Get Form 25t
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Form 25t online
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.
- Press the ‘Get Form’ button to obtain the form and open it in the editor.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Related links form
Filing a workers' compensation claim involves several key steps. First, report your injury to your employer and seek medical treatment if necessary. Next, complete the required forms, including the Form 25t, and submit them to your employer or the insurance company. Finally, keep track of all correspondence and follow up regularly to ensure your claim is processed efficiently. By staying organized, you can navigate the claims process with confidence.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.