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Texas DWC048 Travel Reimbursement Form

Texas DWC048 Travel Reimbursement Form 2026

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The document DWC048 is a form used to request reimbursement for travel costs related to medical treatment or exams for work-related injuries. It provides instructions for completing the form, including necessary information about the injured employee, travel details, and required signatures. The document outlines eligible expenses, such as mileage, overnight stays, and meals, and specifies that claims must be submitted within one year of incurring costs. Additionally, it explains the process for insurance carriers to respond to reimbursement requests and offers guidance on further actions if claims are denied.

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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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