Mileage Reimbursement Record

Document Number: WKC-18613-E

Description: Complete this form to receive mileage reimbursement for travel to obtain treatment or attend vocational rehabilitation training due to a worker's compensation claim. The rate is the same as what state employees receive for business related mileage expenses.

Comments: This form can be filled out on the computer as a fillable pdf.

Content Contact: Lynn Weinberger

Document Attachment: WKC-18613-E (Electronic version - pdf/489 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.