Get Dwc048

The Dwc048 form is essential for requesting reimbursement for travel costs associated with medical treatment related to work-related injuries. This guide provides a comprehensive overview of how to fill out the form accurately and effectively, ensuring users can easily navigate the process.

Follow the steps to complete the Dwc048 form online.

1. Click the ‘Get Form’ button to access the Dwc048 form and open it in your preferred editor.
2. In Section A, provide the required information about the injured employee, including their name, date of injury, mailing address, social security number (last 4 digits), phone number, employer at the time of injury, insurance carrier name, and fax number.
3. Proceed to Section B, where you will detail your travel for medical treatment. List trips that were over 30 miles one way, including the date, travel from (street address), travel to (health care provider’s name and address), and the total round-trip miles driven.
4. For overnight stays and meals, provide the required dates and locations of your stay, along with meal and lodging expenses. Ensure that you include receipts for these costs.
5. In Section C, review your filled information and confirm its accuracy by signing and dating the form.
6. For the insurance carrier's response, Section D will be filled out by the insurance provider after they review your request. They will indicate whether the requested amount is approved, denied, or partially denied.
7. Once you have completed the form, save any changes made. You can either download, print, or share the form as necessary.

Complete your Dwc048 form online to simplify the reimbursement process for your travel costs.