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This form should be used for medically related travel covered by the Federal Employees' Compensation Act and the Energy Employees Occupational Illness Compensation Program Act of 2000. For travel expenses reimbursement under the Black Lung Benefits Act (30 USC 901; 20 CFR 725.406 and 725.701) use the Form OWCP-957 Part B OMB No. 1240-0037
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.
3 mar 2020 · The workers’ compensation insurer has 15 days to provide reimbursement after you’ve submitted documentation of mileage, meals, and lodging. If the insurer doesn’t pay within this timeframe, it can be subject to a late penalty. Download FREE Medical Mileage Reimbursment Form.
20 mar 2024 · The employee uses the form to record mileage to receive reasonable and necessary medical treatment for the covered work-related injury or illness. The mileage is then reimbursed to the employee as part of the workers’ compensation benefit.
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.
Form OWCP-915 can be used to seek reimbursement for expenses in regard to medical treatment, prescription medication and medical supplies. Please submit a separate reimbursement claim for each provider where an out of pocket expense was incurred. Please print clearly and legibly.
25 sty 2022 · From January 1, 2019 the IRS's 2019 standard mileage rate is 58 cents per mile for regular business driving. Learn more about mileage reimbursement for employees. Includes FAQs and a free employee mileage reimbursement form for download.
