THIRD QUARTER 2019
By: Michael Holt and Austin Moore
In Illinois, is mileage to and from necessary medical care compensable?
Yes, provided the travel expense is for related medical care that is not otherwise available in the employee’s area of residence such as when access to a specialist is unavailable or other special circumstance making an award of travel reasonable in the eyes of the Commission.
Under Section 8(a) of the Illinois Workers’ Compensation Act, employers are required to pay for necessary medical care which is reasonably required to cure or relieve from the effects of the accidental injury. Reimbursement for mileage expenses to and from medical appointment is not expressly addressed within Section 8(a). Case law exists, however, to delineate the circumstances when the Commission has awarded mileage expense.
The general rule is that an employee is not entitled to reimbursement for travel expenses going to and from the doctor when the treatment is obtained in the same general vicinity as the employee’s residence or employment. However, if the employee is required to travel outside the immediate vicinity of his residence, travel expenses may be awarded. The Commission’s decision to award or deny mileage is reviewable under a manifest weight of the evidence standard.
The leading appellate court case on this subject is General Tire & Rubber Co. v. Industrial Comm’n, 221 Ill. App. 3d 641 (1991). In General Tire & Rubber Co., the court applied a “reasonableness” standard and held that it was not against the manifest weight of the evidence for the Commission to award roughly $1,500.00 in travel expense. The facts showed that the petitioner lived in Mt. Vernon, Illinois. Petitioner had an existing physician-patient relationship with Dr. Marrese at the time of his work injury. Petitioner travelled from his home in Mt. Vernon, Illinois to Wood River, Illinois and to Evansville, Indiana to treat with Dr. Marrese. The travel distances involved were 90-100 miles one way. The appellate court noted that it was reasonable for petitioner to travel to treat with Dr. Marrese given that petitioner was most familiar with and trusted Dr. Marrese. Further, the other known orthopedic surgeon in Mt. Vernon testified against petitioner on the issue of medical necessity. As such, the appellate court affirmed the Commission’s award of travel expense.
In Perla Kosinski v. Mobil Chemical Co., 92 IL.W.C. (Ill. W.C. Comm. 1999), the Illinois Workers’ Compensation Commission reiterated the general principle that local mileage is not deemed to be reasonable and necessary medical expenses under Section 8(a) of the Act. In that case, the arbitrator awarded petitioner $162.84 in mileage expenses representing petitioner’s six-mile round trip visits to and from physical therapy. In a second claim, the arbitrator awarded $513.43 in mileage expenses, $92.40 of which was local travel for physical therapy and the other $421.03 for reasonable and necessary long-distance mileage expenses. The Commission held that the employer would only be responsible for reimbursing petitioner for the $421.03 in mileage for her long-distance travel to St. Louis. Petitioner’s local travel mileage of $162.84 and $92.40 was found to be not reimbursable under the Act.
Similarly, in Bevolo v. Continental General Tire, 25 IL.W.C. 87 (Ill. W.C. Comm. 2016), the petitioner was denied mileage reimbursement for travel to an orthopedic surgeon about 106 miles from his residence. The Illinois Workers’ Compensation Commission found that the petitioner could have found treatment near his residence and was not required to travel for treatment. The Commission’s decision implied, however, that if local treatment was not available, travel outside of his area of residence would have been medically reasonable and reimbursable.
In Smith v. Fram Filtration, 27 ILWCLB 32 (Ill. W.C. Comm. 2018), the employee was denied mileage reimbursement after she treated at an out-of-town facility and provided no evidence as to why she had to treat with that facility. The travel was a personal choice and not unique or medically necessary.
Section 8(a) is silent with regards to an employer’s liability for an employee’s travel expenses for necessary medical treatment. The available guidance on this issue arises out of case law which can be very fact specific. The general rule appears to be that an employer is not required to reimburse a petitioner for local travel to and from necessary medical care. “Local” seems to mean the same city as the petitioner but also the same general vicinity as where petitioner resides. However, if there are no real physician choices to treat petitioner’s specific condition, out-of-area travel is likely to be awarded by the Commission. It also appears travel is awardable if a long-standing physician of the petitioner moves out of area. Continuation of care would likely be considered reasonable as would the associated travel expense. Any review of a Commission determination on travel expense will be subject to a manifest weight of the evidence standard of review.