Get Form 25t

Filling out the Form 25t is a crucial part of the process for employees seeking reimbursement for travel expenses related to medical treatment. This guide will walk you through the steps to complete this form online efficiently.

Follow the steps to successfully complete Form 25t online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the employee's information section. Enter the employee's name, social security number, and date of birth. Ensure accuracy in this information as it is vital for processing.
3. Complete the employer's details. Input the employer's name, address, city, state, zip code, and FEIN number. This information links the employee's claim to the correct employer.
4. Fill in the insurance carrier's information, including the insurance carrier's name, address, and telephone number. This section is essential for the reimbursement process.
5. In the travel expenses section, start documenting the total miles for the round trip to the medical provider. Remember that you are entitled to reimbursement for travel exceeding 20 miles.
6. Calculate and input the travel expenses, using the provided mileage rate. Be sure to reference the current rate of $0.50 per mile for travel starting January 1, 2010.
7. Include any additional expenses such as motel fees, meal expenses for breakfast, lunch, and dinner, as well as other costs like parking or cab fare. Provide a total for each category.
8. At the end of the form, certify that all expenses listed have been incurred as a result of your workers' compensation injury by signing where indicated.
9. Once completed, save your changes, and ensure you have a copy for your records. You can print or share the finished form as required.

Take the first step towards receiving your reimbursement by filling out your Form 25t online today.