Medical Mileage Expense Form | Pdf Fpdf Docx | California

 California   Workers Comp   General 
Medical Mileage Expense Form | Pdf Fpdf Docx | California

Last updated: 1/10/2024

Medical Mileage Expense Form

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Description

MEDICAL MILEAGE EXPENSE FORM. If you have to travel to get treatment for your work injury, you are entitled to re-payment of your travel costs. The mileage rate is 67 cents ($0.67) 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. Do not send the original or a copy to the local Workers’ Compensation Appeals Board (WCAB) or the information and assistance officer. If your travel costs are not paid within 60 days, contact the information and assistance officer. www.FormsWorkflow.com

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