Reimbursement of Travel Expense - WorkCompCentral 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information in Section 1, including your last name, first name, middle initial, social security number, and address.
3. In Section 2, enter your claim number. This is essential for processing your reimbursement.
4. For Section 3, indicate the dates of travel by entering the month, day, and four-digit year.
5. In Section 4, calculate and enter your total car mileage per day. Ensure that the distance exceeds 50 miles round trip.
6. Section 5 requires you to detail other types of travel expenses. Specify the type of transportation used and enter costs for meals and lodging as applicable.
7. Finally, sign and date the form in Section 7 to certify that all information provided is accurate before submitting it for reimbursement.

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