Insurer not obligated to prepay worker's travel costs for physician appointments
Winter v. Industrial Claim Appeals Office of the State of Colorado, No. 12CA2437 (Colo. Ct. App. 08/15/13).
Ruling: The Colorado Court of Appeals held that a worker was not entitled to the prepayment of hotel and meal expenses he incurred while traveling to see his authorized treating physician.
What it means: In Colorado, an insurer is not required to prepay a worker's hotel and meal expenses used to travel to visit his authorized treating physician.
Summary: A worker suffered a compensable knee injury that required surgery. His employer's insurer designated a specialist located in another city. The worker had a number of routine post-surgical appointments with the specialist. Initially, the insurer prepaid the worker's mileage, hotel room, and meals. After the worker's third appointment with the specialist, the insurer advanced only the cost of the worker's mileage. The worker asserted that the insurer was required to advance the costs of mileage, meals, and hotel accommodations for his scheduled appointments with the specialist. The Colorado Court of Appeals held that the worker was not entitled to the prepayment of his hotel and meal costs.
Although the worker argued that his meals and lodging were medical benefits because they were recoverable as services incident to his medical treatment, the court explained that the rules did not define "health care service." The court said that the "tangential relationship" the worker's lodging and meals held to his treatment precluded their classification as health care services. The court also explained that restaurants and hotels cannot be considered "health care providers."
The court explained that the reimbursement of travel costs accounts for the possibility that an injured worker may cancel an appointment or spend less than anticipated. In this case, the worker did not have to forgo treatment, and the insurer reimbursed him within 30 days, minimizing any financial burden.
The court also rejected the worker's argument that the insurer's prepayments of expenses for meals and lodging for his first three visits to the specialist made it contractually obligated to prepay all of his travel expenses.
The court concluded that the insurer was not obligated to prepay the worker's travel expenses but recognized the potential harshness of the result for a worker who could not afford to advance substantial costs for lodging and meals. The court suggested that the Division of Workers' Compensation address the issue in a rule.
Read more at the WorkersComp Forum homepage.
November 4, 2013
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