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Injured Worker Reimbursement Rates For Travel Expense BWC-1186 - Ohio
| Injured Worker Reimbursement Rates For Travel Expense Form. This is a Ohio form and can be used in Injured Workers Workers Comp . |
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Injured Worker Better Workers Compensation Built with you in mind. Reimbursement Rates Instructions: for Travel Expense Use these rates in computing reimbursement of travel expense for the inj ured worker. Rates are subject to change every year and this chart will be updated to reflect the changes as they occur. NOTE: When the injured worker has been requested to appear for a medical exa mination by a physician of the employers choice, the travel expense statement form should be submitted to the employer. Year Year Year July 1, 2004 - June 30, 2005 July 1, 2003 - June 30, 2004 July 1, 2002 - June 30, 2003 CATEGORY RATE RATE RATE Car mileage - Must travel 50 miles round trip. 30 per mile 30 per mile 30 per mile Mileage in excess of 400 miles round trip must be authorized in advance. Meals - Distance traveled must be 100 miles or more Reimbursement per day Reimbursement per day Reimbursement per day one way. 100-199 one way= $10.00 100-199one way= $10.00 100-199 one way= $10.00 200-300 one way= $18.00 200-300one way= $18.00 200-300 one way= $18.00 over 300one way= $35.00 over 300one way= $35.00 over 300one way= $35.00 Lodging - Must be authorized in advance. Receipts $75.00 per night plus $70.00 per night plus $75.00 per night plus are required. applicable taxes applicable taxes applicable taxes Miscellaneous - Tolls and parking only. Receipts are Actual amount Actual amount Actual amount required. Other types of travel - Bus, taxi, train, air or other Over 50 miles round trip = Over 50 miles round trip = Over 50 miles round trip = special transportation. Must be authorized in advance. actual & necessary fare actual & necessary fare actual & necessary fare Receipts are required. Over 50 miles round trip Over 50 miles round trip Over 50 miles round trip Out-of-state travel or companion travel - Mode: actual & necessary fare Mode: actual & necessary fare Mode: actual & necessary fare Must be authorized in advance. Receipts are required. Lodging: reasonable actual costLodging: reasonable actual cost Lodging: reasonable actual cost Meals: $60.00 per day Meals: $60.00 per day Meals: $60.00 per day including gratuities including gratuities including gratuitiesBWC-1186e5/7/20.04) Released by BWC Policy & Support 5/7/2004C-60-A American LegalNet, Inc. www.USCourtForms.com
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