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Policy
and Procedure Name:
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Travel
Reimbursement
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Policy
#:
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CP-20-01
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Code/Rule
Reference:
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R.C. 4123.52; O.A.C.
4123-3-09;
O.A.C.
4123-6-40;
O.A.C.
126-1-02(I)
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Effective
Date:
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05/05/2025
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Approved:
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Shawn
Crosby, Chief Operating Officer
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Origin:
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Operational
Policy
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Supersedes:
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Policy
# CP-20-01, effective 10/07/2021
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History:
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Previous
versions of this policy are available upon request.
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Table
of Contents
I. POLICY PURPOSE
II. APPLICABILITY
III. DEFINITIONS
Reasonable Travel Expenses
IV. POLICY
A. BWC
Reimbursement of Travel Expenses
B. SF and SI
Employer Reimbursement of Travel Expenses to the IW
C. IW
Reimbursement and Overpayment of Travel Expenses
D. Review
E. Preauthorization
and Prepayment of Travel Expenses
V. PROCEDURE
A. Claim Note and
Documentation Requirements
B. Claims Services
Staff and MCO Responsibilities
C. Travel
Reimbursement Requests for Medical Examinations
D. Travel
Reimbursement Requests Due to Medical Treatment
E. Travel
Reimbursement Requests as Part of Vocational Rehabilitation Services
F. Pre-Authorization
for Travel Expenses
G. Payment for
Transport by Ambulance or Ambulette for Non-Emergency Travel
H. Travel for the
$15,000 Medical-Only Program Claims
I. Calculating and
Approving Reimbursement
J. Denial of
Travel Reimbursement
K. Pre-Payment of
Travel Expenses
L. Overpayment of
Travel Expenses
M. Issues
Regarding Travel
This
policy ensures appropriate application of the travel rule, including reimbursement
to the injured worker (IW) for allowable travel expenses.
This
policy and procedure apply to managed care organization (MCO) staff and BWC
staff.
Reasonable
Travel Expenses: For purposes of this policy,
“reasonable” means the expenses incurred are medically necessary due to the IW’s
allowed conditions in the claim, and the cost is consistent with the usual and
customary market price for these services.
1. It is BWC’s policy
to reimburse an IW for medically necessary, reasonable, and appropriate travel
expenses when the:
a. IW is required
by BWC or the Ohio Industrial Commission (IC) to undergo a medical examination
that is more than 45 miles round trip from the IW’s residence;
b. MCO has
approved medical treatment, including a service contained in an approved
vocational rehabilitation plan or related to the provision of a prosthetic
device that cannot be obtained within 45 miles or less round trip from the IW’s
residence; or
c. IW’s allowed
conditions in the claim require using a taxi or other special transportation to
obtain treatment or attend an examination, and the taxi or other special
transportation has been pre-authorized (no minimum mileage requirements are
necessary in this circumstance).
2. Allowed
condition(s) in the claim must support the requested travel expenses. Examples
of reasonable travel expenses include, but are not limited to:
a. It may be
medically necessary and reasonable for an IW to fly economy class to receive
medical treatment. Flying first class would not typically be medically
necessary or reasonable.
b. It may be
medically necessary and reasonable for the IW to rent a vehicle for
transportation to medical treatment. It would not typically be medically
necessary or reasonable for the IW to rent a multi-passenger luxury vehicle for
such purposes.
3. In determining
whether travel expenses are reasonable, BWC may consider whether a lower-cost
travel arrangement meets the IW’s needs. In such instances, BWC may authorize
reimbursement for the lower-cost travel arrangement.
4. BWC will
publish reimbursement rates on the Injured Worker Reimbursement Rates for
Travel Expenses (C-60A), which also details the criteria for reimbursement
of travel expenses.
5. IC-Scheduled
Examinations: When the IC schedules an examination, the associated travel is
reimbursed by:
a. BWC for
state-fund (SF) claims; or
b. The
self-insuring employer for self-insured (SI) claims.
6. Travel
Reimbursement Requests Related to an Approved Vocational Rehabilitation Plan
a. When travel
expenses are authorized as part of an approved vocational rehabilitation
assessment plan, comprehensive vocational rehabilitation plan, or job retention
plan, BWC will pay travel reimbursement.
b. Vocational
services that may be eligible for travel reimbursement include, but are not
limited to:
i.
Training;
ii. Job simulation;
or
iii. Job search
outside the IW’s community.
c. Any travel
reimbursement requests related to an approved vocational rehabilitation plan
are subject to the requirements of the procedures below.
