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OhioBWC - Worker - Form: (C-60) - Introduction
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Injured Worker Statement for Reimbursement of Travel Expenses - C-60
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| Introduction |
The injured worker uses this form to obtain reimbursement for travel expenses incurred as a
result of examinations or treatment for a work-related injury or disease. Before completing the C-60
online you may want to review the Injured Worker Reimbursement Rates for Travel Expenses (form C-60A)
for current reimbursement.
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| Data required for completion of the C-60 form online |
When the C-60 is completed online, the injured workers’ name,
address, phone number, social security number and claim number will be
automatically populated on the form. The following additional information is
required to complete the C-60 online:
- Dates corresponding to travel;
- Type of transportation for travel;
- Cost for transportation fare(s);
- Car mileage (if traveling by car);
- Other expenses include: parking/tolls, meals, lodging, and companion related travel.
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Receipts are required for parking/tolls, transportation
fares, lodging, out-of-state meals and companion related travel expenses. The
C-60 may be completed online if receipts are required, however if the form
cannot be submitted online – the completed form must be printed off and mailed
in with all required receipts attached.
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| Complete the forms |
The free Adobe Reader
software is required to display and print the application.
Do you have all the required information at hand? If so, you are ready to begin
completing the form. When completing the online form, please use the previous and next
buttons located at the bottom of the page to navigate
through the form.
Begin online form now.
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Are you missing some of the required information? If so,
you may return here at a later time when you have all the
information you need, and complete this online form.
Or, you may print a blank copy of the form to complete by hand
and either mail or fax it to BWC.
Print a blank form.
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