Mileage reimbursment (California) (California)

Post your questions here, get professional advise. DO NOT post experiences, rants, raves, diatribe or anything other than a direct legal or medical question. Any deviation from this specific forum category WILL be deleted without further warning.

Mileage reimbursment (California) (California)

Postby hardluck1 on Thu Mar 12, 2009 1:34 pm

When I was P&S the PTP gave me a one year gym/pool prescription(self physical therapy) which was approved and paid for by the insurance company.DOI is 01/17/00. P&S is 05/29/2005 .

May I claim mileage and which Labor code cover's it?

Thank You
hardluck1
 
Posts: 44
Joined: Thu Mar 12, 2009 1:28 pm

Re: Mileage reimbursment (California) (California)

Postby stevepsca on Thu Mar 12, 2009 1:50 pm

You won't find "gym mileage'' in a labor code... you are entitled to mileage reimbursement for trips that are 'medically necessary'... if you have a RX from your PTP... that would contitute "medical necessity". Submit your mileage request on the proper form. PROVIDED you have a Stipulation w/Award, or a Finding w/Award-Order.
If you have a C&R'd claim... SOL

gym/pool prescription(self physical therapy)

It would be a good idea however to HAVE the Rx... generally providing for 3x's week, etc. If you don't have some kind of paperwork/document that backs up the 'medicall necessity' you are again SOL. Even at that, I bet you find some challenge on this one. I'll be curious to read the UR denial.
stevepsca
 
Posts: 655
Joined: Mon Mar 09, 2009 11:50 am

Re: Mileage reimbursment (California) (California)

Postby hardluck1 on Sat Mar 14, 2009 7:40 am

Why the UR determination? The Insurance Company approved and paid for the one year membership. I have a written prescription.

Which labor code may I cite when I'm paid for other mileage one year after I submit it?

At a court hearing I was able to prove that the Insurance company had short changed my TTD . They were ordered to pay me the $8565.40. They did however it came with a letter stating that until it was definitely ruled, the payment was to be considered against any future Permanent Disability award. How definite must a ruling be for an Insurance company to accept it as final?

History: We actually had five (5) hearings over the issue until the fifth one when I prove my hourly rate.
My employer fired me when I turned 65 years of age. I knew that when I was injured (01/17/2000) I had twenty six (26) hours of vacation time left. I demanded payment of my unused vacation time. I received a check and then took the total number of hours (26) and divided them into the sum paid and that is what I had my attorney present to the Judge at the hearing. There was no way they could challenge the numbers so the defense agreed to the backpay. I had to do the work and then give my attorney his instructions.

Anyone reading this board remember, You have to take care of yourself because your attorney has too many clients.
hardluck1
 
Posts: 44
Joined: Thu Mar 12, 2009 1:28 pm

Re: Mileage reimbursment (California) (California)

Postby stevepsca on Sat Mar 14, 2009 4:35 pm

Why the UR determination? The Insurance Company approved and paid for the one year membership. I have a written prescription.
Paying for the membership is one thing....continuing a 'self administered' course of PT is yet another. "Medical necessity' is required for PT, and there must be a stated goal of functional restoration. You may have a RX for the gym membership, however that does not mean you have a RX for the PT....

You are requesting mileage for something based on 'medical necessity'... and if UR determines that your 'self administered' PT, w/o supervision is not 'medically necessay' per the adopted treatment guidelines...ACOEM/MTUS or EBM provided by your PTP... you won't be entitled to the mileage.

Which labor code may I cite when I'm paid for other mileage one year after I submit it?

It is not a matter of time on when you submit the request for mileage...and the other issue you cite here have nothing to do with your question in this post.
What does your vacation time have to do with mileage reimbursement...?
stevepsca
 
Posts: 655
Joined: Mon Mar 09, 2009 11:50 am


Return to Questions and Advice

Who is online

Users browsing this forum: No registered users and 2 guests