7. When an IW’s
death is related to the allowed condition(s) in the claim and occurs outside
the area where they lived, BWC will pay
for related exceptional transportation costs (e.g., returning the decedent’s
body to where they lived). See the Death
Claims policy for more information.
1. The employer is
responsible for reimbursing the IW for travel expenses when the travel is
related to a request for a medical examination by a physician of the employer’s
choice.
2. Reimbursement
by the employer of travel expenses under this provision will not:
a. Require a BWC
or IC order, unless there is a dispute; and
b. Be subject to
the minimum mileage requirement applicable to travel expenses reimbursed by
BWC.
3. SI Employer
Reimbursement of Travel Expenses
a. The SI employer
is generally responsible for reimbursement of travel expenses if related to a
SI claim.
b. The exception
is that BWC is responsible for the reimbursement of travel expenses in an SI
claim if the travel is for an:
i.
Exam
to determine percentage of permanent partial disability (%PP); or
ii. Appointment
related to the provision of a prosthetic device.
1. Reimbursement:
To obtain reimbursement for travel expenses, the IW must complete and submit an
Injured Worker Statement for Reimbursement of Travel Expense (C-60) or
equivalent travel expense request to the party responsible for payment within
two years of the IW’s date of travel.
2. Overpayment:
BWC will collect any overpayment of travel expenses to the IW at 100% from any
future approved travel reimbursement to the IW.
1. MCO and BWC
staff will review travel expenses prior to reimbursement to ensure that they
are reasonable, medically necessary, and appropriate.
2. MCO and BWC
staff will discuss travel expense requests, and the MCO will provide BWC staff
with documentation of its efforts to inform and assist the IW regarding travel.
1. Preauthorization
a. BWC must
pre-authorize the following types of travel expenses for the expenses to be
reimbursable:
i.
Lodging;
ii. Travel more
than 400 miles round trip from IW’s residence;
iii. Companion
travel; and
iv. Travel by taxi,
bus, train, non-emergent air transport, or other special transportation, only
with proof of medical necessity based on the allowed conditions in the claim.
b. The MCO may
pre-authorize and reimburse medically necessary transportation by ambulance or
ambulette.
2. Prepayment: BWC
may, at its sole discretion, assist an IW by pre-paying allowable lodging and
transportation expenses, such as airplane or railroad fares.
1. BWC staff will
refer to the Standard Claim
File Documentation and Altered Documents policy and procedure for claim
notes and documentation requirements; and
2. Must follow any
other specific instructions for claim notes and documentation included in this
procedure.
1. Upon receipt of
a C-60 or equivalent travel expense request, Claims Services staff responsibilities
include:
a. Determining if the
request contains complete and accurate information.
b. Requesting IW
information or supporting documents (e.g., receipts) that are missing or
require clarification.
c. Determining if
the travel expense request is medically necessary and reasonable under the
requirements of these procedures; and
d. Processing the
request within seven calendar days, or within 14 calendar days if additional
information or clarification was requested.
2. MCO
Responsibilities
a. The MCO will
make the following efforts to minimize unnecessary or unreasonable travel
expenses:
i.
The
MCO will provide written notice to the IW regarding travel reimbursement. The
written notice will use the following language: “Travel for medical treatment
in excess of 45 miles round trip from your residence may be eligible for
expense reimbursement. Any travel expenses related to this treatment request
must meet the requirements of Ohio Administrative Code rule 4123-6-40 to be reimbursed
and may require pre-authorization. For more information, please contact your CSS
at {contact info here}.”
ii. When an IW
requests treatment, the MCO will contact the provider and/or IW to attempt to
determine:
a) Who is
providing the service;
b) Where treatment
will occur; and
c) Whether it will
require travel more than 45 miles round trip from the IW’s residence.
iii. If the provider
or IW informs the MCO that treatment will require travel more than 45 miles
round trip from the IW’s residence, the MCO will:
a) Evaluate BWC’s
certified provider list to determine whether there are treatment alternatives
that either eliminate or minimize the amount the IW must travel;
b) If no BWC
certified provider is available, evaluate whether there are non-certified
providers willing to enroll with BWC that can provide necessary services that
either eliminate or minimize the amount the IW must travel; and
c) Assist the IW
in locating treatment options closer to home.
iv. If alternate
treatment options all require travel more than 45 miles round trip from the
IW’s residence, the MCO will work with the IW to minimize the amount of travel
in a reasonable and necessary manner.
b. The MCO will
provide written documentation to the BWC claim file of its effort to educate
and inform individual IWs when travel expense requests are made (e.g., entering
a claim note).
