January 2007 - WBC Practice

Reimbursement Rule Changes

The Board voted, 4-to-3, to change the requirement for lodging reimbursement in the Medical Fee Schedule from 80 to 100 miles. The discussion involved balancing an insurer's reluctance to permit out-of-state medical opinions if lodging must be paid versus the desire to prevent employees from having to drive five to six hours in a one-day round trip if overnight lodging is not reimbursed. One attorney commented that generally adjustors are reasonable and will pay overnight expenses for procedures, such as a spinal injection, but not something like physical therapy. He opined that increasing the mileage minimum would take away that discretion on the part of adjustors.
The Board also voted, 4-to-3, to include a mileage allocation of 50 miles for meal reimbursement in the fee schedule.

The rule text is as follows:

Chapter 5.

1. The employer must pay the employee's travel-related expenses incurred for treatment related to the claimed injury as follows:

A. Mileage must be paid at the standard rate for business travel set by the Internal Revenue Service pursuant to 26 U.S.C. §162()(1) . . .

B. Actual costs or a maximum of $120.00 per evening for overnight lodging. Reimbursement for overnight lodging is allowed only when the employee has traveled 100 miles or more, one way, from the employee's place of residence.

C. $6.00 for breakfast, $6.00 for lunch, and $16.00 for dinner. Reimbursement for meals is allowed only when the employee has traveled 50 miles or more, one way, from the employee's place of residence.

D. Actual charges for tolls, accompanied by a receipt.

New Compliance Calculation

The Board also voted that in light of the quicker timeframe resulting from electronic filing, the calculation of compliance with initial indemnity and notice of controversy filings will be based on 14 instead of 17 days.

Compliance Review for 2005

In August, the Board released statistics for the year 2005 and the first two quarters of 2006. The following reflects some of the highlights:

2005 First Two
Quarters 2006

The hearing officers attributed the majority of the 30-40 cases pending more than eight months to a specific situation regarding Central Maine Orthopedics, which performed many independent medical examinations before it became engaged in a dispute which will be heard by the full Board.

All hearing officers but one met their benchmark of issuing 25 decisions per quarter.

Lost-time First Report filings numbered 14,403 in 2005, a decrease from 14,989 in 2004. Ninety-percent of the forms were filed within 10 days. Payment compliance improved to nearly 87% of initial payments made within 14 days. Much of this was attributed to the Monitoring, Audit & Enforcement Division focusing on third-party administrators, which represent 14% of the market and typically have the lowest compliance levels, and Corrective Action Plans for noncompliant entities. Maine Employers' Mutual Insurance Company data was not included in the compliance section because the company has such a large share, one-third, of the market and is legislatively mandated. Eleven insurers or employers are currently working under CAPs because of the Board's compliance concerns.