9.1.2 Travel and/or accommodation costs reasonably incurred to attend treatment

The provision of medical treatment for an accepted condition under the MRCA is a hybrid system, including both Treatment Pathway 1 (reimbursement) and Treatment Pathway 2 (provision of a DVA Health Card).  Chapter 6 of the MRCA contains these two treatment paths for providing treatment.  Part 2 of Chapter 6 refers to treatment under Pathway 1, and Part 3 of Chapter 6 refers to treatment under Pathway 2. Delegates should note that it is Departmental policy to issue a DVA Health Card, rather than provide treatment via Treatment Pathway 1, wherever practical.

Once a decision regarding the appropriate treatment path has been made, the Commonwealth is liable to reimburse a person for travel and/or accommodation costs reasonably incurred in order for the person to attend treatment.  This reimbursement is subject to certain conditions and criteria as outlined in the sections below.

The MRCA provisions relating to compensation for costs reasonably incurred for a journey made to obtain treatment apply in the same way, irrespective of whether the person is placed on Treatment Pathway 1 or Treatment Pathway 2. The exception to this general rule is the provision of emergency ambulance transport. Further details about this can be found in section 9.1.2.2 Ambulance or public transport.

It is important to note that if the person holds a DVA Health Card for Specific Conditions (White Card), then the client is only able to receive reimbursement of travel and/or accommodation costs incurred for a journey made to access treatment for their accepted or non-liability health care conditions.

However, if the person holds a DVA Health Card for All Conditions (Gold Card) then they are able to receive reimbursement of travel and/or accommodation costs for treatment of any condition (whether accepted or not) that they require. This is because section 290 of the MRCA enables costs incurred in respect of a journey that is necessary to obtain compensation treatment to be paid. Where the person holds a Gold Card, compensable treatment is defined as treatment for any injury or disease.

9.1.2.1 Calculating travel reimbursement for rehabilitation assessments or medical treatment

Delegates processing requests for the reimbursement of travel for medical treatment or rehabilitation assessments should ensure that when they confirm or verify the distance travelled they:

·      use a publically available internet trip calculator, such as Google Maps or Travelmate etc;

·      apply the principle of ‘reasonableness’ to account for variations in the distance being claimed and the distance calculated, for example:

–    unexpected circumstances occur – ie difficulties experienced in finding parking, the claimant getting lost in an unfamiliar location or unexpected detours due to road works or changes to street access/routes etc, and

–    in rural or remote areas the exact location of the client’s place of residence may be difficult to determine using the internet calculator and/or a commercial directory or map.

·      investigate any significant variation being claimed and calculated, with the claimant (an allowance or margin of up to 10km around that claimed by the client for travel should be considered an acceptable variation);

·      reimburse the claimant for the distance claimed in the following circumstances:

–    where the variation is within the acceptable range, or

–    where an acceptable explanation is given by the claimant for the variation.

9.1.2.2 Ambulance or public transport

Ambulance transport under both treatment pathways

Compensation can be paid for costs reasonably incurred of a journey made by a person to obtain treatment where:

·      the person uses ambulance services; and

·      the person’s service injury or disease requires using those services.

The issue of whether a person’s injury or disease requires ambulance services for transport is a matter for consideration by the delegate based on the evidence.  For example, if the person has a need for care during transportation, has lost control of effective bodily systems required for travel or is bed-ridden, then the delegate should be adequately satisfied that the person requires ambulance transport.

Under both Pathway 1 and 2, a MRCA claimant should have non-emergency ambulance transport reimbursed or paid by their MRCA claims manager.  The claimant is to contact the delegate prior to the travel being undertaken to obtain prior-approval for the travel and to allow the appropriate amount to be reimbursed to the claimant or paid directly to the ambulance service provider.

Even if the claimant has  a White or Gold Card under Pathway 2, they are to be informed that non-emergency ambulance transport is only to be obtained via prior-approval from their MRCA delegate and not arranged through the Repatriation Transport Scheme.

Medical emergency ambulance transport under pathway 2

Special note must be made by a delegate when the person receives ambulance transport for a medical emergency, and that person is being treated under Treatment Pathway 2.  The MRCA Treatment Principles contain provision for the Repatriation Commission to accept financial responsibility for the emergency ambulance transport of an entitled person, if DVA is notified on the first working day (or as soon as practicable) after the transport is undertaken.  This provision is applicable to a White Card recipient, when the emergency ambulance transport is required for the accepted condition/s covered by their card.  For Gold Card recipients, the emergency ambulance transport costs can be covered for any injury or disease (whether accepted or not) as long as the delegate is satisfied that the emergency transport was reasonably required.

Therefore the delegate should be aware that for emergency ambulance transport a person under Treatment Pathway 2 may be provided with emergency ambulance transport outside of section 290 and the cost for this transportation will be met automatically by the Repatriation Commission through the MRCA Treatment Principles and therefore established Repatriation Transport Scheme contract billing procedures.

