The employee appeals from the compensation judge’s denial of medical mileage as claimed by the employee.  We affirm in part and remand for further consideration.

The employee, Sara Willy, sustained injuries to her left knee on April 22, 1997, December 1, 1998, and January 24, 1999, during her employment as an airline cleaner for Northwest Airlines, the employer herein, which was insured by Liberty Mutual.

The current litigation concerns whether the employee is owed reimbursement for mileage between her home in Wisconsin and medical appointments in the Twin Cities and Fairmont, Minnesota.  At the time of the employee’s 1997 and 1998 work injuries, she lived in Burnsville, Minnesota.  Around the time of her last work injury in 1999, the employee married and moved to New Prague, Minnesota.  Between 1999 and 2009, the employee was receiving medical treatment from Sister Kenny Institute in Minneapolis, the Phoenix Pain Management Center in Golden Valley, and Dr. Ron Wutchiett, a psychologist in Edina.  The employee also treated with Dr. Corey Welchin, an orthopedic surgeon in Fairmont, who performed a number of the employee’s left knee surgeries.  The compensation judge noted that Fairmont is about 125 miles south of the Twin Cities and New Prague is about 45 miles south of Minneapolis.  The employer and insurer paid all of the employee’s medical mileage while she was living in Minnesota.

In 2009, the employee separated from her husband.  She moved to Saukville, Wisconsin, just south of Green Bay, and lived with friends because she had no income other than Social Security disability benefits.  The employee lived there through April 2012, at which time she moved to Tomahawk, Wisconsin, north of Wausau.  She was living in Tomahawk at the time of the hearing.

After moving to Wisconsin in 2009, the employee continued to treat with her providers in Minnesota, and the insurer continued to pay for her care.  She did not submit a claim for medical mileage relating to her Minnesota treatment until 2012.  Her claimed medical mileage begins in January 2010 and was itemized through November 21, 2012.  The mileage was for treatment with Dr. Welchin at the Center for Specialty Care, Dr. Wutchiett, and attendance at the Phoenix Center Chronic Pain Support Group.  The employee’s initial claim for medical mileage totaled approximately $18,000.00.  At the hearing, the employee claimed additional mileage for trips in 2013 and up to the date of hearing.  The compensation judge found that the employee made an effort to schedule her treatment appointments and support/therapy sessions together so that she made as few trips as possible between Wisconsin and Minnesota.

At the hearing, the employee testified that she would usually rent a car for her Minnesota trips because her car was not reliable.  The employee did not submit a claim for rental car charges or lodging expenses for her Minnesota trips.

The compensation judge found that “The employee has well-established trusting relationships with her doctors in Minnesota,” noting, for example, that she had treated with Dr. Welchin since 1997.  The employee has also seen Dr. Wutchiett since 2000 for her mental health care.  The employee testified that at times since her injuries she has been suicidal; she is still depressed and has periodic thoughts about suicide, but trusts Dr. Wutchiett for her care.  The employee also treated with Dr. Monsein for chronic pain since 1999.  He recently informed the employee that he was unable to continue treating her, and she is in the process of selecting another doctor for treatment of her chronic pain.  The employee also attended a monthly chronic pain support group for many years, originally through Sister Kenny Institute, and more recently through Phoenix Center.  The compensation judge stated that the employee “credibly testified she faithfully attends the support group every month.”

The employee testified that she did not wish to change her care to a doctor closer to her current home because of her established relationships and history with her doctors in Minnesota.  The employee also contends that Minn. Stat. § 176.136, subd. 1b.(d) limits the insurer’s liability for out-of-state treatment to charges that the health care provider would be paid for the service under the other state’s Worker’s Compensation Law.  The employee stated she is concerned that she may be personally billed for a portion of her medical bills in Wisconsin if the insurer’s liability is limited.  The employee stated she wants to treat with Dr. Todd Hess in Minnesota for chronic pain because of recommendations regarding his expertise.  The compensation judge made no determination regarding any change of doctors, nor was any such determination requested by the parties.

