Worker reimbursement request form

Request reimbursement for claim-related medical or travel expenses.
Last updated

Jul 2021

Reading level

easy

File type and size

PDF, 62.58 kB

Document length

2 pages

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. For more information:

Further information