Sample Mileage Claim Form for Workers' Compensation Claims

Mileage reimbursement is just one of several benefits that the workers’ compensation insurance company should be providing you. Mileage is paid to injured workers to compensate for the trips made to doctors and therapy.

You can receive reimbursement for the expense of driving to doctor appointments if the appointment is related to your on-the-job injury.

In order to receive mileage reimbursement you need to keep a mileage log. 

Tips for Filling Out Your Mileage Claim Form 

1. Make sure to write the actual, full address of the doctor’s office. For example, write “1285 N Orange Ave Winter Park, FL 32789” not “Jewett Orthopaedic Clinic.”

2. The miles logged must begin from where you left from and back. If you ran an errand on your way to the doctor appointment, you cannot calculate that mileage in. 

How to Get Your FREE Sample Mileage Claim Form

To receive your absolutely free sample mileage claim form, just enter your name and best e-mail address below. You will receive an email with your free download shortly after submitting the form. 

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