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 October 11, 2001. The hearing officer determined that the appellant (claimant) was not entitled to reimbursement of travel expenses for medical treatment performed at the direction of Dr. A and Dr. TG.
The claimant’s ombudsman filed one appeal for the claimant asserting that the claimant should be reimbursed for travel expenses because the medical treatment was “reasonably necessary” pursuant to Tex. W.C. Comm’n, 28 TEX. ADMIN. CODE § 134.6 (Rule 134.6). The claimant’s appeal stresses that she was never told “that the rules for travel pay had changed,” that she was relying on what a nurse in the doctor’s office said, and that she was just following doctor’s orders. The respondent (carrier) responded that the claimant’s appeal was untimely (based on the date the claimant said she received the hearing officer’s decision and order) and otherwise urges affirmance. The claimant’s ombudsman responds, submitting information that the date the claimant stated in her appeal that she received the hearing officer’s decision and order was clearly in error and that the claimant’s appeal was timely.
DECISION
Affirmed.
The claimant stated in her appeal that she received the hearing officer’s decision and order in (City 1) the same day that the decision was mailed (and postmarked) from (City 2). We accept the ombudsman’s assertion that the claimant’s statement was in error, and determine that the claimant’s appeal(s) are timely.
On the merits, the parties stipulated that on __________, the claimant sustained a compensable injury to her right shoulder, right ankle, and low back. The claimant was treating with Dr. C, an orthopedic surgeon, who, at some point, referred the claimant to Dr. S, a pain management specialist.[1] In November 1999, the claimant changed treating doctors from Dr. C to Dr. S. Subsequently, it was determined that the claimant needed orthopedic surgery for her right shoulder and Dr. S referred the claimant to Dr. A in (City 3), a city more than 20 miles away from City 1. Subsequently, Dr. A referred the claimant to Dr. TG, a neurologist, who also practiced in City 3. At issue are several trips for treatment with Drs. A and TG in 2001.
The claimant testified that there were no orthopedic specialists in City 1 that would treat her. The claimant said Dr. C would not treat her because she was Dr. S’s patient (even though she had initially treated with Dr. C). The claimant testified that another orthopedic specialist in City 1 had died and that she was told by someone in Dr. S’s office that a third orthopedic specialist, Dr. G, did not take workers’ compensation cases. The claimant appeared to agree that there were other neurologists in City 1 but that she was following Dr. A’s orders to see Dr. TG.
The key portion of Rule 134.6(b) provides:
(b)An injured employee is entitled to reimbursement for travel expenses only if:
(1)medical treatment for the compensable injury is not reasonably available within 20 miles of the injured employee’s residence[.]
The hearing officer placed the burden of proof on the claimant. Regarding the claimant’s testimony that Dr. C refused to treat her (after the claimant changed doctors to Dr. S), the hearing officer commented that that “does not make sense,” and that the claimant had not presented anything from either Dr. C’s office or Dr. G’s office that they would not treat the claimant. The hearing officer concluded that the claimant had failed to prove that “medical treatment . . . was not reasonably available within 20 miles of her residence.” It appears undisputed that there were neurologists practicing in City 1.
Regarding the claimant’s assertion that she did not know that the rules for travel reimbursement had changed (effective July 15, 2000), the Appeals Panel has previously commented that ignorance of the law does not excuse noncompliance with it. Texas Workers’ Compensation Commission Appeal No. 980625, decided May 6, 1998 (Unpublished).
The hearing officer did not err in her application of Rule 134.6, and her decision is not against the great weight and preponderance of the evidence. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986).
The hearing officer’s decision and order are affirmed.
The true corporate name of the insurance carrier is AMERICAN HOME ASSURANCE COMPANY and the name and address of its registered agent for service of process is
CORPORATE SERVICE COMPANY
800 BRAZOS DRIVE, SUITE 1000
AUSTIN, TEXAS 78701.
Thomas A. Knapp – Appeals Judge
CONCUR:
Judy L. S. Barnes – Appeals Judge
Gary L. Kilgore – Appeals Judge
- Both Dr. C and Dr. S practiced in City 1. ↑