How To Request a Mileage Reimbursement
Virginia Law allows for Injured Workers to be compensated for their travel expenses for trips to the doctor’s office, therapy and meetings with vocational rehab counselors. The insurance company will reimburse expenses for uncontested claims; they will not however reimburse expenses for contested claims until the claim is approved by the Workers Compensation Commission. You can use any form, but I have one already created. Go to my website www.injuredworkerslawfirm.com and print out the Mileage Reimbursement Form.
Follow the steps listed below to fill out the MILEAGE REIMBURSEMENT FORM and submit it for payment:
1) Completely fill in the MILEAGE REIMBURSEMENT FORM including your name, address, employer (at the time of the injury), social security number, date of birth and date of accident.
2) Fill in the chart including the dates traveled, TRAVELED FROM information (including address), TRAVELED TO information (including address), the total ROUND TRIP MILEAGE and any BRIDGE TOLLS/PARKING/PUBLIC TRANSIT expenses in the appropriate column.
a. If you had to take a taxi or other form of public transportation you do not have to fill in the mileage amount; you can simply list the TRAVELED FROM and TRAVELED TO addresses and the cost of the taxi ride or bus ride but you MUST include the receipt.
3) For ROUND TRIP MILEAGE, Log on to MapQuest or GoogleMaps and print out the directions page showing the distance to the desired locations; you need to do this for each different location you traveled to. The print out will show you the trip distance for one way; double this number and this will be your ROUND TRIP MILEAGE. These directions/distance print outs need to be attached to the form when the form is submitted for reimbursement.
4) Once you have completed the chart, total up all the miles in the ROUND TRIP MILEAGE column and list this figure in BOX A.
5) Once you have the amount of BOX A, multiply it by $0.555 (or multiply by $.505 for mileage expenses incurred prior to October 1, 2011). This will give you the dollar amount of the reimbursement for the miles traveled; list this figure in BOX B.
6) Total up the cost of any public transit, bridge tolls, turnpike fees or cab fare and insert this total into BOX C.
7) Add BOX B and BOX C together and insert this figure into BOX D, this is the amount of your total reimbursement.
8) For any trips made or costs you are requesting reimbursement for, you MUST attach all necessary documentation (the easiest documentation is to call the medical provider's billing department and ask for a bill payment history), including the Mapquest printout for the visits.
9) Send a cover letter with the enclosures to the defense counsel or the insurance adjuster (if there is no defense counsel) requesting reimbursement. “Enclosed please find….for reimbursement directly to me."
10) If the mileage reimbursement check has not been received within 3 weeks, call defense counsel’s office (or adjuster if there is no defense counsel) and let them know. Continue following up every three weeks until you have received the mileage reimbursement.