EEOICPA BULLETIN NO. 03-09
Issue Date: October 31, 2003
Effective Date: October 31, 2003
Expiration Date: October 31, 2004
Subject: Travel over 200 Miles Round Trip
Background: The Energy Employees Occupational Illness Compensation Program (EEOICP) will reimburse specific transportation costs associated with travel to medical appointments for approved claims.
When the employee receives his/her medical benefits package from the Division of Energy Employees Occupational Illness Compensation (DEEOIC) he/she is instructed to submit a written request to the District Office (DO) for approval of travel over 200 miles (roundtrip). Many times, the employee neglects to submit a request in writing and often calls the DO for approval or submits his/her claim for reimbursement after the travel has occurred. These actions often require further development by the CE which causes a delay in reimbursement for the employee.
Effective immediately, CE’s can authorize travel or reimbursements, before or after claimant travel. Such authorization will remain at the CE’s discretion after due consideration of evidence supporting the travel in question.
Purpose: To clarify the policies and procedures for granting and processing travel requests over 200 miles round trip.
Applicability: All staff.
1. Upon receipt of a request for travel authorization over 200 miles round trip (i.e., in writing, by telephone or subsequent to the travel), the CE must first determine if the travel is warranted.
2. If the travel involves a request to travel to a physician that has already been treating the employee, the CE may authorize the travel over the phone (following up with the approval package discussed below).
3. If the request is to travel to the employee’s first choice of physician, the CE may approve the travel to that physician. The CE may approve all future travel for appointments with that physician.
4. If the travel involves a referral to a physician other than the treating physician, the employee must submit a copy of the referral from the treating physician. If the referral is due to a change in physicians, the CE must inform the employee of the procedure for changing physicians which is found in the EEOICPA PM Chapter 2-300(18).
5. If the request is via telephone call, and medical justification is required, the CE may not authorize the request over the telephone. The CE must inform the employee that he/she must submit the request, in writing, along with the medical justification.
6. If the request involves travel for special treatment, the CE must obtain a prescription or narrative statement from the treating physician relating the need for the special treatment to the approved diagnosed condition(s).
7. If the request involves authorization for a companion, the CE must obtain medical justification from the treating physician. Medical justification must be in the form of a narrative medical report from the treating physician relating the diagnosed medical condition, the special treatment and the need for the companion. The mere fact that a physician states the employee needs to be observed following a medical procedure is not sufficient to approve a companion and will not be authorized. In this instance, the CE may authorize an overnight stay in the hospital for the employee in lieu of a companion. The CE must use discretion when authorizing a companion request and may only approve a companion when there is a definite medical need.
8. If the employee is requesting travel with a companion, and the travel itself is justified, the CE may approve the travel for the employee, but must request justification for the companion.
9. Upon completion of all development, the CE approves the travel request by mailing an approval package to the employee.
The package must include the following: an approval letter and an additional copy; two copies of the OWCP-957; an express air mail envelope (prepaid); and an air bill.
10. The approval letter must include the following: an explanation of the applicable per diem rates (daily rate authorized for meals, lodging and mileage per federal regulations); explanation of what is approved (rental car etc.); and instructions to submit the reimbursement request directly to the medical bill processing contractor. When calculating the current per diem rates the CE may refer to the Government Travel Information page on the DOL website at http://omap/travel.htm.
The letter must inform the employee that receipts must be submitted for meals, lodging, and if applicable, airfare and rental car/gas. Gasoline expenses are only reimbursable if a rental car is authorized. Reimbursement for meals will be for the cost of the meal, up to the per diem rate. Receipts for tips, local transportation (i.e. bus or taxi fares) are not required for amounts up to $75.
The letter must also advise the employee that he/she will only receive ¾ of the per diem rate for meals and incidental expenses for travel days.
11. If a companion is authorized to travel, he/she will be entitled to per diem for meals, incidental expenses such as local transportation costs (i.e. taxi, bus) and lodging ONLY if he/she occupied a separate room. Reimbursements for mileage are payable to the employee only. Both the expenses for the companion and employee must be submitted on an OWCP-957. The expenses for the companion will be reimbursed to the employee.
12. The reimbursement request submitted to the medical bill processing contractor by the employee must include: a copy of the approval letter, the completed OWCP-957 and all applicable receipts.
13. The District Office must complete the following information on the Express Mail Air Bill Label:
14. In the event the CE receives a completed OWCP-957, approved or not, directly from the employee, the CE must review the request for reimbursement to ensure the travel was warranted and within the approved per diem for the given locale according to procedures described in this bulletin.
15. If approved, the CE must write the approved amount and sign and date the OWCP-957 in the top right hand corner and forward it directly to the medical bill processing contractor.
16. If a request for travel is denied, the CE must notify the employee in writing. The denial letter must include a detailed discussion concerning the reason for the denial. In addition, the following paragraph must be included, “This is the final agency decision on your request for prior approval.”
17. Upon approval or denial of a travel request, the CE must enter a note in the case notes field of ECMS. He/she must select the note type of “T” Travel Authorization and enter the following information:
Approved; date(s) of travel; location of travel; mode of transportation; hotel per diem rate; meals and incidental per diem rate; other relevant information (i.e. companion approved or denied); Travel date of approval.
Example: Approved; 10/21/03-10/25/03; Denver, CO; air; $112; $46.00; Companion denied. Approved on 09/20/03.
Denied; date(s) of travel; location; Date of denial.
Example: Denied; 10/30/03-10/31/03; Denver, Colorado. Denied on 09/15/03.
18. Upon receipt of the package from the employee, the medical bill processing contractor will reimburse the employee directly. However, if the employee completes the form in error, or neglects to submit the proper information, the billing facility will return the package to the employee for proper completion.
Disposition: Retain until incorporated in the Federal EEOICPA Procedure Manual.
PETER M. TURCIC
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: (Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections)