IC, field staff shall forward the request to the IC office that scheduled the exam or fax the request to the IC for the IC’s approval and processing.

 

IV.  Review and Approval of Travel Expenses

 

A.      Field staff shall review the C-60 or other equivalent documented travel reimbursement request by the IW, and verify that the expenses submitted meet the criteria for reimbursement, including necessary pre-authorizations. Field staff shall contact the IW to obtain any necessary clarification and/or missing documentation (e.g., receipts).

 

B.      If the travel reimbursement request is for treatment that was not approved by the MCO, field staff shall deny the request. If the treatment is subsequently approved by the MCO, the travel reimbursement request will be approved, consistent with the requirements of this policy.

 

C.     If field staff identifies that the need for treatment was approved, but the need for travel was not staffed or documented in notes, field staff shall approve the travel reimbursement request to the extent it is in compliance with the Travel Reimbursement policy.

 

V.    Calculating Reimbursement

 

A.    After field staff determines that all reimbursable costs are reasonable and necessary, field staff shall calculate reimbursement for travel expenses in the following manner:

1.    Reimbursement for travel by a personal vehicle shall be at the rate indicated on the C-60A, per mile, for the date(s) of travel.

a.    The total reimbursement is determined by multiplying the number of miles traveled by the per mile rate;

b.    Internet resources may be used as a tool to help determine reasonable and necessary mileage.

2.    Field staff shall reimburse for meals at the rates indicated on the C-60A when the travel:

a.Includes an overnight stay; or

b.Totals more than twelve (12) hours in one day.

3.    Pre-authorized lodging for the IW shall be reimbursed at reasonable actual cost (receipts required), up to the maximum amount indicated on the C-60A, plus applicable taxes.

4.    Travel by taxi, train, airplane, bus or other special transportation shall be reimbursed at reasonable actual cost (receipts required).

5.    Miscellaneous travel expenses, such as tolls and parking, shall be reimbursed at the actual amount (receipts required).

6.    Approved travel expenses related to pre-authorized companions shall be reimbursed at the same rates permitted for the IW, except

a.     Field staff shall not reimburse for lodging for the companion unless special circumstances require the companion to have a separate room.

b.    Field staff shall only reimburse mileage to the IW.

 

B.    To process and document the C-60 form, field staff shall:

1.    Enter the calculations in the appropriate section of the “Official Use Only” section of the form;

2.    Indicate the appropriate procedure code(s) to be charged;

3.    Check the “Surplus Fund” box if the travel expenses are related to:

a.a percentage permanent partial exam;

b.services in an approved vocational rehabilitation plan;

c.   a prosthetic provided to the IW pursuant to the Artificial Appliances Requests policy; or

d.a medical exam for a denied statutory occupational disease. (See the Occupational Disease Claims policy for further information).

4.    Sign, date, enter his or her phone number and “A” number where indicated, image a copy of the C-60 into the claim and send a copy to the IW with a copy of the C-60A;

5.    Fax a copy of the completed C-60 to Benefits Payable. Benefits Payable will notify field staff if a C-60 is not completed properly. Field staff shall be responsible for correcting the C-60 and resubmitting.

 

C.   If the request for travel reimbursement has not been submitted on a C-60, field staff shall process and document the request noting on the request or any attached document:

1.    Calculations of reimbursable travel expenses;

2.    The related procedure codes, as designated on the C-60; and

3.    Whether any charges are to be made to the Surplus Fund.

 

D.   If any of the IW’s travel reimbursement request appears unreasonable or unnecessary, or is otherwise questionable, field staff shall contact the IW in an attempt to resolve.

         Example: Mileage submitted by IW is thirty miles more than an online resource indicates the trip would be using the most direct route. Contact with the IW reveals that there was an accident causing a detour, resulting in the additional miles.

     

VI.   Denial of Travel Reimbursement

 

A.   If, after reviewing the C-60 or other submitted documentation, field staff determines that all or some of the submitted travel expenses do not meet the criteria for reimbursement per the Travel Reimbursement policy and procedures, field staff shall publish a miscellaneous order which states:

1.    “After a thorough review of your request for travel reimbursement filed on [date] BWC has determined that [a portion of] your request does not meet the criteria listed below:”

2.    The appropriate travel denial reason; and

3.    Any additional explanation needed to explain the basis for the denial and the statement: Therefore, we have denied [a portion of] your request for travel reimbursement.

