Get Accident Fund Travel Reimbursement Form

Filling out the Accident Fund Travel Reimbursement Form online can seem daunting, but with the right guidance, the process can be straightforward and efficient. This guide provides clear, step-by-step instructions to help you navigate each section of the form with ease.

Follow the steps to complete your reimbursement form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering the injured worker's name in the designated field labeled 'Injured Worker Name'. Make sure to use the full legal name as it appears on official documents.
3. Fill in the home address of the injured worker. Provide complete details including the street address, city, state, and zip code to ensure accurate processing.
4. Input the employer's name in the section marked 'Employer'. This should be the name of the company that employs the injured worker.
5. Enter the claim number in the corresponding 'Claim No' field. This number is crucial as it links the reimbursement request to the specific case.
6. Record the date of the accident in the 'Date of Accident' field. This information is necessary for processing the mileage claim.
7. If applicable, list the trips undertaken by entering the full address for the starting point under 'From' and the destination under 'To'. Include the complete address with street, city, state, and zip code.
8. Indicate the date of each trip in the 'Date of Trip' field next to the corresponding entry. It's important to be as accurate as possible with these dates.
9. Calculate the round trip miles for each journey and enter this in the 'Round Trip Miles' column. Ensure that the distance is verified using an accurate mapping source.
10. Select the mileage reimbursement rate based on the date of travel and fill it in the 'Rate' column. Please refer to the specific rates provided for the date range.
11. After filling out all required sections, review the form thoroughly to ensure that all information is correct and complete. Incomplete forms will be returned.
12. Finally, provide your signature in the 'Signature of Injured Worker' field and date it appropriately. This signifies that all information provided is accurate.
13. Save your changes, then download, print, or share the completed form as needed. Make sure to send the form to the address listed: State Accident Fund, Post Office Box 102100, Columbia, South Carolina 29221-5000.

Complete your Accident Fund Travel Reimbursement Form online today!