1. If the IW’s
travel is for a BWC-ordered or authorized exam (including alternative dispute
resolution) for a SF claim, Claims Services staff will:
a. Verify the IW
attended the exam.
b. Verify the
required mileage was met.
c. Review
appropriateness of other expense requests (e.g. tolls, parking, etc.); and
d. Approve or deny
the travel reimbursement request, following the directions outlined in Sections
V.I and V.J of this procedure.
2. If the IW
travels for an IC-ordered exam, the IC will review travel expense requests for
appropriateness and upload the C-60 or equivalent travel expense request to the
claim file:
a. For an SI claim,
the IC will send the employer a cover letter and the approved C-60 or equivalent
travel expense request for payment.
b. For a SF claim,
the IC will send the approved C-60 or equivalent travel expense request to BWC Benefits
Payable for payment.
3. If BWC receives
a C-60 or equivalent travel expense request for a medical examination scheduled
by a SF employer, Claims Services staff will advise the IW that the request
must be submitted to the SF employer for reimbursement.
4. If BWC receives
a C-60 or equivalent travel expense request and the IW is employed by an SI
employer:
a. Claims Services
staff will advise the IW that the request must be submitted to the SI employer
for reimbursement, unless the travel is for:
i.
An
exam to determine %PP; or
ii. The provision
of a prosthetic device pursuant to the Artificial
Appliance Requests policy.
b. If the travel reimbursement
request is related to V.C.4.a.i. and ii. immediately above, Claims Services
staff will review the request for appropriateness of payment.
5. If an IW is
medically unable to self-transport to a BWC-scheduled exam due to the allowed
conditions in the claim, the minimum mileage requirement will be waived. For
example:
a. The IW’s
allowed conditions are two broken legs. The IW does not have personal access to
transportation that accommodates a wheelchair. In this case, BWC would pay for round-trip
travel to the exam, regardless of the distance.
b. The IW suffered
a concussion, and the treating physician has provided medical documentation to
support that the IW cannot drive due to blurred vision and migraines arising
from the IW’s allowed conditions. In this case, BWC would pay for the travel
expense because it is medically necessary.
D. Travel
Reimbursement Requests Due to Medical Treatment
1. When the
provider or IW informs the MCO that requested medical treatment would require
the IW to travel more than 45 miles round trip from their residence, the MCO
will:
a. Verify the
location of the provider or medical treatment facility;
b. Use the
hierarchy of distance to identify whether there is a closer provider of the
service in the following order of preference: within the local community,
regional community, statewide community, or contiguous states; and
c. Document all
actions taken in claim notes.
2. If the IW can
obtain equivalent medical treatment closer to their residence:
a. The MCO will:
i.
Discuss
its recommendations regarding closer treatment options with the treating
physician and the IW before authorizing treatment and document this discussion
in claim notes; and
ii. Inform the IW
that travel expenses will not be reimbursed should the IW choose medical
treatment that requires travel outside of the IW’s community.
b. If the treating
physician and IW do not agree to move the treatment to a closer facility, the
MCO will also document this information in claim notes.
3. If the MCO has
determined that treatment necessary for the IW’s allowed condition is required
and cannot be obtained 45 miles or less round trip from the IW’s residence:
a. The MCO will
notify BWC; and
b. BWC will
proceed with its review under Section V.I of this procedure.
4. The MCO will
advise the IW to contact BWC for more information regarding requirements and
procedures for obtaining reimbursement of travel expenses.
1. The disability
management coordinator (DMC) will review all travel reimbursement requests when
travel is requested as part of vocational rehabilitation services.
2. For appeals of
travel reimbursement requests associated with vocational rehabilitation, please
see the Disputes
Regarding Vocational Rehabilitation Decisions policy and
procedures.
3. The DMC will
staff any issues with BWC’s Rehab Policy Unit.
1. The MCO and Claims
Services staff will work together to inform and assist the IW when
pre-authorization for travel expenses is necessary.
2. The MCO will
review the medical treatment to determine if closer treatment options are
available as outlined in Section V.D. above.
3. If closer treatment
options are not available and requested treatment has been determined to be
medically necessary, Claims Services staff will contact the IW
to:
a. Provide
information regarding pre-authorization requirements; and
b. Obtain
information on which type of travel expenses the IW anticipates incurring and additional
details regarding lodging and special transportation (e.g., selected hotel and
mode of transportation).
4. If the
pre-authorization request is for travel reimbursement for special transport
(e.g. taxi, bus, train, or air), Claims Services staff will:
a. Discuss with
the MCO to determine if there is a medical necessity for special transportation
due to the allowed conditions in the claim; and
b. Review to
determine whether the type of transportation expenses requested are a reasonable
means of transportation for the IW.
