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Defense Base Act Mileage Reimbursement

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Mileage and the Defense Base Act - by DBA lawyer Bill Turley
 
“When I seek out professional advice, I want advice straight-up. With no B.S.”
 
Bill Turley - Author of the 5 Star book - Win Your Defense Base Act Case
 

Am I supposed to be reimbursed for my mileage when I have doctor appointments for my Defense Base Act case?

When you're a seriously injured overseas civilian contractor, your life has probably been turned upside down. You have gone from making good money to getting by on weekly compensation checks. Not good on any level. 

Gas and car expenses getting to and from medical appointments can certainly start adding up fast. The thing is, the DBA insurance company should be reimbursing you for your mileage and related travel expenses related you you getting medical treatment. 

the short answer is the DBA insurance company has to pay you for your mileage going to and from medical appointments and the like.  The longer answer is that many times it is a battle with the DBA insurance company in order for you to get the weekly compensation money and the medical treatment. Thus, in this article I provide you some "legal authority" in case the DBA insurance company needs some convincing of their obligation to pay for your medical travel costs. 

In this article I answer the following questions and more regarding DBA mileage and travel expenses: 

What do the statutes and regulations say about medical mileage?

Let’s break this down

What do the cases say about DBA medical mileage?

What does the Department of Labor say about medical mileage reimbursement?

Can I get reimbursed for the cost of transportation to medical appointments and, if so, how much?

What form do I use to request mileage reimbursement?

What if the DBA insurance company is contending that my medical treatment is not related to my DBA injury or it’s not reasonable and necessary?

Mileage money can really add up
 
What is the current GSA rate for mileage?

What kind of proof am I going to need in order to be reimbursed for my mileage?

How far can I travel to see the doctor in a Defense Base Act case?

What if the DBA insurance company is telling me that they will only pay 25 miles for mileage to medical appointments

Here is some case law that may help you on the 25 mile issue

 

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Before you do anything related to your DBA case - including, but not limited to - talking to the insurance adjuster, signing any forms (do not sign any forms, releases, etc.!!), giving a statement (don't give a statement!!!), going to your next medical appointment, attending an informal conference, attending a Labor Market Survey meeting, giving a deposition, attending a defense medical exam (also called an IME)... or anything else related to your DBA case - - you MUST first read my 5 Star book - Win Your Defense Base Act Case.

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Avoiding the DBA insurance company tricks and traps

Fact is, the DBA insurance company will lay tricks and traps for unsuspecting people just like you that have legitimate DBA claims.

People have been falling for these tricks and traps for years. This is one of the main areas I cover in my 5 Star reviewed book - Win Your Defense Base Act Case.  My book is all about helping you avoid these case-killing mistakes.


What do the statutes and regulations say about medical mileage?

The law for the Defense Base Act is made up of statutes, regulations and case law. The Defense Base Act is an extension of the Longshore and Harbor Workers Compensation Act. Thus, most of the law regarding Defense Base Act claims actually comes from the Longshore Act. The Act states the following in regards to medical treatment: 
 
The employer shall furnish such medical, surgical, and other attendance or treatment, nurse and hospital service, medicine, crutches, and apparatus, for such period as the nature of the injury or the process of recovery may require.
Section 907(a).
 
Please note that employer means the insurance company. 
 
The regulations actually state that the employer (read: insurance company) must pay for travel costs:
 
§ 702.401 Medical care defined.
 
(a) Medical care shall include medical, surgical, and other attendance or treatment, nursing and hospital services, laboratory, X-ray and other technical services, medicines, crutches, or other apparatus and prosthetic devices, and any other medical service or supply, including the reasonable and necessary cost of travel incident thereto, which is recognized as appropriate by the medical profession for the care and treatment of the injury or disease.
 20 C.F.R. Section 702.401(a) (Emphasis added).
 

