The Sedgwick mileage reimbursement form is a travel log you fill out to be paid back for driving to medical appointments on a workers’ compensation or disability claim. You can download it inside the mySedgwick claimant portal at mysedgwick.com, or ask your assigned claims examiner to send you one. Fill in each trip, multiply your total miles by the per-mile rate that applies to your claim, sign it, and send it back through the portal.
Getting the Form
Log in to mySedgwick, open your specific claim, and look in the forms or document upload area of your claim dashboard.1Sedgwick. Help With My Claim If no blank mileage form is available there, message your examiner through the portal or call them and ask. Some will email a PDF; others mail a paper copy.
Sedgwick also runs an older portal, viaOne (viaone.sedgwickcms.net), that some employers still use. Which system you log into depends on your employer’s setup, so check your welcome letter or initial claim correspondence if you aren’t sure.
What to Have Ready Before You Start
Pull these together first. A form missing any one of them tends to stall:
- Your Sedgwick claim number, exactly as it appears on correspondence from your adjuster.
- The calendar date of each medical visit (the day you traveled, not the day you were billed).
- The full name and street address of each provider you visited: doctor’s office, physical therapy clinic, pharmacy, imaging center.
- Your starting address for each trip. Usually home, but it could be your workplace if you left from there.
- Round-trip mileage for each visit, measured with a mapping tool like Google Maps along the shortest drivable route. Adjusters verify distances against mapping software, so your numbers should line up with what those tools show.
- Receipts for parking, tolls, and public transportation fares tied to the medical travel.
Hang on to appointment confirmation emails, signed check-in sheets, or after-visit summaries. These are the first backup an adjuster looks at to confirm you actually attended the appointments on your log.
Filling In the Form
The top of the form asks for your full legal name, claim number, and contact information. Some versions also ask for your employer and your date of injury. Check the claim number twice. A single transposed digit routes the form to the wrong file.
The body is an itemized travel log. One row per trip, with columns for the date of service, provider name, starting address, destination address, one-way miles, and round-trip miles. If you saw two providers at different locations on the same day, give each leg its own row.
Enter distances based on the shortest direct route. A mile or two of rounding won’t cause problems, but padding by a noticeable margin invites a denial of that line. If your listed distance and the adjuster’s mapping result don’t match, they’ll either reduce the reimbursement to the shorter figure or send the form back.
Calculating the Dollar Amount
Most versions of the form have a column where you multiply total miles by the per-mile rate. The applicable rate depends on your state’s workers’ compensation rules, and a large number of states peg theirs to the IRS business standard mileage rate. For 2026, that rate is 72.5 cents per mile.2Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents per Mile, Up 2.5 Cents If you aren’t sure what rate applies to your claim, ask your adjuster to confirm.
The math is straightforward. A 34-mile round trip to the orthopedist at $0.725 per mile is $24.65 for that visit. Add the per-trip totals to get the grand total at the bottom of the form. Check the arithmetic. A math error is one of the most common reasons a form gets kicked back.
Signing the Form
The signature line sits above a certification statement. Signing means you’re attesting that every trip listed happened and that the distances are accurate. Sedgwick returns unsigned forms without processing them.
Parking, Tolls, and Other Travel Costs
Mileage isn’t the only expense workers’ compensation covers. Depending on your state, you may also be reimbursed for parking fees, bridge and highway tolls, and public transportation fares. If treatment requires traveling a long distance to a specialist several hours away, some states also cover meals and lodging at rates tied to state employee travel allowances.
Attach itemized receipts for each non-mileage expense. A credit card statement showing a parking charge is usually not enough on its own; adjusters want the garage or lot receipt showing date, location, and amount. For tolls, an account statement from an electronic toll service works. List these costs in the form’s designated section, or on a separate sheet attached to the mileage log if the form doesn’t have a spot for them.
Sending It Back to Sedgwick
Uploading through mySedgwick is the fastest route and creates an instant digital record. Open your claim and use the document upload feature to attach the completed form as a PDF.1Sedgwick. Help With My Claim If you’re attaching scanned parking or toll receipts, combine everything into one PDF so nothing gets separated inside the system.
If the portal isn’t an option, fax the form to the number in your claim correspondence with a cover sheet listing your claim number, name, and page count. For paper mail, send it to the claims office address on your adjuster’s letters. Use certified mail or a tracked service. If Sedgwick says they never got the form, a tracking confirmation keeps you from starting over. Keep a copy of everything you send either way.
When Payment Arrives
Once the form reaches an adjuster, they cross-reference each trip date against the medical records in your file to confirm you had an authorized appointment that day. Dates that don’t line up with any billing or treatment record get flagged. When everything checks out, reimbursement typically arrives within 14 to 30 days, by paper check or direct deposit depending on your payment setup.
You can watch payment status inside mySedgwick under authorized transactions for your claim. If 30 days pass with no payment and no word from your adjuster, follow up. A quick call often turns up a missing receipt or a form sitting in a queue.
Why Forms Get Delayed or Denied
Most problems trace back to paperwork rather than any dispute over whether you should be paid:
- The listed mileage doesn’t match mapping software. The adjuster will reduce it to the shorter distance or return the form.
- No matching medical record exists for a listed trip. If your provider hasn’t submitted billing or records for that date, the adjuster can’t verify the visit.
- The form isn’t signed. It comes back without review.
- The provider wasn’t authorized under your treatment plan. Travel to an unapproved doctor or facility may not qualify. Get authorization from your adjuster before seeing a new provider.
- Dates were submitted twice. Duplicates slow the whole batch while the adjuster sorts out which entries are new.
If part of your claim is denied, the notice will say which line items were rejected and why. For math errors or missing receipts, resubmit a corrected form. For substantive disagreements over whether a trip was authorized, start with a call to your adjuster. If that doesn’t resolve it, your state’s workers’ compensation board has a formal dispute process, generally beginning with a request for a review conference or hearing.
Deadlines
Don’t let mileage forms pile up. Submission deadlines vary by state and commonly run one to two years from the date of travel, but waiting creates problems well before any hard cutoff. Medical records get harder to match, adjusters change assignments, and your memory of trip details fades. Submitting monthly, or after every few appointments, works better than saving a year of trips for one giant batch.
Are These Reimbursements Taxable
Workers’ compensation benefits, including mileage reimbursement for medical travel, are not taxable income. The IRS fully exempts amounts received under a workers’ compensation act from federal income tax.3Internal Revenue Service. Publication 525 – Taxable and Nontaxable Income You don’t report these reimbursements on your return, and Sedgwick doesn’t issue a 1099 or W-2 for them.4Office of the Law Revision Counsel. 26 USC 104 – Compensation for Injuries or Sickness