Expenses – Travel & Sustenance – General
Effective date: February 3, 2012
Last updated: December 21, 2010
Application: All new and existing claims on and after the effective date.
Policy subject: Allowance and expenses
To establish guidelines for the reimbursement of travel and sustenance requirements.
Authorizing Agent means a Claims Entitlement Specialist (CES), Case Manager or Vocational Rehabilitation Specialist who is authorized to approve travel and sustenance requirements for injured workers on behalf of the Workers’ Compensation Board (WCB).
- The WCB has approved POL 39/2010, Expenses – Travel and Sustenance – General, which establishes guidelines for the reimbursement of travel and sustenance requirements.
- The following provides detailed guidance for implementation of the policy.
- Case Management Support (CMS) or the CES is responsible for identifying the worker’s normal pre-injury employment travel requirement that occurs outside the resident community. The following formula allows CMS or the CES to determine the worker’s normal pre-injury employment travel requirement over a complete work cycle, and average the sum into a weekly amount:
CMS will provide the Payment Specialist (PS) with the calculated normal pre-injury employment travel requirement.
- CMS or the CES will be responsible to communicate to the worker that depending on the worker’s average weekly expenses normally incurred prior to the work-related injury, the worker may not be eligible for any reimbursement for travel unless the travel required for medical care exceeds the worker’s normal pre-injury employment travel requirements outside the resident community.
- Where the worker’s travel for medical care outside the resident community exceeds the worker’s normal pre-injury employment travel requirements outside the resident community, the PS or CES will calculate entitlement by subtracting the worker’s normal pre-injury employment travel requirement, over an average seven day week, from the travel requirements associated with the worker’s medical care for the corresponding period of time.
- An authorizing agent will advise the worker of the travel requirements that the WCB will reimburse. Where the reimbursements are less than the amount claimed by the worker, an authorizing agent will provide the worker with a written explanation.
- Where necessary, an authorizing agent may grant reasonable transportation and sustenance on the behalf of a donor.
- An authorizing agent may pre-approve travel and sustenance for attendants other than qualified medical personnel where it is considered essential by reason of the worker’s injury and confirmed by the treating physician and or the WCB Medical Consultant. The maximum hourly rate of reimbursement payable to an attendant will be calculated as follows:
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