Employee Expense Form {WCB-206}

WCB-206 - EMPLOYEE EXPENSE FORM. You are entitled to mileage reimbursement pursuant to 39-A M.R.S.A. § 315 for attendance at Board hearings. You are entitled to expenses and fees incurred for medical treatment pursuant to 39-A M.R.S.A. § 206 or for attendance at Board appointed medical exams pursuant to 39-A M.R.S.A. §§ 312 or 611. Complete this form and attach receipts. Send the original form and receipts to the claim administrator and keep copies for your records. Do not send the original or a copy to the Workers' Compensation Board. If your travel costs or other expenses are not paid within 30 days, you may contact a Claims Resolution Specialist at the nearest regional office listed on the form. www.FormsWorkflow.com