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Hearing, bring this completed form and all receipts or bills with you and give them to the W.C. Law Judge. Additionally, we recommend documenting that the claimant failed to provide a sufficient record of his or her medical and travel expenses.NYSIF Claimant Expense Record Reimbursement Request. Medical and Travel Expenses. Claimants Record Of Medical And Travel Expenses Form. Largest forms database in the USA with more than 80,000 federal, state and agency forms. A Claimant's status: (check one) Complete 3. Check only 1 of the following boxes, and then complete the daily log below. I request bus fare travel reimbursement. Compensation may be available for crime-related travel costs for victims and claimants.