(a) An injured employee may request reimbursement from the insurance carrier if the injured employee has incurred travel expenses when:
(1) medical treatment for the compensable injury is not reasonably available within 30 miles from where the injured employee lives and the distance traveled to secure medical treatment is greater than 30 miles one-way; or
(2) the distance traveled to attend a designated doctor examination, required medical examination, or post designated doctor treating or referral doctor examination is greater than 30 miles one-way.
(b) The injured employee shall submit the request for reimbursement to the insurance carrier within one year of the date the injured employee incurred the expenses.
(c) The injured employee's request for reimbursement shall be in the form and manner required by the division and shall include documentation or evidence (such as itemized receipts) of the amount of the expense the injured employee incurred.
(d) The insurance carrier shall reimburse the injured employee based on the travel rate for state employees on the date travel occurred, using mileage for the shortest reasonable route.
(1) Travel mileage is measured from the actual point of departure to the health care provider's location when the point of departure is:
(A) the employee's home; or
(B) the employee's place of employment.
(2) If the point of departure is not the employee's home or place of employment, then travel mileage shall be measured from the health care provider's location to the nearest of the following locations:
(A) the employee's home;
(B) the place of employment; or
(C) the actual point of departure.
(3) Total reimbursable mileage is based on round trip mileage.
(4) When an injured employee's travel expenses reasonably include food and lodging, the insurance carrier shall reimburse for the actual expenses not to exceed the current rate for state employees on the date the expense is incurred.
(e) The insurance carrier shall pay or deny the injured employee's request for reimbursement submitted in accordance with subsection (c) of this section within 45 days of receipt.
(f) If the insurance carrier does not reimburse the full amount requested, partial payment or denial of payment shall include a plain language explanation of the reason(s) for the reduction or denial. The insurance carrier shall inform the injured employee of the injured employee's right to request a benefit review conference in accordance with § 141.1 of this title (relating to Requesting and Setting a Benefit Review Conference).
The provisions of this §134.110 adopted to be effective May 2, 2006, 31 TexReg 3561; amended to be effective March 30, 2014, 39 TexReg 2102.