Let’s break this down

Your physician needs to recommend or prescribe medical treatment. When this happens then the costs of travel to the doctor or medical appointments must be reimbursed by the Defense Base Act insurance company.
 
This includes actual doctor visits, physical therapy, diagnostic tests, etc.  You are also entitled to mileage and travel costs to the pharmacy.
 
Please note it states, “...and necessary cost of travel incident thereto...”  This includes tolls, parking, etc.

What do the cases say about DBA medical mileage?

Costs incurred for transportation for medical purposes are recoverable under Section 7(a). Day v. Ship Shape Maintenance Co., 16 BRBS 38 (1983).
 
Parking expenses, and highway and bridge toll expenses, incurred for obtaining medical treatment for which an employer is liable are chargeable to the employer as transportation costs.  Castagna v. Sears, Roebuck & Co., 4 BRBS 558 (1976).
 

What does the Department of Labor say about medical mileage reimbursement?

On the U.S. Department of Labor website (Frequently Asked Questions) there is the following:

60. Can I get reimbursed for the cost of transportation to medical appointments and, if so, how much?

Reasonable transportation expenses necessary for treatment of the work injury, including mileage, parking, and tolls, are reimbursable costs. Mileage is reimbursed at the rate in effect at the time travel costs were incurred according to the mileage rates for privately owned vehicles set by the US General Services Administration (GSA). The past and current rates are listed on the GSA website.

61. What form do I use to request mileage reimbursement?

There is no special form required to request mileage reimbursement under the LHWCA. Some insurance companies have their own form which they may ask you to use. To claim mileage reimbursement, you must provide accurate documentation including the date of the travel, the destination (doctor's office, physical therapy facility, etc.), and the mileage to and from that destination. While the LHWCA does not impose a time limit for filing mileage reimbursement requests, it is recommended that you submit your requests to the insurance carrier on a regular basis and keep copies for your records.

I suggest you follow the advice of the Department of Labor. 


What if the DBA insurance company is contending that my medical treatment is not related to my DBA injury or it’s not reasonable and necessary?

When the DBA insurance company is contending that your medical treatment is not related to your DBA injury or it’s not reasonable and necessary - then this issue will need to be decided by the Judge. You will need a formal hearing.
 
The bottom line is that you will only be entitled to travel expenses if the Judge rules that your medical treatment is related to your DBA claim and is reasonable and necessary.


Mileage money can really add up

For example, in one case, the Judge Ordered the Employer (read: the insurance company) to pay for all medically related mileage. This included the costs of mileage to pharmacies.  The Judge Ordered that $3,217 in mileage be reimbursed to the Claimant. In another case, the Judge Ordered that $6,428 in mileage be reimbursed to the Claimant.
 
These cases were cases where the Judge Ordered the mileage be paid. We have had cases where the mileage was paid voluntarily (but sometime slowly) by the DBA insurance company where the total mileage money paid over the course of the case was in the five figures. Meaning, serious money. 
 

What is the current GSA rate for mileage?

The current GSA rate (2019) for mileage for use of your private vehicle is $.58 a mile.
 

What kind of proof am I going to need in order to be reimbursed for my mileage?

 
I suggest that you keep records on a daily basis of your doctor visits. You can use your actual mileage and/or use Google maps mileage.
 
You need to keep actual toll charges and parking charges.
 
If the DBA insurance company says you need to use their form, then use their form. Otherwise, you can Google “Mileage Reimbursement Form” and easily find one.
 
Your record needs to state the date, the reason for the travel (for example, an appointment with Dr. Smith or a trip to the pharmacy for medication, etc.).
 
You must have enough details in order to prove that the mileage and related travel expenses were related to your DBA medical care.
 

How far can I travel to see the doctor in a Defense Base Act case?

Here is what the regulations say:
 

Employee's right to choose physician; limitations.

