Simple Concepts for a Complex System – Transportation Reimbursements and Customer Service for the Injured Worker

Most States require the workers' compensation administrator reimburse medical transportation expenses to the injured worker.  Most workers compensation systems utilize the federal mileage reimbursement rate per mile. 

In workers’ compensation, the common reimbursement process for medical treatment mileage reimbursement, a hard copy reimbursement form is sent to the injured worker when the claim is accepted.  Usually, this form is embedded with a large packet of State required benefit notice documents.  If the transportation form is filled out and returned, the claims assistant or examiner pulls out their cell phone and uses their map's features to calculate the accuracy of the submitted distance between the doctor's office and the home address.  If there are no "inaccuracies" the payment is authorized.  If there are any mistakes or inaccuracies which would create an "overpayment" the claim is reported to SIU for a fraud investigation, or the reimbursement is automatically reduced.  Rarely are reimbursements for transportation requests increased if the injured worker has forgotten to include a doctor's visit. 

Concurrently, the claims administrator also pays all of the medical treatment bills for that injured worker.  These bills include the dates of service, and locations of the doctor, hospital pharmacy or PT offices.  The claims administrator also knows the residence of the injured worker.

Assuming the distance was from the home, claims administrators should have their computer system automatically calculate the dates and distances. The systems can automatically tell if the roads included tolls for bridges. 

On a monthly basis the transportation should be paid without requiring the employee to send in a form. 

The system should have an internal override if there are transportation company expenses also paid on the claim.

If the employee has to do a special trip to the pharmacy or some other medical treatment event they should be able to submit the hard copy form or go online and electronically submit an additional or supplemental transportation adjustment or request.

If travelled the mileage and tolls are owed. 

Automatically paying transportation should be a basic customer service for the injured workers.

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Coming Tuesday: Simple Concepts for a Complex System - Top Cost Drivers for the Workers' Compensation System

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William M "Bill" Zachry is a Board member of the California State Compensation Insurance Fund, Appointed by Governors Arnold Schwarzenegger and Jerry Brown. He served 3 years as a Senior Fellow at the Sedgwick Institute. His term ended in January 2020. Zachry was awarded the Summa CompLaude award in November of 2020, the RIMS Risk Manager of the Year 2014, the CCWC Workers Compensation Professional of the Year 2016, Co-Chair AMICUS Committee California Chamber of Commerce. He is the former GVP Risk management Safeway /Albertson's Former Board Member California Self Insurers' Security Fund, former Co-Chair California Chamber of Commerce AMICUS committee Chair California Fraud Assessment Commission Zenith Insurance Company VP Claims HIH (C.E.Heath) (Care America) S.V.P. Claims. References

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