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Medical Travel Refund Request
We have made the process of filing for medical travel reimbursement easier with two new streamlined forms.
- OWCP-957A - Medical Travel Refund Request – Mileage
- OWCP-957B - Medical Travel Refund Request – Expenses
TAC travel forms
Travel expense declaration form.
Use this form to claim reimbursement for travel.
This can be private vehicle, public transport or taxi expenses to go to:
- medical treatment for accident injuries,
- medical examinations arranged by the TAC,
- approved rehabilitation or disability services,
- work, if you take part in a formal Return to Work program.
Resource list
- Travel reimbursement form (634.8 KB)
- Travel reimbursement form (802.0 KB)
Visiting expenses - Declaration for family members of an injured client admitted to hospital
Immediate family members of hospitalised TAC clients can use this form to claim travel and accommodation expenses when they visit their loved ones.
Please note , to be eligible for reimbursement, immediate family members must live more than 100km away from the hospital.
- Travel and accommodation reimbursement for family members form (215.8 KB)
- Travel and accommodation reimbursement for family members form (652.0 KB)
Access to our Brisbane, Canberra and Melbourne offices is currently restricted. To visit us at these locations, call 1300 366 979 to arrange an appointment.
- Income support
- Medical treatment
- Workplace rehabilitation services
- Attendant care services
- Household services
- Aids, appliances and modifications
Travel costs
- Long-term injury or impairment
- Entitlements following a work-related death
You may be entitled to be reimbursed for the cost of travel to attend medical treatment that you need as a result of your work-related injury or illness.
Before you travel
If you want to claim the cost of travel, make sure you meet the requirements and have the necessary evidence and approval before you travel.
Eligibility
To reimburse travel costs, the medical treatment you need must be as a result of your work-related injury or illness.
You must also need to travel:
- in an ambulance, public transport or taxi because of your work-related illness or injury, or
- by private motor vehicle more than 50 kilometres round trip to a single treatment session.
If the type of treatment you need is available from another medical provider who practices within the 50-kilometre round-trip limit, you are not eligible to be reimbursed for travel unless we determine there are special circumstances.
Payment is made at a specific rate per kilometre travelled . This rate is reviewed regularly and updated as appropriate.
How to make a claim for travel costs
Employees of an australian government agency or statutory authority, travel by public transport or taxi.
- Talk to your medical practitioner about your transport needs.
- If your medical practitioner decides that you need to travel by public transport or taxi to your treatment due to your work-related injury or illness, you need a medical certificate or letter from your medical practitioner confirming this.
- Submit the Medical Services Claim form (PDF, 95.9 KB) to us with the medical certificate, together with evidence that you attended the treatment and receipts for your travel.
Travel in an ambulance
- If your medical practitioner considers that you need to travel in an ambulance to your treatment, you need a medical certificate or letter from your medical practitioner confirming this.
- Submit the Medical Services Claim form (PDF, 95.9 KB) to us with the medical certificate or letter, together with the receipt for your travel in an ambulance.
Travel in a private motor vehicle
- Talk to your Comcare claims manager about your transport requirements for medical treatment.
- If the agreed private motor vehicle travel is more than 50 kilometres round trip, complete your journey details on a Medical Services Claim form (PDF, 95.9 KB) and send the form to us.
To submit a form to Comcare:
- email to [email protected]
- mail to Comcare, GPO Box 9905, Canberra ACT 2601.
Employees of a self-insured licensee
If you work for an organisation which is a self-insured licensee, a staff member in your organisation or a third-party provider manages your claim. Speak with your human resources team for more information.
See a list of corporations and organisations with a self-insurance licence .
If you disagree with the determination
If you disagree with our determination, you can ask us to reconsider it. You need to submit an application for reconsideration within 30 days of our determination or apply for an extension of time.
For more information about this process, see Apply for a reconsideration .
Comcare GPO Box 9905, Canberra, ACT 2601 1300 366 979 | www.comcare.gov.au
Date printed 07 Jun 2024
https://www.comcare.gov.au/claims/supports-benefits/travel-costs
Language selection
- Français fr
Pay and pension forms
If you cannot access these forms please contact your Compensation Advisor.
- Application for Social Insurance Number (SIN)/Replacement SIN Card
- Canada Revenue Agency - Forms listed by form number
- Claim Form for Public Service Dental Care Plan
- Government of Canada (GC) Forms Web site (accessible only on the Government of Canada network)
- Service Canada Forms
- Canada Pension Plan and Old Age Security
- Public Service Pension Plan forms
- Pensioners' Dental Services Plan (PDSP) - Claim Form
- Public Service Health Care Plan (PSHCP) Claim Forms
- Quebec Pension Plan
- Source Deductions Return TP-1015.3-V
- Treasury Board of Canada Secretariat TBS-SCT Forms
- TD1 Personal Tax Credits Return
From: Public Services and Procurement Canada
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Travel expense claim form; Sporting injuries . Deceased participant benefit application for schools and departments; ... The automatic translation provided is quick and convenient, however is a guide only and icare does not guarantee that the information is translated accurately. If you provide information via one of our digital products, it ...
icare TM | Insurance and Care NSW ersion 1.IC08491 718 Travel reimbursement request 1 Reimbursement Form Travel reimbursement request 1. Injured person's details Injured person's name* Claim number* Date of injury (DD/MM/YYYY) 2. Employer's details Employer's name Policy number 3. Reimbursement details
You can submit an Expense claim form to us for the following travel costs related to your treatment and rehabilitation services: Public transport fares. You'll need to attach original tickets or an Opal card activity statement for the dates you travelled. Go to www.opal.com.au to get a print-out of an activity statement.
