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Texas DWC048 Travel Reimbursement Form 2026
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- Click ‘Get Form’ to open the DWC048 form in our editor.
- Begin by filling out Part 1, which includes your personal information. Enter your name, date of injury, mailing address, employer's name, phone number, and insurance carrier details in the designated fields.
- Proceed to Part 2 for travel information. Document each trip for medical treatment over 30 miles one way by entering the date, travel addresses, and total miles driven.
- In Part 3, certify that the information provided is correct by signing and dating the form.
- Finally, if applicable, complete Part 4 for the insurance carrier’s response regarding reimbursement. Ensure all required fields are filled before submission.
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Related links
DWC048. DWC048 Rev. 07/21. Page 3 of 3. FAQ. Request to get reimbursed for travel costs (DWC Form-048). What costs can I get reimbursed for? If you have a workRead more
Filing instructions: Complete boxes 1-11 and sign the form. Send it to the insurance carrier within one year of when you incurred (charged) these costs.Read more