5. If the IW
submits a valid request for travel reimbursement for special transport due to
medical necessity, there is no minimum mileage requirement.
6. Upon receipt of
the request for pre-authorization of travel expenses, Claims Services staff will:
a. Review MCO
notes to verify need for travel;
b. Confirm that
the travel expenses requested are reasonable;
c. Contact the IW
via phone, as needed, to resolve any questions or problems related to the
pre-authorized travel reimbursement request, e-authorized or not;
d. Prepare and
send written approval or denial of pre-authorization for travel expenses to the
IW. Template approval and denial letters may be found in COR on the Travel
Reimbursement policy page under correspondence; and
e. Document the
decision in a claim note.
G. Payment for
Transport by Ambulance or Ambulette for Non-Emergency Travel
1. If there is a
request for medical treatment but no specific request for special
transportation (e.g. ambulance or ambulette) exists, the MCO may:
a. Review to
determine whether there is a need for special transportation; and
b. Pre-authorize
special transportation if there is an urgent, time-driven need (e.g., IW needs
to be moved by ambulance from a hospital to a step-down facility) without
staffing with Claims Services staff.
2. When the MCO
determines that special transportation (e.g. ambulance or ambulette) is
necessary and supported by the medical evidence on file, the MCO will:
a. Document its
efforts to pre-authorize the travel for special transportation by ambulance or ambulette.
b. Ensure the
transportation provider is eligible to become or is enrolled as a certified provider.
c. Obtain a C-9
request retrospectively whenever possible, or document rationale as to why a
C-9 was not obtained; and
d. Arrange for
payment for special transportation as an MCO medical payment.
1. When Claims Services
staff receives a travel reimbursement request, they will verify if the claim is
enrolled in the program.
2. If the claim is
enrolled, Claims Services staff will follow the procedures for travel
reimbursement outlined in the $15,000
Medical-Only Program policy.
I.
Calculating
and Approving Reimbursement
1. If travel
expenses associated with an exam or approved medical treatment in the claim
appear necessary, Claims Services staff will determine reasonableness of the
travel expenses by calculating reimbursement in the following manner:
a. Reimbursement
for travel by a personal vehicle will be at the rate indicated on the C-60A,
per mile, for the date(s) of travel.
i.
The
total reimbursement is determined by multiplying the number of miles traveled
by the per-mile rate.
ii. Internet
resources may be used as a tool to help determine reasonable and necessary
mileage.
b. Reimbursement
for meals submitted with receipts will be considered for approval at reasonable
cost, up to the maximum amount indicated on the C-60A.
i.
The
travel must:
a) Include an
overnight stay; or
b) Totals more
than 12 hours in one day.
ii. BWC will not
reimburse for alcoholic beverages or tobacco products.
iii. BWC will not
reimburse for tips for any service in excess of 20% pretax.
iv. Meals may be
purchased at any location that sells food (e.g., restaurant, grocery, or
convenience store, etc.)
c. Reimbursement
for pre-authorized lodging submitted with receipts will be considered for
approval at actual cost, up to the maximum amount indicated on the C-60A, plus
applicable taxes.
d. Reimbursement
for pre-authorized travel by taxi, train, airplane, bus, or other special
transportation submitted with receipts will be considered for approval at actual
cost, up to the maximum amount indicated on the C-60A.
e. Miscellaneous
travel expenses submitted with receipts will be considered for approval, such
as tolls and parking, at actual cost.
i.
If
a rental car is approved for special transportation, reimbursement for gas is
considered a miscellaneous travel expense.
ii. If travel by
air is approved, payment for parking at the airport and baggage fees may be
considered a miscellaneous travel expense.
f.
Approved
travel expenses related to a pre-authorized companion will be reimbursed at the
same rates permitted for the IW, except:
i.
Claims
Services staff will not reimburse for lodging for the companion unless special
circumstances require the companion to have a separate room; and
ii. Claims Services
staff will only reimburse mileage to the IW.
2. Claims Services
staff will complete the C-60 TECH form per the instructions tab on the form to
document the travel reimbursement request.
a. Upon
completion, Claims Services staff will image the worksheet into the claim and
fax it to the Benefits Payable Department at 614-621-1140.
b. Claims Services
staff will be responsible for correcting and resubmitting the C-60 TECH form or
equivalent, as needed.
3. If any part of
the IW’s travel reimbursement request appears unreasonable or unnecessary, or
is otherwise questionable, Claims Services staff will contact the IW in an
attempt to resolve the issue.
Example:
Mileage submitted by the IW is 30 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.