Clean Claim Requirements (CMS 1500) The Centers for Medicare and Medicaid Services (CMS) developed claim forms that record the information needed to process and generate provider reimbursement. This document summarizes the required elements that must be complete, legible and accurate to be handled as a clean claim. Plans.
VA Forms; Forms & Publications. Forms; Popular Forms. DD-214 — Report of Separation; 21-4138 — Statement in Support of Claim (PDF) 22-1995 — Request for Change of Program or Place of Training (PDF) 22-1990 — Application for Education Benefits (PDF) 10-10ez — Health Benefits Renewal (PDF)
Please post to EML, GPO 3228, Sydney NSW 2001 or fax to (02) 8251 9495. EML ABN 67 000 006 486 Level 3, 345 George Street, Sydney NSW 2000, GPO Box 3228, Sydney NSW 2001 T: 02 8071 3400 T: 1800 365 401 (toll free) F: 02 8251 9495. Employers Mutual Limited acting as the agent of NSW Self Insurance Corporation, known as icare Self Insurance ...
Call your servicing Prime Travel Benefit office before booking airfare or traveling more than 400 miles one-way. You must confirm the maximum amount you may be reimbursed. Your reimbursement only includes the actual costs of lodging and meals. This is not to exceed the government per diem rate for the ZIP code of your specialty care provider ...
Member Reimbursement Request Form You will receive a response within 30 days of iCare receiving this form. Completed forms may be mailed to: Or faxed to: iCare 1555 N. RiverCenter Dr. Suite 206 Milwaukee, WI 53212 Attn: PA Department 414-231-1026 Member Information Member Name: DOB: Member ID#: Phone: Mailing Address: City: State: Zip:
Medical Travel Refund Request. We have made the process of filing for medical travel reimbursement easier with two new streamlined forms. OWCP-957A - Medical Travel Refund Request - Mileage. OWCP-957B - Medical Travel Refund Request - Expenses. Federal Employees. Energy Program. Black Lung. Longshore.
EML ABN 67 000 006 486 Level 3, 345 George Street, Sydney NSW 2000, GPO Box 3228, Sydney NSW 2001 T: 02 8071 3400 T: 1800 365 401 (toll free) F: 02 8251 9495. EML acting as the agent of NSW Self Insurance Corporation, known as icare Insurance for NSW. icare is the brand of Insurance & Care NSW and provides services to the NSW Self Insurance ...
Completion of this form does not guarantee reimbursement. The member must be eligible for services and materials on the date that services were provided. Expenses for eye exams and eyewear can be claimed on this form. Only services listed on this form will be considered for reimbursement. Please submit a separate form for each patient.
icare TM˜|Insurance and Care N IC Travel reimbursement request2 Reimbursement Form Travel reimbursement request 1. Injured person's details Injured person's name* Claim number* Date of injury (DD/MM/YYYY) 2. Employer's details. Employer's name. Policy number. 3. Reimbursement details. Period claimed. Travel details
Travel expense declaration formUse this form to claim reimbursement for travel.This can be private vehicle, public transport or taxi expenses to go to:medical treatment for accident injuries,medical examinations arranged by the TAC,approved rehabilitation or disability services,work, if you take part in a formal Return to Work program.
Talk to your Comcare claims manager about your transport requirements for medical treatment. If the agreed private motor vehicle travel is more than 50 kilometres round trip, complete your journey details on a Medical Services Claim form (PDF, 95.9 KB) and send the form to us. To submit a form to Comcare: email to [email protected].
File a claim for general health care travel reimbursement online. General health care travel reimbursement covers these expenses for eligible Veterans and caregivers: Regular transportation, such as by car, plane, train, bus, taxi, or light rail. Approved meals and lodging expenses. You can file a claim online through the Beneficiary Travel ...
Use this form to claim reimbursement of travel expenses. Go to form ... EML NSW Limited ABN 52 003 201 885 for the Nominal Insurer (icare) and for certain NSW government agencies (Insurance for NSW); EML VIC Pty Limited ABN 93 606 104 910 for Worksafe Victoria;
Find out what travel expenses are covered and if you or your caregiver may be eligible for VA travel pay reimbursement. Get VA Form 10-3542, Veteran/Beneficiary Claim for Reimbursement of Travel Expenses. Use this VA travel reimbursement form when you want to ask VA to pay for transportation expenses related to your care.
Canada Revenue Agency - Forms listed by form number; Claim Form for Public Service Dental Care Plan; Government of Canada (GC) Forms Web site (accessible only on the Government of Canada network) Service Canada Forms; Canada Pension Plan and Old Age Security; Public Service Pension Plan forms; Pensioners' Dental Services Plan (PDSP) - Claim Form
The best Covid-19 travel insurance policies all offer a "cancel for any reason" travel insurance upgrade that provides 75% reimbursement of your insured trip cost.