Claimant was a restaurant employee who sustained an admitted ankle injury in February of 2020. General admissions of liability were filed on February 28, 2020 and July 21, 2020. Each of these admissions included the mandatory brochure which advised claimant that she may be entitled to mileage reimbursement and to contact the adjuster regarding mileage. On June 20, 2020, the claimant completed, signed, and dated two separate mileage reimbursement forms for mileage traveled between February and June of 2020. The forms were on the carrier’s letterhead and had been provided by the adjuster. Two months later on August 31, 2020, the claimant submitted the two requests for reimbursement along with a third request for reimbursement of mileage from June through August. After reviewing the request, the adjuster issued reimbursement for mileage incurred no earlier than 120 days from the date of the submission and for trips corroborated by medical records. The claimant requested reconsideration and payment of all of the mileage and claimed that her recent retention of counsel was good cause for the late submission. With respect to the uncorroborated trips, the claimant issued an amended handwritten log in which she attempted to account for three of the denied trips representing approximately 10% of the mileage that had been denied as uncorroborated. The request for reconsideration was denied and the matter proceeded to hearing.
The claimant admitted at hearing that she had completed requests in June but did not submit those requests for reimbursement until August 31, 202. She provided no explanation for this failure. She also presented no additional evidence for the uncorroborated trips. The ALJ found that the requirement in Rule 16 that mileage be submitted within 120 days precluded the claimant’s claim for mileage submitted more than 120 days after the trips. He further found that the uncorroborated trips were not reimbursable. The claimant’s request for additional mileage reimbursement was denied and dismissed.
Bess Rael v. Chick-Fil-A, W.C. 5-130-980-00 (Mar. 22, 2021)