Our client was injured in a motor vehicle accident and sought funding for mileage expenses associated with treatment provided by a Rehabilitation Support Worker (RSW). These treatment sessions involved transportation to community-based activities, such as hydrotherapy and other therapeutic outings, all essential to our client’s recovery.
The Motor Vehicle Accident Claims Fund (MVACF) denied reimbursement for mileage expenses incurred during these sessions, relying on the Transportation Expense Guideline (TEG) and a FSCO bulletin, arguing that they excluded all mileage payments to providers.
The issue before the Tribunal was whether the mileage expenses incurred during treatment sessions, when the RSW transported our client using the RSW’s personal vehicle, qualified as “authorized transportation expenses” under the Statutory Accident Benefits Schedule (“Schedule”).
In its initial decision, the Tribunal sided with MVACF due to an apparent misapprehension of the argument. Our firm filed a request for reconsideration under Rule 18.2(b) of the LAT Rules, citing errors in fact and law, given the Tribunal’s error. We reiterated that the mileage expenses were not for commuting to the client’s home to provide therapy, but rather for transporting the insured during therapy sessions and outings, and thus should be compensable.
Adjudicator Pahuta granted the reconsideration request and conducted a rehearing on this issue.
On reconsideration, the Tribunal concluded that the original decision misapplied the TEG and FSCO bulletin.
Key facts that led to the Tribunal’s decision included:
- The RSW transported our client during therapeutic sessions to various locations; this travel was an integral part of the treatment sessions. Locations our client was transported to included parks, pools (for therapy), and community integration outings.
- The transportation was not part of the provider’s commute, but rather for transporting the insured.
- The FSCO bulletin excludes mileage reimbursement when transportation relates to someone other than the insured person, which was not the case here.
- Our client had no access to a personal vehicle, or means to fund a taxi service, thus relying on the RSW’s transportation as the most cost-efficient and easily accessible option available to him during rehab sessions.
As a result, the Tribunal found that the $1,440.00 in mileage expenses claimed by the RSW in their OCF-18 was reasonable. It qualified as authorized transportation expenses under the Transportation Expense Guideline, and under the Schedule. The Tribunal also awarded interest pursuant to section 51 of the Schedule for the overdue amount.
Why this decision is important:
This decision is the only one of its kind, and establishes an important legal precedent for other insured victims, affirming that when medically necessary treatment involves in-session transportation of the insured person by a care provider, the associated mileage expenses may be considered an “authorized transportation expense”, and therefore be compensable under the Schedule, particularly when no other transportation is reasonably available to the insured person.
