Injured worker's name and claim number
- What to put
- Your name as it appears on the claim, and the number the claims administrator uses
A trip to treatment is paid at the rate in force on its own date. Send the form for that period to the insurance company, and claim parking, tolls and public transport beside the miles.
On or after July 1, 2026
76 cents per mile
The rate is the same whatever the date of injury.
January 1 through June 30, 2026
72.5 cents per mile
The rate for a trip in the first half of 2026.
Travel to treatment for a work injury pays 76 cents per mile for trips on or after July 1, 2026, and 72.5 cents per mile for trips from January 1 to June 30, 2026. The claims administrator, which is the insurer adjusting the claim, owes that figure for the day you travelled, whatever the date of the injury. Claim it on the Division of Workers' Compensation mileage form for the period, with parking, bridge tolls and public transport in their own boxes.
The rate in force on the day of the visit prices that visit, and each period has its own form.
| Travel dates | Rate | Announced | Announcement | Form |
|---|---|---|---|---|
| On or after July 1, 2026 | 76 cents per mile | July 23, 2026 | DWC Newsline 2026-60 | Current mileage form, from the Division's form list |
| January 1 through June 30, 2026 | 72.5 cents per mile | January 5, 2026 | DWC Newsline 2026-02 | Mileage form for travel on or after January 1, 2026 |
| January 1 through December 31, 2025 | 70 cents per mile | December 20, 2024 | DWC Newsline 2024-112 | Mileage form for travel on or after January 1, 2025 |
Figures checked on November 3, 2026 against the Division of Workers' Compensation mileage rates and the announcement beside each figure. You claim parking, bridge tolls and public transport on the same form, and the per-mile figure does not cover them. A period that is no longer listed is still claimable, and the Division's form list holds the older sheets.
The claim takes one sheet. Fill in a line for each visit and send it to the insurance company, not to the Workers' Compensation Appeals Board.
The form is a single sheet in English and Spanish. It prints the rate for its own period and works out the total, so the figure on the paper is the figure the claim pays.
Fill one line for each visit, sign the form, and send the original to the insurance company. Keep a copy for your own file.
The Division of Workers' Compensation publishes a separate form for each rate period, and each one prints the figure it pays. The newest form is not the right one for an older trip.
Each line names its own day and route, the round-trip miles, and the parking and tolls you paid. A visit priced at one rate can sit beside a visit priced at another.
Parking, bridge tolls and public transport need a receipt. The mileage does not, because the form totals your miles at the printed rate.
The form says not to send the original or a copy to the local Workers' Compensation Appeals Board or to the information and assistance officer. The insurer's address is the one on your claim paperwork.
If your travel costs are not paid within 60 days, the form says to contact the information and assistance officer at the Division of Workers' Compensation district office nearest you.
| What the form asks for | What to put |
|---|---|
| Injured worker's name and claim number | Your name as it appears on the claim, and the number the claims administrator uses |
| Date and route | The day of the visit, the address you travelled from, and the name and address of the doctor, hospital, therapist or pharmacy |
| Round-trip mileage | The miles for the whole visit, there and back |
| Parking and tolls | What you paid, with the receipts attached |
| Signature | Your signature, your printed name and the day you signed |
The form has a box for parking and a box for tolls, and it totals each one separately before adding them to the mileage.
A claim that covers several appointments is a list of trips with different dates. The calculator prices each trip at the rate in force on its own date and adds them up.
Enter the day and the round-trip miles for each visit. The calculator prices each one at the rate in force on its own date, and nothing is sent anywhere.
There and back, as the form counts it.
The per-mile figure pays for the driving. Everything else you spend getting to treatment goes in its own box on the same form, and the Division lists the costs it covers.
Reasonable travel means the trip to a doctor, a hospital, a therapist or a pharmacy for the injury. A detour for something unrelated to the treatment is not part of the claim.
A rate change in the middle of treatment does not change the price of the visits you already made. Each trip pays the figure in force on its own date, so a claim that spans June and July carries both.
