Search results
Instructions – Form OWCP-957 Part A – Medical Travel Refund Request – Mileage This is a mileage only reimbursement form. If you need other travel expenses reimbursed, complete Form OWCP-957
You can calculate mileage reimbursement in three simple steps: Select your tax year. Input the number of miles driven for business, charitable, medical, and/or moving purposes. Click on the "Calculate" button to determine the reimbursement amount.
This form should be used for medically related travel covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act and the Energy Employees Occupational Illness Compensation Program Act of 2000.
Drivers should keep a mileage log, noting the miles that you drive during each trip to your doctor, therapist, or other treatment approved through workers' comp. The workers' comp agencies in many states provide standard mileage reimbursement forms that can be used for this purpose.
Medical mileage expense form. If you need a medical mileage expense form for a year not listed here, please contact the Information and Assistance Unit at your closest district office of the Workers’ Compensation Appeals Board.
If you are injured on the job in California and you need to travel to a doctor's office, therapy office, a pharmacy to pick up medication, or to a law office to attend a deposition, the insurance carrier has to reimburse you for your mileage. The medical mileage rate for 2023 is 62.5 cents per.
REQUEST FOR MILEAGE REIMBURSEMENT. CLAIM NUMBER: EMPLOYER: DATE OF ACCIDENT: CLAIMANT: DATE OF TRIP ADDRESS FROM. DESTINATION PARKING/TOLLS (Receipt must be includ; ed) NUMBER OF ... Author: Travelers Subject: Workers Compensation Request for Mileage Reimbursement Keywords: Workers Compensation Request for Mileage Reimbursement Created Date:
