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We recommend keeping track of the mileage and related expenses pertaining to your workers' compensation claim. You may use this form to calculate mileage reimbursement for transportation expenses primarily for and essential to medical care.How to properly fill out the Medical Mileage Form for Workers Compensation. Make the steps below to complete Workers comp mileage reimbursement 2022 form online easily and quickly: Sign in to your account. All Users of the Medical Assistance Transportation Program (MATP). Purpose. Mileage Worksheet for Medical Treatment - Examination - Physical Therapy - Laboratory Test. Pharmacy or other medical care provider. You are entitled to reimbursement of travel expenses for medical treatment resulting from your work related injury. This Request for Mileage Reimbursement form can be used to keep track of your travel to and from your doctor's appointments. Mileage Reimbursement Request. EMPLOYEE. EMPLOYEE. ADDRESS.