This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on November 5, 2001. The hearing officer resolved the disputed issue by determining that the appellant (claimant) is not entitled to reimbursement of travel expenses for medical treatment at the direction of Dr. B, her treating doctor, and that the Texas Worker’s Compensation Commission (Commission) properly designated a new designated doctor in accordance with Tex. W.C. Comm’n, 28 TEX. ADMIN. CODE § 130.6 (Rule 130.6)). The claimant appealed the hearing officer’s determination with respect to the mileage reimbursement issue on sufficiency grounds and the respondent self-insured (carrier) responded, urging affirmance. The determination that the Commission properly designated a new designated doctor has not been appealed and has become final.
DECISION
Reversed and rendered.
The claimant testified and offered evidence that she was seeking mileage reimbursement for travel for medical treatment during 1998; that there was an agreement reached at a prior benefit review conference (BRC) with respect to mileage reimbursement; and that she had been reimbursed for some of her previous travel expenses. The carrier contends that, pursuant to the previous BRC agreement, the claimant was reimbursed for the mileage that she submitted at that BRC; that after being reimbursed for mileage the claimant filed for more reimbursements for 1998, which was during the same time period that she had already been paid; that there were other doctors available within 20 miles of the claimant’s residence; and that the claimant had not proven that her travel, if any, for medical care was reasonable or necessary.
The hearing officer concluded that the claimant had traveled on certain dates to obtain medical care at the direction of her treating doctor. The hearing officer also determined that the claimant had not sustained her burden to prove that the travel reimbursement that she was claiming was for reasonable and necessary medical treatment and that the care that the claimant received was reasonably available in her own hometown. It is apparent that the hearing officer has applied the incorrect standard. Rule 134.6 was amended for all dates of travel on or after July 15, 2000, and it now contains limitations that did not exist in the prior version. The prior rule is applicable to the determinations in this case because all the claimed travel was for dates in 1998. Before being amended, Rule 134.6 simply required that travel expenses for medical treatment be “reasonably necessary . . . to obtain appropriate and necessary medical care . . . .” Under that rule, if the carrier had not disputed the selection of a treating doctor, or a change of treating doctor, it lost the right to dispute travel expenses to go to that doctor. See Texas Worker’s Compensation Commission Appeal No. 990862, decided June 7, 1999, Texas Worker’s Compensation Commission Appeal No. 010522-S, decided April 18, 2001, and cases cited therein.
It was undisputed that Dr. B was the claimant’s treating doctor. The claimant claimed reimbursement for travel expenses for nine appointments (listed in Finding of Fact No. 9) with Dr. B in city 1; for eight appointments (listed in Finding of Fact No. 10) with a doctor in city 2 to whom she was referred by Dr. B; and for two appointments (listed in Finding of Fact No. 11) with a doctor in city 3 to whom she was also referred by Dr. B. She also testified that the carrier had never disputed the services of the treating doctor or the referral doctors, and she placed in evidence a Benefit Dispute Agreement (TWCC-24), dated January 17, 2001, which memorialized her agreement with the carrier that she is entitled to travel expenses from her residence to city 1 (60 miles round trip), to city 2 (179 miles round trip), and to (city 4) (131.2 miles round trip). A second TWCC-24, dated the same day, agreed that the claimant was owed additional travel expense reimbursement in the amount of $350.39. We note that none of the dates of travel covered by the agreement coincide with the dates of travel for which the claimant is now seeking reimbursement. The agreement did not cover travel to city 3, but the hearing officer’s finding that “the claimant traveled to obtain medical care at the direction of her treating doctor” and that she made two round trips of 260 miles each to city 3 is supported by the evidence. The claimant established that she traveled to obtain medical care at the direction of her treating doctor, to include medical care from referral doctors to whom she was sent by her treating doctor, and the evidence shows that the carrier was aware of the medical care from the referral doctors. Under Rule 134.6, in effect at the time of the travel, the claimant has demonstrated entitlement to reimbursement. The hearing officer applied the incorrect version of Rule 134.6. The carrier is responsible for reimbursement of the travel expenses as claimed.
As it is undisputed that Dr. B was the claimant’s treating doctor, whose services were not disputed by the carrier at the time travel was undertaken, we reverse the decision of the hearing officer and render a decision that the claimant was entitled to reimbursement of the claimed travel expenses.
The true corporate name of the insurance carrier is STATE OFFICE OF RISK MANAGEMENT (a self-insured governmental entity) and the name and address of its registered agent for service of process is
For service in person:
RON JOSSELET, EXECUTIVE DIRECTOR
THE STATE OFFICE OF RISK MANAGEMENT
300 W. 15TH STREET
WILLIAM P. CLEMENTS, JR. STATE OFFICE BUILDING
6TH FLOOR
AUSTIN, TEXAS 78701.
For service by mail:
RON JOSSELET, EXECUTIVE DIRECTOR
THE STATE OFFICE OF RISK MANAGEMENT
P.O. BOX 13777
AUSTIN, TEXAS 78711-3777.
Michael B. McShane – Appeals Judge
CONCUR:
Thomas A. Knapp – Appeals Judge
CONCUR IN THE RESULT ONLY:
Robert W. Potts – Appeals Judge