The compensation judge determined that the mileage reimbursement requested for travel from Minnesota to Wisconsin was not reasonable.  The compensation judge stated “it was not reasonable to expect the insurer to continue paying the transportation costs to the employee’s doctors in Minnesota when the employee traveled 238 and 388 miles one way for the treatment or to attend a support group.”  The compensation judge indicated that the employee was not required to change doctors to providers closer to her home if she wanted to continue to travel back to Minnesota to see the same doctors.  However, the compensation judge concluded that “it is not reasonable to expect the insurer to pay mileage costs for extensive travel when it has not been established that the same or similar care was not available to the employee more locally.”

In reviewing cases on appeal, the Workers’ Compensation Court of Appeals must determine whether “the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.”  Minn. Stat. § 176.421, subd. 1.  Substantial evidence supports the findings if, in the context of the entire record, “they are supported by evidence that a reasonable mind might accept as adequate.”  Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984).  Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed.  Id. at 60, 37 W.C.D. at 240.  Similarly, “[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed.”  Northern States Power Co. v. Lyon Foods Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).  Findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole.”  Id.

“[A] decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which [the Workers’ Compensation Court of Appeals] may consider de novo.”  Krovchuk v. Koch Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993).

An employer is obligated to furnish an injured employee such medical treatment as may reasonably be required to cure and relieve from the effects of the injury.  Minn. Stat. § 176.135, subd. 1.  As a part of medical treatment, an employee is entitled to expenses incurred in obtaining medical care, including mileage, when the employee travels by car for that care.  See Kuhnau v. Manpower, Inc., slip op. (W.C.C.A. Dec. 16, 2013) (citing Sorcan v. U.S. Steel Corp., slip op. (W.C.C.A. May 9, 1988) and Minn. R. 5221.0500, subp. 2.E.).^[1])  The reasonableness and necessity of medical treatment is a question of fact to be determined by the compensation judge.  See Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993).  In the present case, the compensation judge determined that the mileage expense claimed by the employee was not reasonable and denied the claim.  The employee has appealed that finding.

The employee argues that treatment with her current doctors in Minnesota is reasonable, especially given her complicated knee condition and her mental health and pain issues.  Accordingly, she argues that her medical mileage to treat with those providers must also be considered reasonable and should be paid in full.  In her memorandum of law, the compensation judge indicated that there were “multiple good reasons for the employee to continue treating with the same doctors in Minnesota.”  She agreed that the employee’s case was medically complicated and treatment by specialists was warranted.  There has been no dispute as to the reasonableness of the treatment provided to the employee by her medical providers in Minnesota.  Charges for the employee’s treatment have been paid by the employer and insurer.  Reasonable treatment by a provider, however, does not automatically mean that expenses for travel to that provider are reasonable as well.

In Dombai v. Gold ’N Plump, this court affirmed a compensation judge’s denial of the employee’s claim for mileage expense.  51 W.C.D. 506, 509 (W.C.C.A. 1994), summarily aff’d (Minn. Dec 21, 1994).  The employee, living in the Twin Cities, had been prescribed various therapeutic injections.  Id. at 507-08.  The employee traveled to Rochester for the injections, although she testified that these treatments were available closer to her home in the Twin Cities area, because she had confidence in her doctors there.  Id. at 509.  The compensation judge concluded that the employee failed to prove that receiving the treatments in Rochester rather than the metropolitan area was reasonable, and this court determined that substantial evidence supported that conclusion and affirmed the compensation judge’s decision.  Id.  This court stated that “[t]he issue is not the distance which the employee must drive to obtain medical care, but whether the travel expenses are reasonable under all of the circumstances.”  Id.

In Sellner v. Bituminous Materials, slip op. (W.C.C.A. Nov. 19, 1991), a compensation judge awarded travel expenses for a specific type of chiropractic care.  The insurer argued that the same type of chiropractic care was available closer to the employee’s home but provided no evidence on that point.  The compensation judge issued her award with the proviso that if the insurer were able to locate a chiropractor closer to the employee’s home who could provide similar care, the employee would either have to change chiropractors or forego his claims for mileage expenses, and this court affirmed.  Here, the employee argues that the employer and insurer are essentially requesting that she change providers to treat closer to her home.  We disagree.  As in Sellner, the employee in the present matter can forego her mileage claim in order to treat with her current doctors.

