Get Imwca

Filling out the Imwca medical mileage reimbursement request form is a straightforward process that helps ensure you receive the compensation you deserve for your medical travel. This guide will walk you through each section of the form, offering clear instructions tailored for users of all experience levels.

Follow the steps to complete the Imwca form online.

1. Press the ‘Get Form’ button to access the document and open it in your chosen editor.
2. Begin by entering your name in the 'Employee' field. Ensure that your name is spelled correctly to avoid any issues.
3. In the 'Date of injury' section, provide the exact date of your injury, formatted as MM/DD/YYYY.
4. Next, under 'Employer', write the name of your employer as it appears on your records.
5. Fill in the 'Claim Number' field with the relevant claim number associated with your injury.
6. Under 'Medical Provider', list the name of the medical provider you visited for treatment.
7. In the 'Date of Treatment' field, input the date you received medical treatment, also formatted as MM/DD/YYYY.
8. The 'Mileage (round trip)' section requires you to indicate the total mileage for your round trip to the medical provider; ensure you calculate this accurately.
9. Once all fields are completed, review your entries for accuracy.
10. Finally, save your changes, and then download or print the completed form to submit. You can also share it via email or fax using the provided contact information.

Complete your medical mileage reimbursement request online to ensure efficient processing of your claim.