THIRD QUARTER 2019

WISCONSIN

By: Lizzy A. King

Question:

In an otherwise compensable workers’ compensation case, is mileage compensable for travel to and from necessary medical care?

 

Short Ansewr:

Yes, in Wisconsin, mileage is compensable for travel to and from necessary medical care, payable at a rate of $0.51/mile (as of this writing).

 

Discussion:

Where travel is reasonable to obtain treatment, an injured employee is entitled to compensation for mileage. Mileage is considered a necessary incidental compensation, as with medical and surgical supplies, and lodging. Wis. Stat. § 102.42(1). The employer is liable to an injured employee at a rate of $0.51 per mile for all reasonable travel expenses incurred to obtain treatment. See also Mileage Reimbursement Record, Department of Workforce Development Worker’s Compensation Division, WKC-18613-E. This mileage rate is comparable to the rate State employees receive for business travel, and the rate has remained the same since 2017. Wis. Stat. § 102.42(2)(b).

 

In an otherwise compensable claim where an employer would be held liable for travel expenses incurred by the employee, there are instances in which an employer would not be found liable. If an employee’s travel expenses for treatment are found unreasonable because he could have obtained a treating provider within closer proximity or the employee sought medical treatment outside the scope of Section 102.42(2)(a), a court will unlikely find in favor of reimbursing the employee.

 

When considering the compensability of travel expenses, an injured employee’s expenses must represent a reasonable, necessary, and actual expense. Choice of Practitioner and Payment of Medical Expenses, Rejection of Treatment, and Examination by Employer/Insurer’s Practitioner, State of Wisconsin: Department of Workforce Development, https.//dwd.wisconsin.gov/wc/medical/med_treatment_selection.thm (last visited September 11, 2019). An employer is not liable for unreasonably incurred travel expenses. Montag v. LIRC, 119 Wis.2d 899 (Wis. Ct. App. 1984). An employer may decline to compensate an employee’s mileage where a claim for reimbursement is unsubstantiated because the employee sought treatment from a third provider (outside of the two afforded practitioners under Wis. Stat. §102.42(2)). Fallucca v. Palermo Villa Inc. / Home Insurance Co., 88013914 (LIRC, Dec. 6, 1995).

 

An injured employee can be denied travel compensation where similar, competent treatment could be given without extensive travel. Montag, 199 Wis.2d at 1. In Montag, the court denied compensation for travel expenses where an employee who resided in Florida sought treatment in Wisconsin. Id. Though the employee treated with the Wisconsin physician since the onset of the injury, the court found that the employee should have sought for a referral once he moved to Florida. Id.  The employee claimed that he could not find a physician with the same experience as his Wisconsin physician, and that it was easier to continue seeing a physician who assisted him since the start of the claim. Id. The court noted that the Wisconsin physician had adequate connections to provide referrals in Florida. Id. Because the employee could have reasonably received competent treatment by a medical care provider within proximity to his new residence, his travel expenses were deemed unreasonable. Id. Accordingly, the court correctly denied the employee’s claim for reimbursement of incidental compensation. Id.

 

Another manner by which an employer or insurer may decline reimbursement for a travel expense is when the expense falls outside the scope of Wis. Stat. § 102.42(2)(a). Under Section 102.42(2)(a), an injured employee has the right to the choice of two physicians, and there are limits on treatment outside Wisconsin. In Montag, the court noted that the employee could have sought reimbursement for travel expenses with a Florida referral because his Wisconsin board primary care provider would have been the referring physician. Accordingly, the referral would have rendered the treatment course compensable under Section 102.42(2)(a). Unlike Montag where the travel for treatment was simply unreasonable, in Fallucca, the court found that the treatment was reasonable and necessary. Falluca, 88013914 (LIRC, Dec. 6, 1995). However, the court did not side in favor of the employee for the travel expenses he incurred because his treatment did not fall within the two physician limit. Id. The employee was not reimbursed for mileage when he sought out a third physician for treatment. Id.

 

Practice Tip: Generally, if an injury is compensable, mileage should be paid at $0.51/mile for all travel expenses incurred while seeking treatment. Insured should be actively seeking information surrounding the injured employee’s mileage expenses throughout the claims handling process.  We recommend providing a form for the claimant to document mileage costs, explaining reimbursement will be provided periodically during the claim handling process.