PURPOSE
The purpose of this policy is to provide direction to WorkSafeNB staff for paying claim-related travel expenses for medical treatment related travel.
SCOPE
This policy applies to:
POLICY STATEMENTS
1.0 General
WorkSafeNB adjudicates all claims using the criteria outlined in Policy 21-100 Conditions for Entitlement – General Principles.
Once a claim is accepted, WorkSafeNB provides medical aid and rehabilitation benefits under section 41 and 43 of the WC Act as necessary and sufficient to help injured workers return to work and to assist in lessening or removing any handicap resulting from the work-related injury.
This includes helping injured workers pay for travel expenses incurred while travelling in relation to a claim when the expenses exceed those generally incurred in day-to-day living. Payments are intended to offset additional costs that an injured worker may incur while travelling.
Payments may include, but are not limited to transportation, accommodation, meals, and associated child/dependant care expenses.
This policy outlines when payments will be made for when travelling for medical reasons, which includes treatment and therapy related to the claim.
2.0 Transportation
When injured workers are expected to travel medical reasons because substantially equivalent medical services are not available in the workers’ locality, WorkSafeNB reimburses transportation costs based on the actual distance travelled after meeting the threshold of 40 km in one direction by the most reasonably direct route. For clarity, WorkSafeNB will not pay for transportation where the distance travelled is less than 40 km in one direction.
WorkSafeNB calculates transportation costs using the following formula:
Transportation costs = Actual distance travelled multiplied by the transportation rate if the distance travelled is equal to, or more than, 40 km in one direction.
For the current transportation rate see Fee Schedule 29-220 Medical Expenses Related Travel.
a) Travel Within New Brunswick
For travel within New Brunswick, that meets the threshold of 40 km in one direction, the above formula is used to determine the amount payable, regardless of whether the injured worker chooses to travel by some other transportation method, unless the injured worker’s needs and condition warrants using an alternative mode of transportation (see section “c” below).
b) Travel Outside New Brunswick
For travel outside New Brunswick, that meets the threshold of 40 km in one direction, WorkSafeNB arranges (or pre-approves) and pays for the injured worker’s transportation. When doing so, WorkSafeNB uses the most cost-effective and suitable means available.
If WorkSafeNB recommends that an injured worker travel outside the province by car, the injured worker is reimbursed for transportation costs using the same formula and transportation rate outlined above.
WorkSafeNB reimburses injured workers at cost for pre-approved transportation by bus, taxi, train, ferry, or plane. Receipts are required.
When an injured worker chooses to travel by means other than that approved by WorkSafeNB, WorkSafeNB pays the lesser of:
c) Alternative Modes of Transportation
When injured workers are unable to drive due to the injury or have a legitimate need to travel by an alternative mode of transportation, WorkSafeNB may approve and pay for an alternative mode of transportation (e.g. taxi, ambulance, plane, etc.).
In situations where personal use of a motor vehicle is not possible, workers are required to use the most appropriate and cost-effective mode of transportation (e.g. bus, taxi, etc.).
Before approving or paying for an alternative mode of transportation, WorkSafeNB:
The use of alternative modes of transportation must be pre-authorized by WorkSafeNB, except in the case of a medical emergency.
d) Carpooling
If injured workers drive together, or with an attendant or companion, only the driver of the vehicle may claim transportation expenses.
e) Other Transportation Expenses
Expenses are paid at cost for ferries, road and bridge tolls, and parking fees. Receipts are required.
3.0 Accommodation
WorkSafeNB may pay for accommodations for injured workers who stay away from home overnight to attend appointments. For the payment of accommodations, the threshold of 80 km, in one direction, must be met.
If the 80 km, in one direction, threshold has been met, WorkSafeNB will consider paying if:
If the injured worker does not accept the recommended travel option, (i.e., travelling or staying overnight) WorkSafeNB reimburses the injured worker for the costs of the lesser of:
a) Travel Within New Brunswick
When injured workers are asked to stay overnight at a location within the province, they are reimbursed their accommodation costs up to the negotiated rate. Receipts are required.
For more information see Fee Schedule 29-220 Medical Expense Related Travel .
When WorkSafeNB or injured workers make hotel reservations, WorkSafeNB rates should be requested. To receive WorkSafeNB rates for accommodations, injured workers must take with them a copy of the letter confirming the injured worker is required to travel to the area for a medical appointment.