In Richardson v. Hot Shot Prods., Inc., the employer and insurer denied the employee’s claim for mileage to and from a health club for pool therapy because, they contended, there were other health clubs nearer to the employee’s home where she could obtain that therapy.  72 W.C.D. 113, 116-17 (W.C.C.A. 2012).  The employee testified that the health clubs offered different services and she itemized the reasons why the pool at her chosen health club and her therapy there were unique.  Id. at 117.  The compensation judge approved the employee’s claim and this court affirmed that decision.  Id. at 117-18.  Because the employee in Richardson established that the same or similar care was not available closer to her home, the employee’s claim for medical travel was approved.

A key question in this matter, as the compensation judge indicated in her memorandum, is whether or not same or similar care was available closer to the employee’s home in Wisconsin.  Neither party investigated this question or presented any evidence on this question.  There was evidence that at one time the insurer had provided a list of some doctors in Wisconsin and Chicago, but there was no evidence as to their specialties or whether any of them would be willing to treat the employee.  Because of the employee’s insistence that she would only consider treating with her current doctors, the employee did not pursue other options.

The employee did not pursue the possibility of medical care closer to her home in Wisconsin because of her concern that if she were required to treat in Wisconsin for her work injury, she faces the possibility of personal liability for the difference between the Wisconsin workers’ compensation fee schedule and the total amount of the bill.  She cites to the decision in Schatz v. Interfaith Care Center, 811 N.W.2d 643, 72 W.C.D. 155 (Minn. 2012).  The Minnesota Supreme Court held, in that decision, that Minn. Stat. § 176.136, subd. 1b(d) “operates to limit the liability of the employer to pay an out-of-state medical provider in accordance with the workers’ compensation fee schedule of that state . . . .”  811 N.W.2d at 651, 72 W.C.D. at 162.  The Supreme Court noted that the parties argued, at length, about whether the plain language of Minn. Stat. § 176.136, subd. 1b(d) would make a covered employee responsible for paying an out-of-state medical provider’s charges that exceed a Minnesota employer’s liability.  Id. at n.2.  However, the Court explicitly declined to decide that issue.  Id.  The out-of-state medical providers were not involved with the case and were not attempting to collect payment from the employee.  Id.  In the present case, as in Schatz, the employee’s concern is not with current bills from Wisconsin providers but is instead based on her concern as to personal liability in the future if she treats in Wisconsin.^[2]

We affirm the compensation judge’s determination that the employee failed to establish that her mileage claim for travel to Minnesota for medical care, as submitted, was reasonable.

In response to the employee’s claim, the employer and insurer argued that it would not be appropriate to award any medical mileage in this case because the employee generally rented a car and did not use her own vehicle.  The compensation judge referred approvingly to that argument but did not rely upon it in reaching her determination.  We do not conclude, however, that use of a rental car for medical travel precludes reimbursement for that travel based on mileage.  Minn. R. 5221.0500, subp. 2E provides for payment of reasonable “travel expenses” incurred by an employee for compensable medical services based on mileage.^[3]  See, e.g., Kuhnau, slip op., supra, (reversing a compensation judge’s denial of payment relating to the assistance to the employee’s spouse in obtaining medical care for the employee and stating that “the employer and insurer’s liability in this regard includes the responsibility to provide whatever transportation assistance is reasonably required to allow the employee to obtain proper treatment”).

There is no dispute that the employee’s treatment by her Minnesota providers was reasonable.  Since travel to a medical provider is inherent in receiving medical care, some amount of medical travel expenses may be reasonable in this case, even though the employee’s total claim for mileage between Wisconsin and Minnesota, as submitted, has been determined not to be reasonable.  We note in this regard that the employer and insurer paid mileage expense when the employee lived in New Prague and travelled to the Twin Cities and Fairmont.  Accordingly, we remand for consideration of whether the employee is entitled to payment of reasonable travel expenses for the treatment she has received.

Finally, the employee argues that the denial of her medical travel expenses from Wisconsin to Minnesota is an infringement of her constitutional right to travel.  The employee properly recognizes that this court has been granted limited jurisdiction by statute, which precludes determining issues of constitutionality.  See, e.g., Kline v. Berg Drywall, Inc., 64 W.C.D. 326, 331-32 (W.C.C.A. 2003).  We do not consider this question further.