The Full Board, at its meeting held on July 16, 2013, considered the above captioned case for Mandatory Full Board Review of the Board Panel Memorandum of Decision filed October 17, 2012.
The issue presented for Mandatory Full Board Review is whether the State Insurance Fund (SIF) should reimburse the claimant travel expenses in the amount of $2,091.28.
The Workers' Compensation Law Judge (WCLJ) established the claim for a back injury; set the claimant's average weekly wage at $2,241.95; made awards for temporary total and partial disability; and directed SIF to audit and reimburse the claimant for medical and travel expenses in the amount of $2,091.28 for travel from his home in Syracuse, New York, to his physician, whose office is located in Ossining, New York.
The Board Panel majority affirmed the WCLJ's decision, but advised the claimant that in the future he must either schedule medical appointments during days that he is working in Ossining or find a physician closer to his home in Syracuse.
The dissenting Board Panel member concurred with the Board Panel majority's determination regarding the claimant's medical and travel reimbursement request for doctor's appointments during the period that the claimant was out of work, but found that the claimant was not entitled to reimbursement for medical and travel expenses related to treatment after April 25, 2011.
The carrier filed an application for Mandatory Full Board Review on November 1, 2011. The carrier did not seek review of the Board Panel majority's finding that the claimant is entitled to reimbursement for medical and travel expenses related to physician's appointments prior to his return to work on April 25, 2011. However, the carrier argued that the claimant's travel expenses after that date were unreasonable and that they should not be required to reimburse claimant for those expenses.
The claimant filed a rebuttal on November 12, 2012, arguing that the Board Panel majority decision should be affirmed.
Upon review, the Full Board votes to adopt the following findings and conclusions.
The claimant, a correction officer, filed a C-3 (Employee Claim) on March 14, 2011, asserting that he suffered a back injury as a result of a motor vehicle accident on February 25, 2011. SIF did not dispute the claim.
On September 6, 2011, the claimant's attorney filed a Form RFA-1LC (Request for Further Action by Legal Counsel), requesting a hearing regarding the fact that SIF had underpaid the "claimant's out of pocket mileage expenses." The claimant's attorney attached an August 22, 2011, letter from SIF to the claimant, stating that SIF would not reimburse the claimant's travel expenses from his home in Syracuse, New York, to his physician's office in Ossining, New York, because the expenses were unreasonable in light of the fact that other similar facilities were located closer to the claimant's home.
At a hearing on November 15, 2011, the claimant advised that he had submitted a medical and travel expense reimbursement request in the amount of $2,091.38, but only received a reimbursement in the amount of $86.00. The claimant, who was not under oath during the hearing, stated that he traveled to Ossining, New York, on eight occasions for doctor's appointments, and it was 246 miles each way. The claimant stated that his primary work location was in Ossining, New York, and he maintained temporary housing there when he worked. His schedule varied, but usually involved four to six days working and four to six days off of work. The claimant noted that he was temporarily totally disabled for 60 days following his work accident, and returned to work on April 25, 2011.
At the close of the hearing, the WCLJ found that the claimant was entitled to reimbursement of his medical and travel expenses because the physician was located near the claimant's place of work, and directed SIF to audit and reimburse the claimant's request accordingly. The WCLJ also established the claim for a back injury; set the claimant's average weekly wage at $2,241.95; and made awards for temporary total and partial disability. The WCLJ's findings were memorialized in a Notice of Decision filed on November 18, 2011.
Pursuant to Workers' Compensation Law (WCL) § 13(a), claimant is entitled to reimbursement of expenses for travel required to obtain necessary medical care (see Matter of Morrell v Onondaga County, 244 AD2d 695 , Matter of Simpson v Glen Aubrey Fire Co., 86 AD2d 909 ). However, the employer is not obligated to pay for expenses beyond what is necessary and reasonable under the circumstances of the case (see Matter of Morrell, 244 AD2d 695 ; Matter of Langford v William Rogers, Inc., 144 AD2d 785 ).
In the present case, the claimant elected to seek treatment from a physician located near his place of work in Ossining, New York, rather than near his home in Syracuse, New York, necessitating substantial travel. The record does not contain any evidence indicating that the claimant could not have received comparable treatment at a facility closer to his home.
While the Board has previously found medical and travel expenses unreasonable in similar cases, see Matter of NYS Dept. of Corrections, 2009 NY Wrk Comp 50613233; Matter of Lonero Transit Bus Co., Inc., 2009 NY Wrk Comp 00805629, the present claimant's decision to seek treatment close to his place of work could be considered reasonable if his purpose in doing so was to facilitate the continuation of treatment once he returned to work. Presumably, treating with a provider close to work would allow the claimant to quickly and easily attend follow up appointments. However, the claimant's decision to schedule his follow up appointments on days that he was not working and thus unnecessarily incurring additional travel expenses was not reasonable. No evidence suggests that the claimant could not schedule his doctor's appointments to coincide with his work schedule, thus avoiding incurring additional travel expenses.
Therefore, the Full Board finds that the preponderance of the evidence in the record supports a finding that the claimant is not entitled to reimbursement for travel expenses related to treatment rendered on May 12, 2011, June 30, 2011, and July 12, 2011.
ACCORDINGLY, the WCLJ decision filed on November 18, 2011, is MODIFIED to find that the carrier is not required to reimburse claimant for travel expenses from his home to Ossining, New York, to attend medical examinations after his return to work on April 25, 2011. No further action is planned by the Board at this time.