Two visits to the same clinic, one in June at 72.5 cents per mile and one in July at 76 cents per mile, show how the arithmetic splits. Parking and the toll sit beside the mileage rather than inside it.
| Visit | Travel date | Miles | Rate | Amount |
|---|---|---|---|---|
| Round trip to the clinic | June 24, 2026 | 34 | 72.5 cents per mile | $24.65 |
| Round trip to the clinic | July 15, 2026 | 34 | 76 cents per mile | $25.84 |
| Parking at the clinic | July 15, 2026 | $6.00 | ||
| Bridge toll | July 15, 2026 | $4.00 | ||
| Mileage for the two visits | 68 | $50.49 | ||
| Total to claim | $60.49 |
Each visit is priced at the rate in force on its own date. Parking and the toll are added after the mileage because the form prints them in separate boxes.
Travel to a medical-legal examination is paid at the same rate as travel to treatment, and the Division's announcements name both kinds of travel.
Section 4600(e)(1) covers an examination the claim sends you to. It applies when the employer, the insurer, the Division's Administrative Director, the Workers' Compensation Appeals Board or a workers' compensation judge asks you to attend. The reasonable cost of getting there is a benefit.
A private employer's duty to cover the cost of business driving is a different rule with a different payer. Labor Code 2802 makes an employer reimburse the expenses the job causes, such as a customer visit or a delivery, and none of it is a workers' compensation benefit.
The two are easy to confuse because both follow the federal figure. The claims administrator pays treatment travel, and the employer pays business driving. If your employer has not paid for miles you drove for work, the claim is under Labor Code 2802 and not on this form.
For 2026 the IRS allows 20.5 cents a mile for medical travel from January 1 to June 30 and 23.5 cents a mile from July 1. That figure is a deduction, not a payment. It reduces taxable income on Schedule A when you itemize, and only medical costs above 7.5 percent of your adjusted gross income count towards it.
A trip the claims administrator paid for cannot be deducted as well, and the workers' compensation rate is not a deduction figure. Put the cents the form prints on the form, and leave the medical deduction out of it.
The private employer's Labor Code 2802 duty, the IRS medical deduction, the 2026 IRS figures and every state's rule.
Travel on or after July 1, 2026 pays 76 cents per mile. Travel from January 1 to June 30, 2026 pays 72.5 cents per mile, and travel in 2025 pays 70 cents per mile. The figure in force on the day of the trip decides the rate, whatever the date of the injury.
The one published for the period you travelled. The Division of Workers' Compensation lists a form for each period: travel on or after July 1, 2026, on or after January 1, 2026 and on or after January 1, 2025. Each one prints the rate it pays. A period that is no longer on that list is still claimable, and a district office can supply the form.
The claims administrator pays it as part of the claim. The form tells you to send the original to the insurance company and keep a copy. Do not send either to the Workers' Compensation Appeals Board.
The rate does not depend on the injury date. Each announcement applies the figure to travel on or after its effective date, whatever the date of injury, so an older claim still pays the current figure for a current trip. Travel from January 1 to June 30, 2026 keeps the 72.5-cent figure.
You claim parking and bridge tolls on top of the mileage. The form reimburses parking, bridge tolls, public transport and other travel-related costs in their own boxes, and the per-mile figure covers the driving alone. Keep the receipts, because the form asks you to attach them.
The form covers a bus or train fare. It names public transport among the travel costs it reimburses, so you claim the fare and its receipt for that visit instead of mileage.
The IRS medical figure is 20.5 cents a mile from January 1 to June 30, 2026 and 23.5 cents a mile from July 1. It is a deduction, not a payment. A trip the claims administrator paid for cannot also be deducted.
The form says to call the information and assistance officer at the nearest Division of Workers' Compensation district office once 60 days pass without payment.
The treatment an employer owes an injured worker, and the reasonable transportation a requested medical-legal examination adds.
The published rate by start date, with the expenses of transportation it covers: mileage, parking and bridge tolls.
Announced on July 23, 2026. The 76-cent figure is paid for travel on or after July 1, 2026, whatever the date of injury.
Announced on January 5, 2026. The 72.5-cent figure is paid for travel on or after January 1, 2026, whatever the date of injury.
Announced on December 20, 2024. The 70-cent figure is paid for travel on or after January 1, 2025, whatever the date of injury.
A form for each rate period in English and Spanish, including periods that have closed. Ask a district office when a form is missing.