© 2019 Workers' Compensation Law Center. Representing Injured Workers with offices in Crescent City, Eureka, Redding, and Susanville.

 

The materials on this website do not, nor are they intended to create an attorney-client relationship or constitute legal advice. All California Workers' Compensation claims are different.

For advice regarding your claim, please contact a workers' compensation attorney.

  • White Facebook Icon
  • Twitter - White Circle
  • YouTube - White Circle

FOLLOW US:

DESIGNED BY:

P.HDZ

Medical Mileage Forms:

 

As part of your workers compensation claim, you are entitled to reimbursement for the miles you drive to attend a medical, chiropractor, or other treatment related appointment, drop-off/ pick-up a prescription, or attendance at a deposition. 


In order to receive reimbursement, you must keep a log of the miles driven. To ensure prompt payment, it is recommended you utilize the DWC's mileage form. (see below)

Once you have filled out the medical mileage form, submit it directly to your workers compensation insurance carrier, specifically to the adjuster. Prior to mailing the form, make sure to make a copy for your records. Make sure you send your attorney the copies you kept.

The carrier has 60 days to pay mileage upon receiving the medical mileage form. Should the carrier fail to pay within this time, penalties can be awarded by the Workers Compensation Appeals Board. Please contact your local Work Comp Law Center office if you have not received reimbursement. 

 

2013 Medical Mileage Form 

 

2014 Medical Mileage Form 

 

2015 Medical Mileage Form 

 

2016 Medical Mileage Form

 

Mileage Rates:

 

  • 01/01/16-                 = .56

  • 01/01/15 – 12/31/15= .575

  • 01/01/14 – 12/31/14= .56

  • 01/01/13 – 12/31/13= .565

  • 07/01/11 – 12/31/12= .555

  • 01/01/11 – 06/30/11= .51

  • 01/01/10 – 12/31/10= .50

  • 01/01/09 – 12/31/09= .55

  • 07/01/08 – 12/31/08= .585

  • 01/01/08 – 06/30/08= .505

  • 01/01/07 – 12/31/07= .485

  • 07/01/06 – 12/31/06= .445

  • 10/01/01 – 06/30/06= .34