Reimbursement for Personal Expenses

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). Attached to the form must be 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.