1. If, after
reviewing the C-60 or equivalent travel expense request and other submitted
documentation, Claims Services staff determines that all or some of the
submitted travel expenses do not meet the criteria for reimbursement, Claims Services
staff will publish a BWC Subsequent Order which
states:
a. “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:”
b. The appropriate
travel denial reason; and
c. Any additional
explanation needed to explain the basis for the denial and the following
statement: “Therefore, we have denied [a portion of] your request for travel
reimbursement.”
2. If only a
portion of a travel reimbursement request is denied, Claims Services staff will
do the following after all administrative appeals are finalized:
a. Redact the
lines of the denied expenses that are not payable on the C-60.
b. Calculate the
totals for the allowed expenses and indicate the reimbursement amount on the C-60
TECH form.
c. Image a copy of
the amended C-60 into the claim and send a copy to the IW with a copy of the
C-60A; and
d. Fax the amended
C-60 and C-60 TECH form to BWC Benefits Payable.
1. If the IW
requests assistance from BWC to prepay lodging and other transportation
expenses (e.g., hotel, airfare, bus fare, train fare), Claims Services staff will:
a. Advise the IW
that BWC must approve pre-payment of travel expenses before any travel
arrangements are made; and
b. Submit the request
to their supervisor for review and approval as soon as possible prior to
travel. The Pre-Pay Travel (PPT) Unit will be available for consultation via
the BWC
Pre-Pay Travel email box.
c. If BWC
management approves, Claims Services staff will complete the Injured Worker
Travel Card Authorization Log (A-53), located on COR, in consultation with
the IW.
i.
If
requesting flight/bus/train, the A-53 must include:
a) The to and from
terminal;
b) Flight /bus/train
numbers and departure times;
c) IW information
full name, and date of birth;
d) A list of any
special travel requirements (e.g., accommodations, service animal); and
e) If traveling
with a companion, the companion’s name, and date of birth.
ii. If requesting
hotel lodging, the A-53 must include:
a) Hotel name;
b) Hotel address;
c) Hotel phone
number; and
d) Any special
accommodations the IW requires (e.g., handicapped accessible, service animal).
iii. Upon completion
of the A-53, Claims Services staff will submit it to the BWC Pre-Pay Travel email box for
final approval or disapproval.
d. Car rental
cannot be prepaid due to insurance liabilities.
e. If taxi or other
ground transportation cannot be prepaid, Claims Services staff will consult the
PPT Unit for other alternatives that may be available.
2. Within two
business days of receipt of the A-53, the PPT Unit will approve or disapprove
the request and notify Claims Services 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 Claims Services staff.
c. Claims Services
staff will document the approval or disapproval in the claim notes.
3. To process the
approved A-53:
a. The PPT Unit
will:
i.
Document
the travel arrangements on the A-53 with the confirmed vendor, dates of travel,
the total cost of travel, and the confirmation numbers.
ii. Attach any
itineraries received from the appropriate vendors and fax this information
along with the approved A-53 to Claims Services staff; and
iii. Maintain the
completed and confirmed copy of the A-53 and fax a copy to BWC Benefits Payable
to be processed.
b. Claims Services
staff will:
i.
Image
the A-53 and document the travel approval in the claim notes;
ii. Prepare a
letter of confirmation to send to the IW via email and regular mail, 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;
iii. Set a work item
for the next business day after the expected return date of the IW’s travel;
iv. Verify the IW
traveled and kept the appointment per the arrangements confirmed on the A-53
and document the verification in claim notes; and
v. Ensure that any
travel reimbursement request submitted by the IW does not include the pre-paid
travel arrangements.
c. If Claims Services
staff determines that the prearranged travel was not utilized, Claims Services
staff will:
i.
Contact
the IW to determine if there are justifiable reasons or circumstances that
prevented the travel; and
ii. Document the
details of the contact in claim notes.
4. If, for any
reason, the IW cancels the arrangements and does not make alternative
arrangements, Claims Services staff will 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.
a. Upon receipt of
the cancellation notice, the PPT Unit will send a copy of the A-53 with the
required cancellation notations, including any fees or penalties to BWC
Benefits Payable.
b. Claims Services
staff will document the travel cancellation in the claim notes; and
c. If new travel
arrangements are made, a new A-53 will be prepared and processed consistent
with these procedures.
1. If there is an
overpayment of travel expenses, Claims Services staff will 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.
2. Claims Services
staff may notify the IW that they can repay the overpayment amount at any time.
1. Claims Services
staff will staff any questions and unusual situations regarding travel
pre-authorization and reimbursement with BWC Legal as needed.
2. The MCO will
staff catastrophic and complex injury travel issues with the BWC catastrophic nurse
assigned to the claim.