Get Wa F245-145-000 2019-2026

The WA F245-145-000 form is used for requesting travel reimbursement related to workers' compensation claims. This guide provides step-by-step instructions on how to accurately complete the form online, ensuring you have all necessary information for a smooth reimbursement process.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the WA F245-145-000 form and open it in the online editor.
2. Begin by filling out the ‘Worker Information’ section. Provide your full name, date of injury, home address (not a PO Box), city, state, zip code, and phone number. Ensure all details are accurately entered.
3. Specify the reason for your travel by checking only one option: medical visit or treatment, vocational services, or attending retraining class. If attending a retraining class, remember to attach the signed Transportation Encumbrance form (F245-375-000) from your vocational counselor.
4. In the ‘Travel Information’ section, confirm whether you have attached your expense receipts by selecting either ‘Yes’ or ‘No’.
5. Complete the travel details for each trip. For each line, enter the date of travel, travel code, the city you are traveling from, the city you are traveling to, the total number of miles traveled, and the expense cost. Make sure to attach receipts for all expenses incurred, except for parking costs under $10.
6. At the end of the line, provide the provider's name and reason for your visit. This verification is crucial for the reimbursement process.
7. Ensure the provider or office staff signs next to their respective visits for verification and add the date of service. Also, include your signature in the ‘Worker’s Signature’ section, stating that the expenses are related to your workers' compensation claim and confirming that the information provided is accurate.
8. Once all sections are completed, review the form for accuracy. You can save your changes, download, print, or share the completed form as necessary.

Complete your travel reimbursement request online today for a smoother experience.