Workers' Compensation Forms

For mileage that occurs in 2026, the rate is 72.5 cents per mile. Use this form to claim your mileage or travel reimbursement by sending a completed copy to your claim examiner.

For mileage that occurs in 2025, the rate is 70 cents per mile. Use this form to claim your mileage or travel reimbursement by sending a completed copy to your claim examiner.

For mileage that occurs in 2024, the rate is 67 cents per mile. Use this form to claim your mileage or travel reimbursement by sending a completed copy to your claim examiner.

For mileage that occurs in 2023, the rate is 65.5 cents per mile. Use this form to claim your mileage or travel reimbursement by sending a completed copy to your claim examiner.

Locate the Medical Mileage Expense Forms starting in 2022.

In October 2024, Governor Newsom signed AB1870, which amended LC section 3550 to include language in the DWC-7 (Notice to Employee – Injuries Caused by Work) to advise injured employees of their right to obtain an attorney and note that ‘in most instances, attorney’s fees will be paid from an injured employee’s recovery.’ As such, the state then updated the required notice forms accordingly.

Complete and send the form to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within 1 working day from a work-related injury or occupational disease.

The employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time past the date of injury or illness or which requires medical treatment beyond first aid.