Worker reimbursement request form

What it contains

Use this form to request reimbursement for claim-related medical or travel expenses.

Travel reimbursement is for reasonable travel expenses you incur attending medical and hospital services required as a result of an accepted work-related injury or illness or where a worker* is entitled to provisional payments on a claim that includes a mental injury. It includes reasonable costs associated with:

• private motor vehicle, including road tolls and car parking
• public transport
• in some cases, taxi travel to and from your treatment

Requests for travel expense reimbursements must be submitted within 6 months of date of travel.

* Eligible Victorian volunteers are also entitled to provisional payments.