The employee shall have the right to choose his/her attending physician from among those authorized by the Director, OWCP, to furnish such care and treatment, except those physicians included on the Secretary's list of debarred physicians. In determining the choice of a physician, consideration must be given to availability, the employee's condition and the method and means of transportation. Generally 25 miles from the place of injury, or the employee's home is a reasonable distance to travel, but other pertinent factors must also be taken into consideration. 
20 CFR Section 702.403 (Emphases added). 

 
There are two important parts to this. First, is says “Generally 25 miles” from your “home is a reasonable distance to travel.”
 
Second, it says “... but other pertinent factors must also be taken into consideration.” It depends on the treatment, where you live and other factors.


What if the DBA insurance company is telling me that they will only pay 25 miles for mileage to medical appointments

 
Many courts have held that the 25 miles travel distance is reasonable. However, what is “reasonable” in a metropolitan area may not at all be reasonable in a rural area.
 
And the regulations states, “... but other pertinent factors must also be taken into consideration.”  What other factors need to be taken into consideration? 
 
  • The nature of the medical treatment you are receiving.
  • The alternatives to the treatment that your are receiving in relation to the location where you are receiving the medical treatment.
  • The relative quality of the physician and/or facility that is providing the treatment.
  • Your relationship with the doctor or facility providing the medical treatment. 
 

Here is some case law that may help you on the 25 mile issue

In Reed v. Jamestown Metal Marine, (BRB No. 97-881)(March 23, 1998) (Unpublished), the Board held the employer liable for the claimant's mileage and travel costs associated with her treatment for her work injury which involved her traveling 197 miles round-trip. The Board noted that Section 702.403 normally provides 25 miles to be a reasonable distance, but, in this case, the Board emphasized that "the importance of claimant's maintaining her relationship with her current treating physician and the uniqueness of [her physician's] day treatment program, made it evident that [her physician's] treatment is reasonable and necessary even though claimant must travel more than 25 miles."
 
When competent medical care is available close to a claimant's residence (Houston), the claimant's medical expenses can reasonably be limited to those costs that would have been incurred had the treatment been provided locally rather than where the treatment was actually incurred (Boston). Schoen v. United States Chamber of Commerce, 30 BRBS 112 (1996), See generally Welch v. Pennzoil Co., 23 BRBS 395.
 
In Schoen, the Board noted that the ALJ had considered the treatment available at both clinics, their professional accreditations and success rates, and the experience of each clinic's director, and then reasonably concluded based on the record, that the claimant's claim for reimbursement for the Boston clinic was unreasonable because adequate comparable treatment was available in Houston at a lesser cost..
 
In Nides v. 1789, Inc., (BRB No. 99-0162)(Oct. 18, 1999)(Unpublished), the Board held that when the employer did not challenge the claimant's credibility regarding travel records, the ALJ should sustain those costs. The Board noted 20 C.F.R. Section 702.401(a) which defines medical care, in pertinent part, as including "the reasonable and necessary cost of travel ... which is recognized as appropriate by the medical profession for the care and treatment of [claimant's] injuries. 
 

I suggest you might want to check out these articles:

Top 10 DBA questions 

DBA Case Studies

Defense Base Act and PTSD 

 

You always have to tell the truth

The DBA insurance company is hoping you will lie, fib, exaggerate, embellish, and/or  distort about things. Anything. Because when you do they will try and destroy your credibility. When that happens successfully - you lose. I cover this in my book. 

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This article isn't legal advice
 
These discussions and/or examples are not legal advice. All legal situations are different. These testimonials, endorsements, photos and/or discussions do not constitute a guarantee, warranty, or prediction regarding the outcome of your legal matter, or your particular case/ situation. Every case is different. There are any number of reasons why DBA cases are not won and/or are not as successful as folks might have hoped for.
 
Just because we have gotten great results in so many other Defense Base Act cases, doesn't guarantee in particular result in other cases. Including, your DBA case. Every case is different.
William Turley
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“When I seek out professional advice, I don’t want B.S., I want it straight up. I figure you do also.”
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