Carlos D. Silveti v. Ohio Valley Nursing Home, Inc.

Citation: 813 S.E.2d 121Docket: 17-0746

Court: West Virginia Supreme Court; April 11, 2018; West Virginia; State Supreme Court

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The Supreme Court of Appeals of West Virginia addressed the case of Carlos D. Silveti, who sought reimbursement for meal expenses incurred while attending a mandated medical examination by the claims administrator for his workers' compensation claim. The examination was located one hundred miles from Silveti's home, necessitating six hours of travel. The claims administrator denied the reimbursement request, arguing it was not warranted since the travel did not involve overnight lodging. However, under West Virginia Code 23-4-8, the Court found that the claims administrator was obligated to reimburse reasonable travel expenses, including meals, regardless of the need for overnight accommodation. The Court ruled that the claims administrator lacked discretion to deny Silveti's meal expense reimbursement based on this criterion and remanded the case to the Workers’ Compensation Board of Review for further action consistent with the law. Silveti, who worked as a chef at Ohio Valley Nursing Home, had sustained injuries that were deemed compensable, and the claims administrator was authorized to order his examination to assess the necessity of his treatment and recovery status. The claims administrator's decision to send him to a location far from his home, rather than a nearby examiner, was noted but not directly addressed in the reimbursement decision.

Mr. Silveti submitted a voucher with a meal receipt for reimbursement related to his travel for a medical examination, but the claims administrator denied the request, deeming the meal an unreasonable expense since the trip did not require overnight lodging. Despite being aware that Mr. Silveti spent six hours traveling, the administrator's decision was upheld by the Workers’ Compensation Office of Judges and subsequently by the Workers’ Compensation Board of Review. Mr. Silveti appealed this affirmation, arguing that the Board's decision violated statutory provisions. Under West Virginia Code 23-4-8, claimants undergoing medical examinations are entitled to reimbursement for reasonable travel expenses, including meals. Mr. Silveti contends that the statute mandates reimbursement for reasonable meal expenses incurred in connection with ordered medical examinations, while the employer argues that reimbursement is not required if the travel does not necessitate overnight lodging. The standard of review for these decisions includes criteria for reversal based on constitutional or statutory violations, erroneous legal conclusions, or material misstatements in the evidentiary record.

West Virginia Code St. R. 85-1-15.1 [2009] stipulates that when assessing the reasonableness of travel expenses for medical examinations, guidelines for state employee travel should be followed. Specifically, meal expenses are reimbursable only when travel necessitates overnight lodging, according to West Virginia Code St. R. 148-NA-4.3 [2018]. The employer contends that meal expenses related to medical examinations are not "reasonable" under West Virginia Code 23-4-8 unless overnight lodging is required. While agency interpretations of workers’ compensation laws typically receive deference, such interpretations must align with the statute’s plain meaning. The judiciary holds final authority on statutory construction and will reject administrative interpretations that conflict with clear statutory language.

In this context, West Virginia Code 23-4-8 mandates reimbursement for reasonable travel expenses, including meals, related to ordered medical examinations. The use of "shall" in the statute indicates that the claims administrator lacks discretion to deny reimbursement for legitimate expenses. The claims administrator’s refusal to reimburse Mr. Silveti for his meal expense contradicts the statutory requirement and the overarching purpose of West Virginia’s workers’ compensation law, which aims to cover the costs of medical expenses incurred by injured workers. The application of the cited regulations improperly shifted the financial burden of travel expenses onto Mr. Silveti, contrary to legislative intent. Other states also recognize the right of workers’ compensation claimants to be reimbursed for reasonable travel expenses, and no comparable law severely limits this right based on the absence of overnight travel. A referenced case, Carr v. Indus. Comm’n of Ariz., exemplifies that workers are entitled to reimbursement for travel expenses incurred for medical treatment, regardless of travel distance.

Mr. Silveti was required to travel approximately one hundred miles for a medical examination related to his workers’ compensation claim. Under West Virginia Code 23-4-8, claimants ordered to attend such examinations are entitled to reimbursement for reasonable travel expenses, which include meals, lodging, and mileage. Despite the six hours Mr. Silveti spent traveling, the claims administrator denied reimbursement for meal expenses, stating it was unreasonable since he did not spend the night away. This denial contravenes the explicit provisions of the statute, which does not condition meal reimbursement on overnight lodging.

The court acknowledges the authority of the Insurance Commissioner to issue regulations interpreting the workers’ compensation statutes but emphasizes that such regulations cannot undermine the rights granted by the legislature. Specifically, the court rejects the Insurance Commissioner’s interpretation of "reasonable" travel expenses, as it conflicts with the clear meaning of the statute. The court clarifies that its ruling does not imply that claimants are entitled to reimbursement for meals if they travel locally, as the facts of this case involve significant travel outside the claimant's area.

In conclusion, the Board's affirmation of the claims administrator's decision was inconsistent with the statute's plain language. The court reverses the Board's decision and remands the case for an order that aligns with the established state law. Additionally, the responsible party must arrange for medical examinations as close to the claimant's residence as possible, as per the relevant regulation.