Mileage and taxi (California) (California)

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Mileage and taxi (California) (California)

Postby lacompfun on Sat May 04, 2019 7:11 pm

Scenario

1. No prescription or RFA on transportation.

2. Applicant uses taxi to and from treatment .

Question

1. What is defense liability to pay?

Seems like just statutory mileage rate.
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Re: Mileage and taxi (California) (California)

Postby vampireinthenight on Mon May 06, 2019 8:56 am

Yes, mileage rate.
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Re: Mileage and taxi (California) (California)

Postby LawAdvocate on Mon May 06, 2019 9:23 am

Going to disagree here slightly. So you can't just say yes mileage rate. It is counter intuitive to have such a knee jerk reaction to save a penny when it might cost you a pound.

Defendant has a duty to investigate.

Is the person taking a taxi for medical reasons - in other words - physical inability to drive due to loss of functions injured right leg, head injuries, etc., physical inability to drive due to narcotic usage, mental inability to drive due to cognition, focus or concentrations issues, etc.

Realize a taxi or Uber/Lyft is significantly less expensive then providing medical transportation, so you might not want to cut off your nose in spite of your face.

Apply some common sense here - is there a valid medical reason? Then you may wish to pay the taxi rate, because once some injured workers get used to medical transportation without having to shell out the money, they tend to hang on to that service longer than not.
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Re: Mileage and taxi (California) (California)

Postby vampireinthenight on Tue May 07, 2019 8:34 am

Apply some common sense here - is there a valid medical reason?


Sure, you could play "what if" all day long, but this is the key. It's all about the medical and if there is a medical necessity for a certain type of transport.

Don't forget, a lot of cities have some fine, good-old bus routes! Cheaper than a taxi and you're saving the planet!
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Re: Mileage and taxi (California) (California)

Postby LawAdvocate on Tue May 07, 2019 8:51 am

You could also get sanctioned and have to pay costs if you don't INVESTIGATE, which is the "what if" we do play all day long.

Buses are in the same category as taxis - can the person physically take a bus.

All of the excuses on the planet do not excuse the Defendant's requirement to INVESTIGATE, that is why it is called claims adjusting - you adjust to the facts.
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Re: Mileage and taxi (California) (California)

Postby LawAdvocate on Tue May 07, 2019 8:51 am

You could also get sanctioned and have to pay costs if you don't INVESTIGATE, which is the "what if" we do play all day long.

Buses are in the same category as taxis - can the person physically take a bus.

All of the excuses on the planet do not excuse the Defendant's requirement to INVESTIGATE, that is why it is called claims adjusting - you adjust to the facts.
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Re: Mileage and taxi (California) (California)

Postby vampireinthenight on Tue May 07, 2019 10:21 am

Relax... no one said not to investigate. It was a limited question based on limited facts.
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Re: Mileage and taxi (California) (California)

Postby LawAdvocate on Tue May 07, 2019 11:18 am

That is why you start asking questions based on your experience to assist someone to not make the same mistakes you may have made. We play out all types of scenarios here based on limited facts.
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Re: Mileage and taxi (California) (California)

Postby carmenita on Wed May 08, 2019 6:41 pm

I fight these fights…but the doctor requests authorization with medical rationale for the transportation, sometimes its retro but with the medical rationale. I would say no RFA or medical rationale as to why the applicant needs transportation…I wouldn't pay. When it hits our office the defense has dug in even with the RFA and medical rationale. Most times we get it paid in full, waive interest and penalty. But if I were defense and the PTP didn't request it with rationale I would recommend no payment and a cost and sanctions petition to boot but clearly as LawAdvocate suggests use common sense. If the applicant is on a morphine drip or heavily medicated and you denial transportation and the guy gets into a car and kills a family…well think of that liability…
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Re: Mileage and taxi (California) (California)

Postby jpod on Thu May 09, 2019 7:37 am

I think two things are being conflated. The medical mileage reimbursement benefit and medical necessity.

Decades ago I asked if applicant testified he/she took a bus to the doctor what is the reimbursement owed: the bus fare cost or the mileage between home and the doctors office? The unanimous answer was the mileage is what is owed bc that is what LC 4600 says is the reasonable value of the benefit. How the employee got there is immaterial in the ordinary case.

If the issue is medical necessity then it goes to UR if not approved outright and is paid for by employer as a component of medical treatment and there is no reimbursement required.

In the original post, If the adjuster pays the mileage as reimbursement and writes to doctor asking about medical necessity there is no basis for sanctions or penalties.
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