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The mileage rate is 65.5 cents ($0.655) per mile. Mileage for reasonable travel to the pharmacy, parking, bridge tolls, public transportation and other travel-related costs are also included. Complete this form. Attach receipts. Send the original to the insurance company and keep a copy.
Millas por un viaje de distancia razonable a la farmacia, estacionamiento, pago de peajes, transporte público y otros viajes y costos relacionados están también incluidos. Complete este formulario y adjunte los recibos. Envíe la forma original a la compañía de seguros y guarde una copia.
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. December 2023.
Mileage for reasonable travel to the pharmacy, parking, bridge tolls, public transportation and other travel-related costs are also included. Complete this form.
1 lip 2006 · Medical mileage reimbursement is your right as an injured worker in California. It is up to you to take full advantage of this benefit in the state's workers' compensation system. Download the California Medical Mileage Expense and Reimbursement Form for Workers' Compensation.
Rates Change Regularly. Mileage reimbursement rates vary depending on when you have traveled. Per the Labor Code, “it is dependent upon the mileage rate adopted by the Director of the Department of Personnel Administration pursuant to Section 19820 of the Government Code, whichever is higher, plus any bridge tolls.”
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
