WebAn easy way to keep track of your mileage is by using the Medical Travel Expense Form which can be found in the Document Center on our website. If you have any questions related to mileage reimbursement or filing a workers’ compensation claim, do not hesitate to contact Kenrick Roberts today at 301-670-6552 or [email protected]. WebThis form should be used for medically related travel covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act and the Energy Employees Occupational Illness Compensation Program Act of 2000. Expires: 06/30/2024 1. Claimant's Name (Last, First, Mi.): 2. Case/Claim Number: 3.
www.tdi.texas.gov
Web2 days ago · Entities that sent out 1099 tax forms were required to send to a copy to the IRS by March 31. Deadline for employers to mail W-2s to employees Your employer is required to have sent you a W-2 by ... WebHow to file this form: Complete and sign the form. Send it to the insurance carrier within 1 year of when you incurred (charged) these costs. Keep a copy of the completed form and receipts. If you need help, call us at (800) 252-7031. date from and date to
New DWC Form-048, Request to Get Reimbursed for Travel Costs
WebApr 2, 2024 · Medical Mileage Expense Form - English and Spanish (01-2008) Nontransferable Training Voucher Form. DWC-AD10133.57. Notice of Change or Rate in Payment Schedule. DWC-500F. Notice of Delay in Determining Liability - Instructions. Notice Of Delay In Determining Liabilty For Workers' Compensation Benefits. WebIn connection with the above workers compensation case, you are entitled to be reimbursed for (1) medications or supplies properly prescribed by your health care provider that you paid for yourself and for (2) fares, automobile mileage or other necessary expenses going to and from your health care provider's office or the hospital. Webwage statement as required by the Texas Workers' Compensation Act, Texas Labor Code, Section 408.063(c) and Worker’s Compensation Rule 120.4 may be assessed an … date from and to