In Pennsylvania, Do I Get Reimbursed for Mileage for Doctors Visits under Workers Compensation?

04102-box2A work-related injury can be financially devastating for many Pennsylvania workers.   If your workers compensation claim is denied and you are out of work, while you litigate the Claim Petition, you will have no income, unless you can obtain short term and/or long term disability.  Even if your work-related injury is accepted, many injured workers struggle, because, depending on your pre-injury wages, your workers compensation benefits are either 90% or 2/3 your pre-injury wage. For some who live pay check to pay check, that reduction can be a financial hardship.

Beyond the wage loss benefits, I am often asked by clients if they can be reimbursed for travel to and from their doctor and physical therapy.  In a rural area like South Central Pennsylvania,a specialist could be 30-50 miles away.  In a time period where we are experiencing high gasoline prices, those travel expenses can bet significant.  Unfortunately, in Pennsylvania, insurance carriers are not required to reimburse injured workers for travel to and from their treating doctors and therapy.   Insurance carriers are only required to reimburse travel to and from an appointment with their doctor, an Independent Medical Examination (IME).

The other rare exceptions were carved out in Helen Mining Co. v. WCAB (Tantlinger), 616 A.2d 759 (Pa.Cmwlth. 1992), in which the court said:

1.  If treatment is available locally, the claimant is not entitled to reimbursement for travel expenses except in exceptional circumstances;

2.  If treatment is available locally and the claimant chooses a physician outside the local area, the claimant is not entitled to reimbursement for travel expenses;

3.  If treatment is not available locally, the claimant is entitled to reimbursement for travel expenses as long as the claimant travels to a facility where others are or would be referred.

The court later clarified what the term “local” means.  The established rule is 100 miles.   If the travel was over 100 miles one way, then travel may be reimbursable.  If it is under 100 miles, then the three rules above are applicable.

As an example, if you chose to go to a hand specialist in Philadelphia because you heard he/she was the best, but a hand specialist/surgeon is available in your area, then that travel, despite being over 100 miles, will not reimburse that travel.

Fact is, in terms of travel to doctors appointments, physical therapy, and other appointments, generally, insurance carriers are not required to reimburse any travel.

Mark Buterbaugh

Attorney representing injured workers and Social Security Disability clients in Pennsylvania and Maryland.