 

B.   In addition to a miscellaneous order, if only a portion of a travel reimbursement request is denied, field staff shall:

1.    Strike out the denied expenses on the C-60;

2.    Calculate the totals for the allowed expenses and indicate the amount of reimbursement;

3.    Image a copy of the C-60 into the claim and send a copy to the IW with a copy of the C-60A; and

4.    Fax the amended C-60A to Benefits Payable.

 

VII.  IW Pre-pay Travel Program (Restricted Use)

 

A.   If an IW requests assistance from BWC to prepay allowable and authorized lodging and or transportation expenses (e.g., hotel, airfare, bus fare) field staff shall advise the IW to submit the request to BWC management (i.e., team leader, supervisor or service office manager) as soon as possible prior to travel. The Pre-Pay Travel (PPT) unit shall be available for consultation via the “BWC Pre-Pay Travel” email box. Field staff shall also advise the IW that approval must be granted before any travel arrangements are made.

 

B.   Field staff and BWC management shall staff the request.

1.    If approved by BWC management, field staff, in consultation with the IW shall complete the Injured Worker Travel Card Authorization Log (A-53) and submit it to the PPT unit for final approval or disapproval. The following information shall be submitted to the PPT:

a.    Date(s) of travel;

b.    Preferred travel time;

c.    Travel destination (city and state);

d.    Mode of travel (automobile travel excluded);

e.    Appointment date and time;

f.      Name, address and phone number of facility or physician;

g.    Companion expenses, if any;

h.    Hotel accommodations, including any special needs (e.g., handicap accessible, non-smoking/smoking, double beds). Incidental room expenses, such as room service, will not be pre-paid, though they may be reimbursable via a C-60, if appropriate;

2.    Within two business days of receipt of the A-53 the PPT unit will approve or disapprove the request and notify field staff by email.

a.    If approved, the PPT unit will proceed with making travel arrangements.

b.    If disapproved, the A-53 will be cancelled and returned to field staff.

c.    Field staff shall document the approval or disapproval in the claim notes.

 

C.  To process the approved A-53:

1.   The PPT unit will:

a.   Document the travel arrangements on the A-53 with the confirmed vendor, dates of travel, the total cost of travel and the confirmation numbers;

b.   Attach any itineraries received from the appropriate vendors and fax this information along with the approved A-53 to field staff;

c.   Maintain the completed and confirmed copy of the A-53 and fax a copy to Benefits Payable to be processed.

2.     Field staff shall image the A-53 and document the travel approval in the claim notes.

 

D.  Once the A-53 is received by field staff:

1.   Field staff shall prepare a letter of confirmation to send to the IW, which includes the arrangements made by the PPT unit, any itineraries, and a C-60 for any expenses incurred by the IW that are not prepaid but approved, or otherwise meet the requirements of the Travel Reimbursement policy and procedures.

2.   Field staff shall set a diary for the next business day after the expected return date of the IW’s travel;

3.    Field staff shall verify the IW traveled and kept the appointment per the arrangements confirmed on the A-53 and document the verification in claim notes;

4.    Field staff shall assure that any travel reimbursement request submitted by the IW does not include the pre-paid travel arrangements.

5.    If field staff determines that the prearranged travel was not utilized, the IW shall be contacted to determine if there are justifiable reasons or circumstances that prevented the travel. This information shall be documented in the claim notes.

 

E.   If, for any reason, the IW cancels the arrangements and does not make alternative arrangements, field staff shall notify the PPT unit immediately via the BWC Pre-Pay Travel email box. The PPT unit will contact the vendors and cancel the arrangements to avoid fees or penalties.

1.    Upon receipt of the cancellation notice, the PPT unit shall send a copy of the A-53 with the required cancellation notations, including any fee or penalties to Benefits Payable;

2.    Field staff shall document the travel cancellation in the claim notes;

3.    If new travel arrangements are made, a new A-53 shall be prepared and processed consistent with the Travel Reimbursement policy and procedures.

 

VIII. Overpayment of Travel Expenses

 

If there is an overpayment of travel expenses, field staff shall issue an order indicating the overpayment and that the overpayment will be collected at 100% from any future approved travel expense reimbursement to the IW. The IW may also repay the overpayment amount at any time.

 


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