Georgia State Board of Workers’ Compensation Rule 203(e) provides in pertinent part as follows: “[m]edical expenses shall include but are not limited to the reasonable cost of travel between the employee’s home and the place of examination or treatment or physical therapy, or the pharmacy.” The Rule goes on to provide that an employer/insurer shall pay the claimant at a rate of 40 cents per mile when the travel to and from authorized medical treatment is by private vehicle. However, Board Rule 203(e) has also been interpreted to require employer/insurers to provide transportation for claimants to get to and from medical appointments in certain situations.
Georgia State Board of Workers’ Compensation Rule 203(e) provides in pertinent part as follows: “[m]edical expenses shall include but are not limited to the reasonable cost of travel between the employee’s home and the place of examination or treatment or physical therapy, or the pharmacy.” The Rule goes on to provide that an employer/insurer shall pay the claimant at a rate of 40 cents per mile when the travel to and from authorized medical treatment is by private vehicle. However, Board Rule 203(e) has also been interpreted to require employer/insurers to provide transportation for claimants to get to and from medical appointments in certain situations. In a recent decision, the State Board Appellate Division discussed that requirement and identified the specific instances in which an employer/insurer must provide transportation services to and from authorized medical appointments as part of a workers’ compensation claim.
In Board claim number 2013-001264, the Administrative Law Judge found that the employer/insurer was required to provide the claimant with transportation services to and from authorized medical appointments even though the claimant was not under driving restrictions from the authorized treating physician. The Administrative Law Judge based her decision on the fact that the claimant did not have a drivers’ license. Specifically, she reasoned that if the claimant’s transportation services were terminated, the claimant would be encouraged to commit the illegal act of driving without a license, and therefore, the termination of transportation services would be against Georgia public policy. The Administrative Law Judge also referenced the fact that Board Rule 203(e) “is not specifically limited to mileage reimbursement and may contemplate an insurer’s provision of expenses other than mileage.”
The claim was appealed to the State Board’s Appellate Division. The Appellate Division agreed with the Administrative Law Judge’s finding that Board Rule 203(e) allows for more than just mileage reimbursement; however, the Appellate Division overturned the Administrative Law Judge’s ruling that the employer/insurer was required to provide transportation services in this claim. The Appellate Division held that an employer/insurer is only required to provide transportation services where the claimant’s request for transportation services bears a causal connection to the compensable work injury. Accordingly, as was the case in the claim before the Appellate Division, in instances where the claimant is not under driving restrictions from the authorized treating physician, the employer/insurer will not be required to provide transportation services under Board Rule 203(e).
In regards to the drivers’ license issue, the Appellate Division found that the claimant’s lack of a drivers’ license had no relationship to his work injury and therefore was not a proper basis for requiring the employer/insurer to provide him with transportation services. The Appellate Division noted that terminating the claimant’s transportation services would not encourage wrongdoing on the part of the claimant since the claimant was free to use public transportation or arrange for transportation to his medical appointments on his own as needed. Furthermore, the Appellate Division found that accounting for the fact that the claimant might have to commit some wrong, such as driving without a license, was outside the scope of the employer/insurer’s responsibility to provide medical and transportation services under O.C.G.A. § 34-9-200 and Board Rule 203(e).
This decision provides a bright-line rule for employer/insurers to follow when determining whether to accommodate a request for transportation services from a claimant. If the claimant’s need for transportation services is not caused by the work related injury, then the employer/insurer is not under an obligation to provide those services. Usually, this will be an easy determination to make based on whether the authorized treating physician has the claimant on driving restrictions. If not, then any alleged inability of the claimant to drive to and from medical appointments is not likely to be related to the work injury.
However, employer/insurers should anticipate claimant’s attorneys attempting to circumvent this ruling by arguing that the physical restrictions imposed by the authorized treating physician, while not explicitly driving restrictions, are limiting enough that they prohibit the claimant from driving him or herself to medical appointments. The Appellate Division decision discussed in this article should be a first line of defense to any such argument. If the claimant’s physical restrictions are not even reasonably related to the alleged inability to drive, then the request for transportation services should be rejected immediately. However, a useful tool in combating such an argument from claimant’s counsel in close call situations would be a simple questionnaire to the authorized treating physician which requests that the physician provide an explicit opinion on whether the claimant is capable of driving to and from medical appointments.
Finally, also consider that if an employer/insurer is able to use this decision to force the claimant into a position of arguing that his or her physical restrictions prevent them from driving, then a follow-up step in the claim might be surveillance targeted specifically on whether the claimant is driving. Catching the claimant in this type of misrepresentation would be very valuable, as it would not only destroy any claim the claimant had to transportation services, but would also provide material impeachment evidence for any hearing on the claim.
In summary, the Appellate Division has clarified that an employer/insurer is only required to provide transportation services to a claimant under Board Rule 203(e) where the claimant’s inability to drive is causally connected to the work injury. This will generally manifest itself in driving restrictions from the authorized treating physician; however, claimant’s attorneys will likely try to argue that the claimant’s general physical restrictions prevent the claimant from driving. In such a situation, the employer/insurer needs to analyze the claimant’s restrictions to determine whether they could be reasonably connected to the alleged inability to drive. If so, the employer/insurer may need to request clarification on the issue from the authorized treating physician.