Personal Expenses Reimbursement

If your claim is accepted, WSI may reimburse you (upon your request) for mileage, meals, and other out-of-pocket costs that are necessary for your medical care, within the limits of the law.

  • Mileage payments are based on map mileage from physical address to physical address.
  • For personal expense reimbursement, complete and return to WSI the Request for Personal Reimbursement form (C40a). Attach the original, itemized, and dated receipts.
  • Request for reimbursement must occur within 1 year of the date the expense was incurred. Some reimbursement exclusions do apply. For more details on reimbursement, see the C40a form.

 

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