Get 2019 Wcab Mileage

The 2019 Wcab Mileage form is essential for individuals seeking reimbursement for medical travel expenses related to workplace injuries. This guide will provide clear, step-by-step instructions to help you navigate the online form with ease.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to access the mileage form and open it in the editor.
2. Enter the injured worker's name in the designated field, ensuring the name matches the claim documents.
3. Input the claim number associated with your injury in the specified section.
4. Record the date of travel in the 'Date' field, using the appropriate format.
5. In the 'Traveled from' section, include the full address from where you started your journey to the medical service provider.
6. In the 'Traveled to' section, specify the name and address of the doctor, hospital, or therapist you visited.
7. Calculate the round trip mileage and enter it in the 'Round trip mileage' field. Use odometer readings or a mapping tool if necessary.
8. Enter any applicable tolls and parking fees in their respective fields, providing total amounts.
9. Multiply the total miles by the reimbursement rate of $0.585 to calculate the total reimbursement request, and enter this amount in the designated field.
10. Sign the form in the 'Signature' section and print your name in the specified area, confirming the accuracy of your information.
11. Lastly, save your changes, download the form, and print a copy for your records. Send the original to the insurance company.

Complete your 2019 Wcab Mileage form online today to ensure your travel expenses are reimbursed.