WorkSafeNB assists with accommodation arrangements if the injured worker requests.
b) Travel Outside New Brunswick
If an injured worker is asked to stay overnight at a location outside the province, WorkSafeNB pays the full cost of the accommodations (room-rate plus applicable tax). Receipts are required.
WorkSafeNB arranges out-of-province accommodations for injured workers. However, in some cases, WorkSafeNB may request injured workers to book their own accommodations. When making hotel reservations, injured workers may request WorkSafeNB rates.
In all cases, WorkSafeNB must approve the costs of accommodation before the stay takes place.
c) If No Receipt is Submitted
Injured workers who do not provide accommodation receipts,will not be reimbursed.
4.0 Meals
WorkSafeNB may pay a daily meal amount to injured workers who travel to appointments and are not at home over meal hours.The threshold of 80 km, in one direction, must be met before meal expenses are paid. It may be paid in part or in full as circumstances warrant. For current rates, see Fee Schedule 29-220 Medical Expense Related Travel.
5.0 Choice of Health-care Providers
WorkSafeNB supports an injured worker’s choice of health-care provider. However, by legislation, WorkSafeNB is responsible for providing medical aid at the right cost which includes using health-care providers within the injured workers locality.
6.0 Attendants and Companions
WorkSafeNB authorizes a companion or attendant to travel with an injured worker, or to be present with an injured worker who is admitted to hospital as a result of the compensable injury,only if a medical practitioner certified in writing that the injured worker was not able to travel alone to obtain medical services.
WorkSafeNB pays authorized attendants/companions’ travel expenses under this policy, in the same manner as it pays injured workers’ expenses.
WorkSafeNB does not normally reimburse any lost wages an attendant/companion may experience. However, WorkSafeNB-authorized personal care attendants hired to assist injured workers at home are paid an allowance or fee for services as outlined in Policy 25-003 Home Care and Independence.
7.0 Child/Dependant Care Expenses (baby-sitting)
WorkSafeNB reimburses injured workers to help offset additional child/dependant care expenses:
Payments are made according to Fee Schedule 29-223 Child/Dependant Care Expenses. Receipts are required.
8.0 Advances
Where it will avoid financial hardship, travel expenses may be paid in advance. Injured workers are required to submit receipts for accommodations and alternate pre-approved transportation (e.g. taxis, buses) at the conclusion of the travel period. All receipts should be submitted to WorkSafeNB within 30 calendar days.
Money paid in advance in excess of the actual travel expense incurred is considered an overpayment and the injured worker is required to repay the overpayment in full. For more information, see Policy 21-290 Recovery of Claim-related Overpayments.
9.0 Exceptional Cases
WorkSafeNB will consider exceptional circumstances, including financial and medical need, on a case by case basis and may pre-approve expenses beyond what is provided by this policy. If an exceptional circumstance is confirmed and the worker’s pre-injury employment commute is less than the 40 km threshold, travel expenses may be reimbursed; however, reimbursement will be restricted to only the portion exceeding the worker’s pre-injury employment commute.
PREVIOUS VERSIONS
LEGAL AUTHORITY
Legislation
Workers’ Compensation Act (WC Act)
41(1) The Commission may provide any medical aid that the Commission considers necessary as a result of a worker’s injury by accident to a worker entitled to compensation under this Part, or a worker who would have been entitled to compensation had the worker been disabled for one day.
41(2) The medical aid referred to in subsection (1) shall be
(a) furnished or arranged for by the Commission as it may direct or approve,
(b) subject to the supervision and control of the Commission, and
(c) paid for out of the Accident Fund.
41(2.1) The Commission shall include the costs of providing medical aid in the assessments levied on the employers.
41(3) All questions as to the necessity, character and sufficiency of any medical aid furnished or to be furnished shall be determined by the Commission.
41(4) The fees or charges for such medical aid shall not be more than would be properly or reasonably charged to the worker if the worker were paying the bill, and except in the case of an employer individually liable and furnishing the medical aid, the amount thereof shall be fixed and determined by the Commission and no action for any amount larger than that fixed by the Commission lies in respect of any medical aid herein provided for; and no action for the recovery of fees or charges for such medical aid may be brought against the Commission unless application for payment thereof is made in writing to the Commission within ninety days after such medical aid has been completely rendered.
