How To Fill Out A Milage Form

When you are under a workers compensation award, part of your medical benefit includes milage reimbursement for your trips to and from the doctor and other medical providers.
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Video Transcript

When you are under a workers compensation award, part of your medical benefit includes milage reimbursement for your trips to and from the doctor and other medical providers.

We’ve put together this presentation to help you learn more about receiving your milage reimbursement.

In a contested case, it is important that you gather and keep your milage documentation, however it will not be possible to submit milage and receive reimbursement until after your claim is accepted and medical treatment has ben approved.

If your claim has been accepted, the process and procedure for getting milage reimbursement is that you would submit the milage forms along with proof of doctors visits. This can be a little tricky as the assumption is that since the insurance company is paying for you to visit the doctor, then they will know that you have made the visits, however the process doesn’t really work that way.

You need to have proof of each visit along with any other expenses for the visit, such as tolls or maybe even a taxi ride for the doctors visit. These items are then submitted to the insurance adjuster, then in about 30 to 45 days you will receive a reimbursement check.

If you have not received your reimbursement check in this time period you would need to contact your attorney or if you do not have any attorney, then contact the insurance adjuster to find out why you have not received your milage check.

If you contact your attorney, we will then contact the insurance company and keep contacting them until they have confirmed the status of the check, given us information on what might be missing or what additional information they are in need of in order to process the milage reimbursement payment.

The most important part of this is that the insurance adjuster is mailing the milage check directly to you, so it’s very important to let us know when you have received the check. If we don’t know that you have received your check, we’ll keep persuing that check for you.

You may go to our website, www.injuredworkerslawfirm.com and download the milage reimbursement form or you can create your own form to include all of the needed information.

You need to make sure that you include your name, address, employers name, social security number, date of birth and the date of the accident on the form.

Next you need to fill in the chart with the dates that you traveled to and the dates that you traveled from and then double this for Round Trip milage.

For example you’ll see on the chart that you would enter the date, then your home address and then the address of the doctor, hospital or therapist and your round trip milage which is the total milage from your home to the doctor and back. Also, be sure to include any other expenses, such as tolls, parking or other transportation.

To determine your actual roundtrip milage, a great short cut is to use mapquest.com or googlemaps.com. Type in your address and the address of the medical provider. If you double the distance this will be your round trip milage that you would log for the visit.

Be sure to print and keep a copy of the mapquest or google maps directions and send them with your milage reimbursement form, as the insurance adjuster will also confirm the round trip milage and not just take your work for it. By sending the directions that you used, you should be getting your reimbursement check sooner.

Make sure that you total the round trip milage and write it in Box A. If your milage report will be several pages long, I suggest that you subtotal each page.

Once you have the total number of roundtrip milage, multiply the milage by 55.5 cents, the amount that is reimbursed at this time. If you happen to have milage from before October 1, 2011, or after January 1, 2013, please call our office for the correct reimbursement rate.

Make sure that you total any additional costs such as tolls, cabe fare, parking, etc and list that expense in box C. Be sure to include a copy of the receipts with your submitted form.

Next add boxes B and C together to get your total reimbursement amount.

Lastly, sign and date the form and mail the packet to the insurance adjuster. Keep a copy for your records and send a copy to your attorney as well.

If you haven’t received your reimbursement check within 3 weeks, contact your attorneys office so they can put some pressure on the adjuster to hurry up and reimburse you or if you don’t have an attorney working on your claim you can contact the adjuster directly.

For additional information be sure to visit our website Injured Workers Law Firm.com

2017-04-23T20:03:10+00:00

About the Author:

The Injured Workers Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers' compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia” , or call our office today (804) 755-7755.