How to Fill Out the California Workers’ Comp Medical Mileage Expense Form

To get paid back for driving to doctor visits in a California workers’ comp claim, you fill out the state’s Medical Mileage Expense Form, log each trip, and mail it to your claims administrator. For travel on or after January 1, 2026, the rate is 72.5 cents per mile, plus bridge tolls, parking, and public transit fares.¹ The form is a single-page PDF, and most of the work is just keeping an accurate log.

Where to Download the Form

The form lives on the Division of Workers’ Compensation forms page, listed as “Medical mileage expense form.”² The DWC posts a new version each time the per-mile rate changes, so download the version that matches your travel dates. The current version prints the 72.5-cent rate directly on the form.³

One naming point worth clearing up: this form is sometimes called “DWC Form 7,” but that name actually belongs to the Notice to Employees poster that employers display at worksites. The reimbursement document is titled simply “Medical mileage expense form” and carries the identifier “I&A mileage form” at the bottom of the PDF.

What to Enter on the Form

Your Name and Claim Number

At the top, write your full name and your workers’ compensation claim number. The claim number is on correspondence from your claims administrator or your employer’s insurer, such as benefit notices and medical authorization letters. Get this number right. A transposed digit routes the whole request to the wrong file.

One Row Per Trip

The body of the form is a grid. For every medical visit, fill in:

The date you traveled
The destination, meaning the name and address of the provider you saw
The round-trip miles from home to the appointment and back
The mileage amount, calculated as round-trip miles multiplied by the per-mile rate on the form (72.5 cents for 2026 travel)
Parking fees and bridge tolls paid that day, listed separately with the receipt attached

Use Google Maps or a similar tool to measure the driving distance. Log each appointment as you go rather than reconstructing months of visits from memory, which is where most missed trips and bad mileage numbers come from. If you took public transit instead of driving, write the fare in place of the mileage calculation and attach the receipt or pass record.

Sign and Date

Sign and date the bottom. An unsigned form is incomplete, and the claims administrator can send it back, which starts the clock over.

Doing the Math

Multiply round-trip miles by the rate in effect on the date you traveled, then add parking and tolls. For any trip on or after January 1, 2026, that rate is 72.5 cents.¹

Worked example: you drive 24 miles round-trip to a physical therapy appointment and pay a $7.00 bridge toll. The reimbursement is (24 × $0.725) + $7.00 = $24.40.

If your trips span two calendar years, apply each year’s rate to the trips that fall within that year. Mixing rates is a common error that produces an overpayment or underpayment the claims administrator will flag. The easy fix is to fill out a separate form for each calendar year.

Which Trips You Can Claim

Labor Code Section 4600 entitles injured workers to reimbursement for “reasonable expenses of transportation” when traveling for treatment related to a workplace injury.⁴ In practice, that covers round-trip travel to:

Your primary treating physician, authorized specialists, and surgeons
Physical therapy, chiropractic, acupuncture, and authorized mental health sessions
Imaging centers, blood draws, and other diagnostic or lab work your doctor orders
Pharmacies, for prescribed medications or orthotic devices
Medical-legal evaluations with a Qualified Medical Evaluator or Agreed Medical Evaluator

For QME and AME evaluations, the claims administrator is required to pay your transportation costs.⁵ Parking, tolls, and public transportation fares are also reimbursable through the form.³ Keep every receipt.

Where to Send the Completed Form

Mail the form to your claims administrator, which is the insurance company or self-insured employer handling your case. Their name and mailing address appear on benefit notices and medical authorization letters they have sent you. If you cannot tell who your claims administrator is, ask your employer or contact the DWC Information and Assistance Unit.

Attach receipts for all parking, tolls, and transit fares. Without receipts, those line items are routinely denied even when the mileage portion gets paid. Certified mail with a return receipt is a good choice because it gives you proof of the delivery date, which matters if payment runs late. Keep a copy of the signed form and every receipt.

How Long Payment Takes

Once the claims administrator receives your form, private-sector insurers generally have 45 days to pay or contest the charges, and government employers get 60 days.⁶ Note the date you mailed the form so you know when the deadline hits.

If payment is late, Labor Code Section 5814 allows a penalty of up to 25 percent of the amount owed for an unreasonable delay in paying any workers’ compensation benefit, including mileage. The state also imposes flat administrative penalties ranging from $25 to $100 per unpaid bill depending on the bill’s size.⁷ If a reimbursement is denied or significantly underpaid, contact the DWC Information and Assistance Unit. You can also file a declaration of readiness to proceed, which sends the dispute to a hearing before a workers’ compensation administrative law judge at the Workers’ Compensation Appeals Board.

Meals, Lodging, and Lost Wages Go Somewhere Else

When you travel to a medical exam requested by your employer, the insurer, or the WCAB, Labor Code 4600(e)(1) also entitles you to reasonable meal and lodging expenses, plus one day of temporary disability pay for each day of wages lost by attending.⁴ Overnight lodging most commonly applies when the appointment is far from home and scheduled early or late enough that same-day travel is not practical.

These claims do not go on the mileage form. Submit them directly to your claims administrator with receipts and a short note explaining why overnight travel was needed. If your doctor has indicated you need someone to drive you, the driver’s meals may also be reimbursable, but you will need written documentation from the physician stating that a driver is medically necessary.

Mistakes That Delay Payment

Using a form from a prior year that prints the old rate. Download the current version.
Reconstructing trips from memory months later. Log appointments the day you go.
Claiming parking or tolls without attached receipts.
Entering the wrong claim number, which routes the request to the wrong file.
Waiting until year-end to submit anything. Monthly or quarterly submissions keep payments flowing and reduce the chance of lost records.
Mailing the only signed copy. Photocopy or scan everything first so you can resubmit if the mail goes astray.

1
California Department of Industrial Relations. Mileage Rate for Medical and Medical-Legal Travel Expenses Increases Effective January 1, 2026
2
Department of Industrial Relations. DWC Forms – Section: Frequently Used Forms
3
Department of Industrial Relations. Medical Mileage Expense Form
4
California Legislative Information. California Code LAB 4600 – Medical and Hospital Treatment
5
Division of Workers’ Compensation. Answers to Frequently Asked Questions About Qualified Medical Evaluators for Injured Workers – Section: About the Qualified Medical Evaluator Process
6
California Legislative Information. California Code LAB 4603.2 – Medical Billing and Payment
7
Legal Information Institute. California Code of Regulations Title 8 Section 10111.1 – Schedule of Administrative Penalties