43 To aid in getting injured workers back to work and to assist in lessening or removing any handicap resulting from their injuries, the Commission may take such measures and make such expenditures as it may deem necessary or expedient, and the expense thereof shall be borne and may be collected in the same manner as compensation or expenses of administration.
Other Relevant Legislation
118.2(2) For the purposes of subsection (1), a medical expense of an individual is an amount paid
(g) to a person engaged in the business of providing transportation services, to the extent that the payment is made for the transportation of
(i) the patient, and
(ii) one individual who accompanied the patient, where the patient was, and has been certified in writing by a medical practitioner to be, incapable of travelling without the assistance of an attendant from the locality where the patient dwells to a place, not less than 40 kilometres from that locality, where medical services are normally provided, or from that place to that locality, if
(iii) substantially equivalent medical services are not available in that locality,
(iv) the route travelled by the patient is, having regard to the circumstances, a reasonably direct route, and
(v) the patient travels to that place to obtain medical services for himself or herself and it is reasonable, having regard to the circumstances, for the patient to travel to that place to obtain those services;
(h) for reasonable travel expenses (other than expenses described in paragraph (g)) incurred in respect of the patient and, where the patient was, and has been certified in writing by a medical practitioner to be, incapable of travelling without the assistance of an attendant, in respect of one individual who accompanied the patient, to obtain medical services in a place that is not less than 80 km from the locality where the patient dwells if the circumstances described in subparagraphs (g)(iii) to (v) apply;
118.2(4) Where, in circumstances in which a person engaged in the business of providing transportation services is not readily available, an individual makes use of a vehicle for a purpose described in paragraph (2)(g), the individual or the individual’s legal representative shall be deemed to have paid to a person engaged in the business of providing transportation services, in respect of the operation of the vehicle, such amount as is reasonable in the circumstances.
Income tax Regulations
232(1) Every person who pays an amount in respect of compensation described in subparagraph 110(1)(f)(ii) of the Act shall make an information return in prescribed form in respect of that payment.
(2) Where a worker’s compensation board, or a similar body, adjudicates a claim for compensation described in subparagraph 110(1)(f)(ii) of the Act and stipulates the amount of the award, that board or body shall make an information return in prescribed form in respect of the amount of the award.
(4) Subsections (1) and (2) are not applicable in respect of a payment or an award in respect of
(a) medical expenses incurred by or on behalf of the employee;
Tax Implications
Transportation that meets the threshold of 40 km in one direction is considered a medical expense is not reported on an injured workers T5007. If reimbursement is provided under section c of this policy and travel is less than 40 km, the amount is not considered a medical expense and may be reported on a T5007.
Meals and accommodations that are paid after the injured worker has travelled more than 80 km in one direction are considered a medical expense and are not reported on an injured workers T5007. If meals or accommodations are paid for when the injured worker has not travelled the 80 km in one direction threshold, the amount is not considered a medical expense and may be reported on a T5007.
Payments made under section 9.0 Exceptional Cases will be included on your T5007.
Policy-related Documents
Policy 21-100 Conditions for Entitlement – General Principles
Policy 21-290 Recovery of Claim-related Overpayments
Policy 25-003 Home Care and Independence
Fee Schedule 29-220 Medical Expense Related Travel
Fee Schedule 29-223 Child / Dependant Care Expenses
Publications
Medical Expenses. Canada Revenue Agency.
https://www.canada.ca/en/revenue-agency/services/forms-publications/publications/rc4065/medical-expenses-2016.html#drvwy. Accessed January 9, 2020.
Health-care provider – practitioner or facility, either within or outside the province, which delivers health care and related services.
Medical expense – a medical expense that meets the eligibility criteria as outlined in subsection 118.2(2) of the Income Tax Act and the Canada Revenue Agency’s guide RC4065
Medical aid – includes medical, surgical and dental aid, hospital and skilled nursing services, services of a registered chiropractor within the chiropractor's legal jurisdiction, artificial members and apparatus including the repair and replacement thereof, transportation, clothing allowances with respect to damage caused to clothing as a result of the use of an artificial apparatus or as a result of any accident, and such other treatment, services or attendance as are necessary as a result of any injury. (WC Act)
Negotiated rate – a fixed rate for accommodation that has been agreed upon between WorkSafeNB and a service provider for provision of accommodations for injured workers.
WorkSafeNB – means the Workplace Health, Safety and Compensation Commission or "the Commission" as defined by the WHSCC & WCAT Act.