Mileage Reimbursement Form

The insurance company is obligated to reimburse an injured worker for miles driven to and from authorized provider visits. Authorized providers include physicians, therapy, diagnostic tests, etc. Additionally, miles driven to and from the pharmacy to pick up authorized medications are also reimbursable.

Employee Earnings Report

For certain periods while an individual is receiving indemnity benefits from an insurance company, they may be required to complete Employee Earnings Reports (DWC-19). This document is used for reporting income received from a wide array of sources. It is important that all income be documented from any amount earned, no matter how minor.

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