Public transport

Where it is necessary for a person to travel to obtain treatment, compensation can also be paid for costs reasonably incurred for the journey where the person uses public transport.

Note: The definition of “public transport” for the purposes of meeting the cost of travel can be a complicated matter.  However, the guidelines established under Case Law for the SRCA will normally apply to the consideration of different modes of transport under the MRCA.

For example:

·      The use of taxis as a form of public transport may be acceptable.  Whether a person has reasonably incurred a cost by using a taxi to travel to treatment must be considered in the light of whether there is another appropriate method of “mass” public transport available (bus, train etc);whether there is a demonstrated need for the person to use a taxi (such as evidence from the treating or referring doctor); or whether there is a family member reasonably available to assist in travel to treatment etc.

·      The use of more expensive forms of “mass” public transport (such as air travel) for travel to treatment has to be considered in light of the options available to the person. Often for a person who is remote from the location where treatment is provided, the use of air travel may be more appropriate (so the delegate considers the cost to have been reasonably incurred). This may be due to either the fact that driving may exacerbate the condition, air travel minimises time off work and provides the most direct (and therefore fastest) route, or the person is unable to drive.

No minimum distance restriction is placed on the use of either public transport or ambulance services for travel to compensable treatment.  That is, the 50 km rule does not apply.

Further information about claiming reimbursement for travel by public transport can be found at 9.1.2.7.
 

9.1.2.3 Journey by means other than ambulance or public transport (private transport)

Generally, where a journey made by a person to obtain treatment is not by ambulance services or public transport, and the reasonable length of the journey (including the return part of the journey) does not exceed or is equal to 50 kilometres, compensation is not payable.

Where the length of the journey is less than or equal to 50 kilometres

Compensation can be paid for the costs reasonably incurred for a journey made by a person to obtain treatment if:

·      having regard to the nature of the person’s service injury/disease, it is unreasonable for the person to use public transport; or

·      public transport is unavailable,

In this case, the  journey may be made by private transport and no distance qualification applies (but only if the above factors apply).

This exemption would generally be applied when the person’s condition precludes them from using public transport or if the access to public transport or ambulance transport is restricted in that person’s location.

Where the length of journey is greater then 50 kilometres

Where the reasonable length of the journey (including the return part of the journey) exceeds 50 kilometres, compensation can be paid for the costs reasonably incurred for a journey made by a person to obtain treatment where the person uses means other than ambulance services or public transport.  This compensation is calculated on the basis of the length of the journey considered reasonable by the delegate, using a specified rate per kilometre as determined by Commission in line with subsection 293(2).

In a situation where a person chooses to travel beyond a location where treatment is available, the shorter distance will be used for the calculation of the reimbursement amount.  For example, if a person travels a 200km round trip to obtain treatment, but the same treatment is available at a location that only required a 100km round trip (and the person is made aware of this fact, but chooses to travel the extra distance), then the reimbursement would only be paid for the 100km trip equivalent.

Matters to be considered for journey and accommodation claims

Section 295 of the MRCA provides the following list of matters which delegates should have regard to when considering journey and accommodation claims for travel to treatment:

(a) the places where appropriate treatment was available to the person;(b) the means of transport available to the person for the journey;(c) the means of transport appropriate for the person to take for the journey;(d) the routes by which the person could have travelled;(e) the accommodation available to the person at the place to which the journey was made; and(f) any other relevant matters.

9.1.2.4 Specified rate per kilometre

The specified rate per kilometre the Commonwealth, under section 290 of the MRCA, is liable to pay a person and/or an approved attendant where they travel for treatment by means other than ambulance services or public transport is determined by legislative instrument.  The most recent instrument can be found in the CLIK legislation library.

9.1.2.5 Accommodation costs reasonably incurred for the purpose of receiving compensable treatment

The Commonwealth is liable to pay reasonable costs for a person’s accommodation at a place where they are required to travel to obtain treatment.  In order for payment to be justified, a number of qualifications must be met:

·      the journey to attend treatment must be deemed “necessary”; and

·      it is necessary for the person to remain at their destination to obtain the treatment; and

·      the costs incurred are in relation to the accommodation at that place.

Section 292 of the MRCA precludes compensation for a journey that is made outside Australia for the main purpose of obtaining treatment. Costs incurred in respect of accommodation required during such a journey can also not be paid.

Information about claiming accommodation costs can be found at 9.1.2.7.

9.1.2.6 Criteria for consideration when accommodation is deemed “reasonable/necessary” (in all accommodation reimbursement situations)

Section 295, adapted from section 16 of the SRCA, lists the matters that the Commission must consider in determining compensation to be paid for journeys and accommodation. They include:

• the places where appropriate treatment is available;
• the means of transport availabke;
• what means of transport is appropriate for the person;
• the routes that could be travelled;
• the accomodation available;
• any other relevant matters.

