To request reimbursement for travel to workers’ comp medical appointments in California, use the State Fund medical mileage expense form, numbered e3065. Download the current revision from the injured worker forms page at statefundca.com, or request a generic version from the Division of Workers’ Compensation at 1-800-736-7401.1State Fund. Forms for Injured Workers The 2026 reimbursement rate is 72.5 cents per mile, and the same form covers parking, bridge tolls, and public transportation costs.2California Department of Industrial Relations. Mileage Rate for Medical and Medical-Legal Travel Expenses
What Travel and Costs Qualify
California Labor Code Section 4600 entitles injured workers to reimbursement for reasonable transportation expenses connected to medical treatment for a work injury.3California Legislative Information. California Labor Code 4600 – Medical Treatment Qualifying trips include visits to your primary treating physician, authorized specialists, physical therapy sessions, and the pharmacy for prescriptions from an authorized provider.4State Fund. How to Manage Your Claim
The form has dedicated fields for parking fees, bridge tolls, and public transportation or other costs.5State Fund. Medical Mileage Expense Form e3065 Bridge tolls are written into the statute as reimbursable.3California Legislative Information. California Labor Code 4600 – Medical Treatment Attach receipts for parking, tolls, and transit fares. If you used a ride-share service like Uber or Lyft, contact your claims adjuster before assuming the full fare will be reimbursed. Adjusters handle these on a case-by-case basis, and State Fund may prefer to arrange transportation through an approved vendor.
The 2026 Mileage Rate
The Division of Workers’ Compensation announced that the mileage reimbursement rate increased to 72.5 cents per mile effective January 1, 2026. The rate is tied to the IRS standard mileage rate through the connection between Labor Code Section 4600 and Government Code Section 19820.2California Department of Industrial Relations. Mileage Rate for Medical and Medical-Legal Travel Expenses The statute sets a floor of 21 cents per mile, but the CalHR-adopted rate has been higher for years, so the IRS rate is what applies in practice.3California Legislative Information. California Labor Code 4600 – Medical Treatment
The date you traveled determines which rate applies, not the date you submit the form. If your form covers trips from both 2025 and 2026, different rates apply to different rows. You do not need to calculate the dollar amounts yourself. The form instructions say State Fund will calculate the total due using the miles you report.5State Fund. Medical Mileage Expense Form e3065 For reference, the 2025 rate was 70 cents per mile and the 2024 rate was 67 cents per mile.6Internal Revenue Service. Standard Mileage Rates
How to Fill Out the Form
Form e3065 is bilingual (English and Spanish) and is a fillable PDF. At the top, enter your claim number and your name as the injured worker. If you don’t have your claim number, check any letter from your adjuster; it’s printed prominently on the first page. Getting the claim number wrong is the fastest way to delay payment.
The body of the form is a table where each row represents one trip. For each row, enter:5State Fund. Medical Mileage Expense Form e3065
- Date of travel
- Traveled from: your starting address, usually your home
- Traveled to: the name and address of the doctor, hospital, therapist, or pharmacy you visited
- Round-trip mileage: total miles for the trip there and back
- Parking and/or tolls, with receipts attached
- Public transportation or other costs, with receipts attached
Use a mapping tool like Google Maps to calculate your round-trip distance. State Fund’s adjusters verify distances against digital mapping, so your numbers should line up with what those tools show. Type the form if you can; if you handwrite it, make the addresses and numbers legible. Sign and date the bottom. The form carries a legal notice that knowingly submitting a false claim is a crime punishable by fines and imprisonment.
Where to Submit It
Mail the completed form to your assigned claims adjuster. If you’re unsure who that is, check the correspondence you’ve received from State Fund; the adjuster’s name and mailing information appear on claim letters. If you can’t locate that information, mail the form to either of State Fund’s Claims Processing Centers:5State Fund. Medical Mileage Expense Form e3065
- Fresno: State Fund, P.O. Box 65005, Fresno, CA 93650
- Suisun City: State Fund, P.O. Box 3171, Suisun City, CA 94585
Keep a copy of the signed form for your records before mailing it.5State Fund. Medical Mileage Expense Form e3065 If you fax the form, save the confirmation page as proof of submission. You can call State Fund’s claim services line at (888) 782-8338 to confirm receipt or check on a submission.7State Fund. Contact Us
When Payment Arrives
No single California regulation spells out a processing deadline exclusively for mileage reimbursement forms. The commonly cited 60-day figure comes from general workers’ comp payment timelines for expense reimbursements. If your reimbursement has not arrived after several weeks, contact your adjuster directly. Delays most often trace back to a missing or incorrect claim number, illegible addresses, or missing receipts for parking and tolls.
Reimbursement typically arrives as a physical check mailed to the address State Fund has on file. If you’ve moved since opening your claim, update your address with the adjuster before submitting the mileage form; otherwise the check goes to the old one.
If Reimbursement Is Denied or Short
If State Fund denies or underpays a mileage reimbursement, start by writing to your adjuster. Include your name, claim number, dates of travel in question, and the amount you believe you’re owed. Attach copies of your mileage form, appointment confirmations, and any mapping screenshots that support the distances you reported. Ask for a written explanation of the denial or reduction, and request a response within 14 days.
If the adjuster doesn’t resolve it, contact the DWC Information and Assistance Unit at 1-800-736-7401 or your local DWC district office. The unit provides free help to injured workers and can hold an informal conference to push the issue toward resolution. If the dispute still isn’t settled, you can file a formal petition with the Workers’ Compensation Appeals Board.
Keeping Good Records
The best habit for smooth reimbursement is logging each trip on the day it happens. Write down the date, destination, and round-trip miles right after your appointment. Reconstructing details months later leads to inaccuracies that give adjusters a reason to question or reject a submission. Keep a running list (a notes app on your phone works) and transfer the entries to a fresh e3065 whenever you’ve accumulated several trips or at least once a month.
Hold onto parking receipts, toll receipts, and any public transit tickets or fare confirmations. These support the corresponding fields on the form. Appointment confirmation emails or text reminders from your provider help if a specific visit date is ever questioned. Retain copies of every submitted form and adjuster correspondence for at least three years after your claim closes, in case a dispute arises later.