Filing a Form 25T

If your claim has been accepted as compensable by the workers compensation carrier, the carrier must pay for medical expenses that you incur as a result of your work-related injuries.  This includes mileage reimbursement at the rate of $.51 per mile (2011 rate) if you have to travel more than 20 miles round-trip from your home to your doctor’s appointments.  To obtain travel reimbursement, you must complete a Form 25T and mail the completed Form 25T in duplicate to the insurance adjuster.

If your physician visit requires an overnight stay, you can also submit your receipts for motel expenses, meal expense, parking and/or cab expenses.   You should send in all supporting receipts, if any, to the adjuster along with the Form 25T in duplicate.

After the adjuster receives the form and the receipts, he or she will issue a reimbursement check directly to you.   You can obtain a blank copy of the Form 25T from the N.C. Industrial Commission.   Click here to see a completed Form 25T as an example.

Share This