There are instances in which employers are responsible for reimbursing an employee's travel expenses under Section 306(f)(1) of the Pennsylvania Workers' Compensation Act. They include when a work-related injury has been accepted and the employee has incurred travel expenses to obtain medical treatment. For instance, if an employee travels more than 100 miles one way for medical treatment, costs are reimbursable as a matter of law. See Holly v. WCAB (Lutheran Home at Kane), 735 A.2d 153, 156 (Pa. Cmwlth. 1999). Where an employee travels less than 100 miles for medical treatment, the employer's responsibility to reimburse travel expenses is less clear. The relevant inquiry is whether the travel expenses required to obtain the medical services were reasonable and would failure to pay travel expenses otherwise render necessary treatment unavailable. See Harbison-Walker Refractories and Commercial Ins. Co. v. WCAB (Huntsman), 513 A.2d 566, 568 (Pa. Cmwlth. 1986).
In Harbison-Walker, the Court delineated several factors that are suggestive of reasonableness:
- Whether the employer was aware of the long distance treatments;
- Whether the employer contested the underlying work injury;
- Whether the employee was specifically referred to the distant location for medical treatment;
- Whether the treatment was available at a closer location; and
- Whether the long distance treatment comprises an integral part of the employee's ongoing medical treatment.
In Helen Mining Co. v. WCAB (Tantlinger), 616 A.2d 759, 762-63 (Pa. Cmwlth. 1992), the Court summarized the Harbinson-Walker factors into three rules:
- If the treatment is available locally and the employee seeks the treatment locally, then absent exceptional circumstances, travel expenses are not reimbursable.
- If the employee choses a physician outside the local area, travel expenses are not reimbursable.
- If necessary treatment is not available locally, the employee is entitled to reimbursement for travel expenses so that employee is not prevented from receiving the treatment he or she requires.
Notably, an employee's longstanding relationship or personal preference for treatment with a particular physician is not a basis upon which travel expenses may be deemed reimbursable. Berrian v. WCAB (Pennsylvania State Police), 829 A.2d 724, 729 (Pa. Cmwlth. 2003). Nor does past payment of travel expenses bind an employer for payment of future travel expenses.
The question of whether travel is considered local or long distance is a finding of fact to be made by the Workers' Compensation Judge. Helen Mining Co., 616 A.2d at 763. The determination of whether treatment is "local" depends on whether residents living in the same area as the employee consider the treatment local. Helen Mining Co., 616 A.2d at 763. If residents in the area where the employee resides routinely travel to the referral area for treatment, then the area is local. If residents do not routinely travel to the referral area for treatment, then it is considered long distance. Because the inquiry concerns the travel of others for treatment similar to that of the employee's, the employee's testimony regarding his or her own usual travel for treatment is insufficient evidence. See Holly, 735 A.2d at 156.
If the Workers' Compensation Judge finds the employee's travel expenses reimbursable, mileage must be reimbursed in accordance with the Internal Revenue Code Standard Mileage Rate, unless the employer provides evidence that the employee's expenses are less. See Barnyock v. WCAB (Garden State Tanning), 664 A.2d 683, 685 (Pa. Cmwlth. 1995)(internal citation omitted).
For more information contact Dawn Nicholson at dnicholson@wglaw.com or 570.961.3169