Claimants reimbursement form 2026

1. Click ‘Get Form’ to open the claimants reimbursement form in the editor.
2. Begin by entering your name and WCB case number at the top of the form. This information is crucial for identifying your claim.
3. Fill in your residential address and, if applicable, a different mailing address. Accurate addresses ensure that all correspondence reaches you promptly.
4. In the 'Nature of Expense' section, list each expense related to your medical care, such as medications or travel costs. Be sure to include dates and amounts for each entry.
5. If you have receipts, attach copies to support your claims. If not, note that obtaining receipts is recommended wherever possible.
6. Once completed, submit the form along with any receipts to your workers' compensation insurance carrier or employer. Retain a copy for your records.

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