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  1. #1
    Join Date
    Jan 2010
    Posts
    10

    Default Mileage Reimbursement

    My claims adjuster won't pay my medical mileage and won't answer my letters telling me why. There is no problem with my billing. What recourse do I have beyond filing a complaint with the Audit Unit?

    Such as, if I call the insurance company do I ask for her supervisor? Or, what is the procedure in going to the top so to speak?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Mileage Reimbursement

    Not much recourse here.
    Mileage reimbursement is not a reason for DOR for a hearing. It's not that important to the WCAB to schedule a hearing with a judge on this.

    If the CA is not paying mileage due, there is a 10% penalty due for unreasonable delay. Mileage is to be paid with in 45 days of receipt of your request/form.

    You can contact a senior claims administrator. Supervisors will step in and see what the problem is.
    You are also on point in filing a AU referral. ANY issue the CA's do that are outside the rules...labor code or Title 8 CCR's deserves a AU or UR referral/complaint. Be sure to back up your ascertions with the appropriate citations/authority you are relying upon in your complaint.

  3. #3
    Join Date
    Jan 2010
    Posts
    10

    Default Re: Mileage Reimbursement

    Thanks BvIA - I forgot the legal length of time a claims adjuster has to pay medical mileage billing. Is it 45 days or 60 days? And, from what date does that time start accruing? Billing date or how many days after?

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Mileage Reimbursement

    45 days from the receipt of your mileage reimbursement request form. That is ''business'' or working days...not calendar. And, the furlough days don't mean anything. 45 days is 45 days. You have to allow 5 days for mailing. That's why it may be a good idea to send correspondance to the CA reg/cert mail to know exactly when the letter was received.

    You'll also hear that the letter was laying around in the mail room and the CA didn't actually receive it timely...that is NOT a valid reason. If the 45 days is not met, you are due a self imposed penalty of 10%.

  5. #5
    Join Date
    Jan 2010
    Posts
    10

    Default Re: Mileage Reimbursement

    Thanks again.

    You said I am due a "self imposed" penalty of 10% (of my billing amount). By self imposed you mean - me, personally, billing it, correct? But you said the courts are not interested in hearing cases for medical mileage. How do I get my billing enforced then if no hearing? I could bill to eternity. I mean, what leverage do I have to FORCE them to pay it if no court hearing?

    For example, my mileage is $487.54. So it would be a 10% penalty of that, period no matter if it was 30 days late, or 120 days late?

    So that would be $487.54 plus 10% of $48.76 equals 536.30?

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Mileage Reimbursement

    Mileage is not a disputed medical issue, That's why it is not subject to a hearing.
    The self imposed penalty is added by the carrier on those payments/benefits that are unreasonable delayed... if your mileage is past 45 working day... you are due a 10% penalty.

    Lots of times mileage is dealt with at the time the claim resolves...either by stipulation, or C&R. Sorry... but there isn't much to be done about this. IF you were to go to hearing on a disputed medical issue, you/AA could bring this up then. It's just not that important. Even though it's the law that mileage is reimbursed.

  7. #7
    Join Date
    Jan 2010
    Posts
    10

    Default Re: Mileage Reimbursement

    It truly is past the point of comprehension. $400.00 to $500.00 is a lot of money to many people.

    If the insurance company is successful in "discouraging" many, many applicants from collecting their justly due medical mileage, it results in quite an unlawful savings to the insurance company doesn't it? Is there anything about Workers Comp that IS on the up and up?

    Lastly, who out there in our government would be concerned in helping a victim of the workers comp system. I mean, is there a branch of government that one can effectively file complaints with that are heard? There has to be someone. You mean to tell me that these people are totally free to bilk the victims and never pay for it?

    Thanks,
    Sally

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Mileage Reimbursement

    The ER/IC is not keeping the mileage money... you'll get it...eventually.
    Have you contacted the carrier/CA ?
    In writing...again.

    When you think of the value of medical treatment, and wage loss benefits, mileage is last on that list.

    When you submit $400 or $500 in a request, you did NOT spend that kind of money in gas to drive those miles. The 50 cents reimbursement covers wear and tear, maintaince, insurance all the costs associated with keeping a car. You didn't have out of pocket costs that amount to $500.
    If the insurance company is successful in "discouraging" many, many applicants from collecting their justly due medical mileage, it results in quite an unlawful savings to the insurance company doesn't it?
    I don't know who your carrier is..but in 15 years I have NEVER had a problem with getting a check for mileage reimbursement. Never. I have received a penalty or two. But that's nothing.
    is there a branch of government that one can effectively file complaints with that are heard? There has to be someone.
    File the Audit Unit referrals.
    WC is not subject, in Calif anyway, to the Dept of Insurance regulations as would be auto, homeowners, life, etc. Write to your elected representative... they are the ones who write these shitty laws.

  9. #9
    Join Date
    Jan 2010
    Posts
    10

    Default Re: Mileage Reimbursement

    Yep, filing an Audit Violation complaint tomorrow.

    By my elected Representative you mean the Representative of my district, correct.

    Have I contacted the carrier/CA? You mean the insurance carrier? Sure, constantly, in writing and by phone. What is CA?

    I am happy that you have never had a problem. I am and that's what counts with me. I talked to the claims adjuster last week and she was down right insultive. my reimbursement is 90 days past due and she won't even give me a reason. of course, there is no valid reason.

    Well, if the Audit complaint does no good I'm filing for a hearing regardless of whether they like it or not. I happen not to "like" this. I am owed a certain amount of money regardless of what it is for. It should be paid in a timely fashion with no runarounds.

    They are already denying medical treatment and medications I need badly and I have already scheduled a hearing on that.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Mileage Reimbursement

    Well, if the Audit complaint does no good I'm filing for a hearing regardless of whether they like it or not.
    Doesn't matter who 'likes' the fact you file a hearing...IF the DOR for MSC is for mileage reimbursement... it won't be scheduled. There is no point in spinning your wheels filing for a hearing that won't be set on calendar. You may get a acknowledgement of your AU referral. Maybe not. At any rate, doubtful you'll see any action. It takes two AR referrals to trigger an audit. That's just the beginning.

    If you have an accepted claim...the mileage is due.
    They are already denying medical treatment and medications I need badly and I have already scheduled a hearing on that.
    That could be reason you are not being paid the mileage. If the treatment/medication are not necessary, the trips aren't either. Bring up the mileage issue at your MSC on the medical issues.

    Have you had a medical/legal evaluation on the denied treatment/med denials..?...You can't go to MSC/hearing with out a medical/legal report by your PTP or a PQME/AME .
    Have you received a notice of the MSC date ?

    Have you discussed your disputed issues with an I&A officer...or an attorney ?

    CA is claims adjuster
    MSC is Mandatory Settlement Conference... 'settlement' of a disputed medical issue.
    By my elected Representative you mean the Representative of my district, correct.
    Yes, state. Not federal. But you should not expect any response. State legislators write the bills...rather vote on them. The IC lobby's write the bills. Then Arnold vetos. Regardless... a State Congressperson can't step in and talk to your CA about anything...and won't.

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