Removing Roadblocks for Injured Employees Needing Medical Care
PartnerSource advises clients whose employees encounter travel-related issues when getting to medical care
Studies show that receiving the appropriate medical treatment in a timely manner helps create better medical outcomes for injured employees. But what if an injured employee has to travel far distances to see the appropriate physician for care?
The most common scenario PartnerSource sees is when an injured employee needs to see a doctor that is far away from the employee’s home. When the distance the claimant has to travel for approved medical treatment is greater than the specified number of miles in the plan, most plans specify the amount of mileage reimbursement for the employee as the same as the IRS’s “medical purposes” rate. This rate is typically updated annually and is easy to find via Google (in 2024, it’s 21 cents/mile).
While that scenario is clear-cut, not all circumstances are quite as intuitive. PartnerSource’s decades of expertise has been called upon to help advise in unique cases, including these situations that PartnerSource clients recently encountered:
- Injury kept employee from driving: The employee sustained a shoulder injury that required his right arm to be immobilized. Meanwhile, he needed to begin treatment with a specialist 70 miles away from his home. He wasn’t able to drive himself and family members couldn’t help. Normally, his travel would have qualified for mileage reimbursement; however, he wasn’t able to drive to get care. In this case, after discussion with PartnerSource and the employer, it was determined transportation would be provided for the employee until he was recovered enough to begin using his arm and it would be safe for him to drive.
- Employee didn’t have a vehicle: An employee was injured at work but was not able to get to the approved physician because this employee did not have a vehicle and usually walked to work. Fortunately, many plans include good-cause exceptions for travel needs that are less than the stated number of miles. In this circumstance, PartnerSource can help employers consider all available options, such as whether there is public transportation available or if the employee has a friend or family member that can drive them. If all else fails, a claims administrator may find good cause and can consider additional options for transportation of the employee to their medical appointments, including utilizing a car service or reimbursing the employee for travel expenses such as ride-share services like Uber or Lyft.
There are any number of scenarios a claims administrator may encounter relating to an employee not being able to get to their medical appointments -- a broken-down car, employee not being able to pay for gas, or medication that makes it unsafe for the employee to operate a vehicle. At first glance, it may appear there is no coverage for these situations under the plan; however, a careful review of the plan’s language often reveals flexibility in determining how to provide temporary assistance to the employee to facilitate continued medical treatment. PartnerSource is adept at helping employers interpret the language of the plan to determine all available options.
Roadmap to Recovery
PartnerSource clients leverage the Texas Option to help achieve better medical outcomes for their injured employees. The goal of providing plan benefits is to aid employees in recovering from their injuries, and to make available to them the most appropriate treatment in a timely fashion. Transportation is an important consideration in addressing an employee’s injury: If medical treatment is delayed or stopped, this could negatively impact recovery from the injury and possibly also create potential non-compliance under the plan.
PartnerSource understands that creating better medical outcomes for employees injured on the job is a critical component of better business. By utilizing available options, employers can avoid transportation becoming a roadblock in achieving those positive outcomes.