Transportation/Travel Expense Form

The Transportation/Travel Expense Form provides a clear and concise means to document travel expenses for which reimbursements may be sought. Request for travel expense reimbursement must be accompanied by a completed Transportation/Travel Expense Form and filed directly with the claim administrator.

If the claim administrator disputes reimbursement, a Claim Form can be filed with the Commission. When requesting reimbursement for transportation/travel expenses, the request must include a completed Claim Form, Transportation/Travel Expense Form, receipts for travel expenses and medical documentation to support the expenses incurred. Examples of medical documentation include, but are not limited to treatment records and/or billing statements that include dates of service. A hearing may be necessary to resolve disputed issues, if any.