Mileage Instructions

You are entitled to reimbursement from your workers’ compensation insurance carrier for travel to and from the following:

  • All of your workers’ compensation doctor’s appointments. This includes specialty provider appointments and QME/AME doctor’s appointments.
  • Your pharmacy when you pick up medications prescribed by your workers’ compensation providers.
  • Toll fare and parking expenses related to the above.

If you have a deposition during your case you are entitled to reimbursement for travel to and from your deposition. Please note that our office will automatically request mileage reimbursement for you if you attend a deposition.

Please note that you are NOT entitled to reimbursement for travel to your attorney’s office or to and from any court hearings that you may attend. You are responsible for the cost of this travel.

When you fill out your mileage request, first make sure you have the correct forms. You should have received mileage forms from your Claims Adjuster. If you did not, you can print blank mileage request forms from the Department of Industrial Relations’ Website. http://www.dir.ca.gov/dwc/forms.html#AdministrativeForms

To find these forms, scroll down to “Claim and Court Forms” and then scroll down to “Medical Mileage Expense Form in English/ Spanish.” Download the appropriate form for the year for which you are requesting mileage. Please note that the per-mile reimbursement amount changes from year to year, so make sure to choose the correct year for the form you download.

If you are using forms given to you by our office or from your Claims Adjuster, make sure to look up the correct per-mile reimbursement amount by using the chart attached here.- PDF of mileage printout

When you fill out your forms, make sure to either type or print legibly, and fill out the form completely with your name and claim number. If you have multiple claim numbers you MUST fill out separate forms for each claim number. To figure out how far you’ve traveled you can use a map search engine. (MapQuest or Google Maps are good options). Your Claims Adjuster will calculate your mileage using the same method. Completely fill out the forms and add up your mileage. Write the total miles traveled and the total amount of reimbursement at the bottom of the form.

To ensure that you receive all of your reimbursement, you should provide supporting documentation for your expenses. Please note that many insurance adjusters will not honor mileage reimbursement requests for toll and parking expenses without a receipt. Make sure to keep your receipts and submit a copy of them with your mileage request. It is also helpful to include a printout of your doctor’s office appointments. Contact your doctor’s office directly to obtain a printout.

Make a copy of your completed forms, supporting documentation and receipts and send them directly to your Claims Adjuster (please contact our office if you do not know the contact information for your Claims Adjuster.)
It is advisable to both fax and mail a copy of your request to your Claims Adjuster. Your Claims Adjuster has 45 days to pay you from the date that they receive your reimbursement request. Please contact our office if your Claims Adjuster does not pay you within this timeframe.

Things to remember:

  • Type or print legibly
  • Fill out your forms completely
  • Use the correct mileage rate for the year that you are claiming
  • Submit your mileage on a regular basis rather than all at once
  • Submit receipts and a printout of your office appointments for each doctor’s office that you visit.
  • Keep a copy of your request for your records!

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