This morning, another attorney in my firm received a request from a Claimant’s attorney for mileage reimbursement for travel to a gym.  The authorized treating physician recommended the gym membership and found it to be medically necessary.  The E/C paid for the membership.

Since I am the “blog guy” in my firm, this attorney naturally asked me to research this.  And, since his initial reaction–and mine–was to deny the request, I thought I would share with you my research. 

What do you want bet that I came up with an answer we didn’t expect?

The issue of medical mileage is a long settled one, going back to a 1964 Florida Supreme Court decision.*  The basic premise is that the Act requires E/C’s to provide remedial medical treatment, care, and attendance.  The Supreme Court interpreted this to include reasonable travel expenses.  The Legislative intent of the Act cannot be accomplished if Claimants have to pay for their own travel expenses.  After all, this is a self-executing Act where the E/C must pull all the levers to get the Claimant her benefits.

The Supreme Court found that when the law requires the E/C to pay for services, it automatically requires the E/C to pay for transportation, with no expense to the Claimant. 

Over the years, the Legislature has made attempts to repeal the payment of medical mileage, but the courts have refused to eliminate this benefit.  Section 440.192(2)(g) specifically mentions that a Claimant must specifically list medical mileage as a sought after benefit in her PFB.  And, we all know section 440.13(2)(c) mandates an E/C must furnish all medically necessary treatment.   So, whatever the Legislature did to try and remove transportation cost, it was not enough.  The intent of transportation is still there.

Most recently, in Remington v. City of Ocala, the First DCA took the premise of medical mileage and applied it to transportation to a pharmacy.  The Court found medical mileage to be a medical benefit.  Like the Supreme Court, the reasoning was that the prescription drugs are medically necessary and without transportation to pick the drugs up they are useless to a Claimant.  (The Court did mention that the E/C could offer mail order drugs to avoid mileage reimbursement.)

Applying these decisions to my fellow attorney’s case, is Claimant entitled to medical mileage for travelling to a gym?  Since the gym membership is medically necessary, I would think that the E/C is responsible for providing reasonable transportation for Claimant.  Applying the reasoning of the Supreme Court and First DCA, without transportation, the gym membership is useless to the Claimant.  If the E/C is responsible for providing the gym membership, it is assumed to be responsible for transportation to the gym.

Now, as E/C’s we can mitigate this exposure.  An initial concern is that a gym membership–unlike physical therapy–is conducted by the Claimant herself, rather than by an institution.  A Claimant could lie about attendance.  Also, a Claimant could use the gym for exercises not related to the compensable injury. 

The best way to mitigate this is to conference with the doctor who prescribed the gym membership.  Ask him specific questions, like how many days a week are reasonable for strengthening Claimant’s injured body part?  How long will she need the membership?  And, can a physical therapist provide the same treatment (which can be monitored by the E/C)?

Should the E/C believe Claimant is being dishonest about her mileage reimbursement forms, they could subpoena the records of the gym to find out when she checked in and out.   This would be considered fraud since mileage forms contain language warning Claimants of fraud.  As per my previous blog entry, a Claimant must prove entitlement to medical mileage reimbursement.

In summary, medical mileage to a gym is compensable.  What E/C’s must be careful is that these mileage reimbursements can pose significant exposure for the claim.  Discussions with the physician recommending the gym membership are key in limiting that exposure.

*Once again, thanks to Dubreuil’s Florida Workers’ Compensation Handbook for guidance on this blog entry.