When considering these matters, certain circumstances should be considered by delegates when deciding whether a person’s accommodation is “reasonable/necessary” in nature.

These circumstances can include:

·      when the person needs to travel more than 300km each way (600km return) to visit the treatment provider, therefore necessitating an overnight stay; or

·      when the appointment is late in the day (eg after 4pm) and the distance travelled to attend would preclude a safe journey home after the appointment is over.

·      when the treating doctor or medical professional certifies that an overnight stay is required due to the nature of the treatment, or that the person’s condition would prevent them from travelling back on the day of the treatment.

In no way are these criteria mandatory, but the delegate must consider these and like restrictions when considering whether the accommodation costs have been reasonably incurred, and consider each case on its merits.

When meeting costs reasonably incurred for accommodation and meals, the delegate should apply the current non-SES DVA Travel Allowance rates to the claim (see 9.1.2.7 below).  The only exception to this might be where the client requires urgent treatment or is unable to reschedule their appointment and there are extenuating circumstances such as might exist during a major event in a particular location, that limits the availability of accommodation in that location (for example the Olympics, Commonwealth Games or Grand Prix).

Therefore, once the accommodation has been deemed reasonable, the delegate will reimburse the person the amount as dictated by the current DVA Travel Allowance rates (including appropriate accommodation and meals, taking into account the times travelled).  No meal or incidentals allowance should be paid unless an overnight stay is necessary.

9.1.2.7 Travel, accommodation and meal rates paid to claimants

Travel and accommodation provisions where a client is entitled to costs relating to travel for treatment or a rehabilitation assessment:

          Prior to approval a delegate should first confirm that the client is reasonably required to travel for the purpose of attending a:

–    medical treatment;

–    a rehabilitation assessment; or an

–    approved rehabilitation activity.

Prior to undertaking the travel the client should be fully briefed of these provisions and the requirements they will be expected to meet, with a file note confirming this activity.

DVA will pay reasonable costs for travel required to undertake the approved treatment and rehabilitation activities.  This may include:

–    air/bus/train/taxi fares; or

–    a kilometre allowance (if using private vehicle).

The delegate has the discretion to determine what "reasonable" costs of airfares may be, based on information and evidence available to them. The delegate may choose to utilise, for example, the DVA Official Travel Policies as a benchmark of "reasonableness". A client's individual needs should be considered, so that for example, if the delegate is provided with appropriate medical evidence that the client has specific needs impacting on their capacity to travel, then he/she may consider that it is reasonable for the person to travel business class, particularly if the client needs to travel a long distance.

DVA will pay reasonable costs for accommodation and meals required to undertake the approved treatment and rehabilitation activities.  This may include:

–    accommodation costs (commercial or non commercial); and

–    a meals and incidental allowance, where required.

·      Clients are required to lodge a claim for reimbursement of approved travel within 12 months of undertaking the travel. Delegates have the discretion to extend this timeframe on a case by case basis, based on individual circumstances.

·      On their return from the approved journey, the client is to retain evidence of travel and accommodation costs associated with treatment or attendance at the approved rehabilitation activity for a period of four months after their claim for reimbursement of travel expenses has been determined by a delegate.

·      Clients must provide these receipts, if requested, within this four month period.

·      Where the client incurs additional travel or accommodation costs beyond their control, which were not initially approved, they are to provide receipts for those additional costs before reimbursement is considered.

·      Where the client stays in commerical accommodation, DVA may, where possible, arrange the accommodation to gain benefit of corporate contracted rates.

·      The DVA Travel Allowance Calculator for non-SES employees and/or the DVA Travel Management Systems may be used as an indicator of "reasonable" costs of accommodation and meals if the delegate chooses to do so.  The Calculator takes into account the times travelled and any accommodation requirement.

9.1.2.8 Attendant journey and accommodation costs

Subsections 290(2) and 291(2) provide for compensation to be paid for journey and accommodation costs reasonably incurred by an attendant who is approved by the delegate to accompany a person to obtain compensable treatment.  These costs are calculated in exactly the same manner as those for the person receiving treatment.

Note:  Attendants’ costs for travel to accompany a client to attend vocational rehabilitation or a medical review are not normally payable under the MRCA. However,  where a medical practitioner has certified that the attendant is required to accompany a client or attend separately when it is clinically recommended that they participate in a Commission approved treatment program, such as a PTSD course, and that attendance is identified as being of benefit to the client, reasonably incurred travel and accommodation costs may be approved by a delegate using the existing legislative provisions as endorsed by the Commission.

When an attendant is the partner/spouse of the person receiving the treatment shared accommodation may be considered appropriate and reasonable.  However, if the person’s medical practitioner certifies that there is a need for the couple to have separate rooms, the additional cost would be reasonable.

Only one travel reimbursement amount should be paid when the attendant travels by the same method as the person obtaining the treatment, if that mode of transport is self-contained (i.e. they travelled in the same car).