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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.
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.
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.
Pharmacy. California has a relatively lenient medical mileage policy compared to other states, but nothing’s a given. An experienced workers’ compensation attorney can help when the insurance carrier questions the submitted expenses. Rates Change Regularly. Mileage reimbursement rates vary depending on when you have traveled.
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.
To help you keep a record of such expenses we have provided this form. In order to help insure that you are properly reimbursed, list each item of expense below -- whether or not you obtained a receipt (wherever possible obtain receipts).
