gio travel reimbursement form

An official website of the United States government.

Here’s how you know

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• FEDERAL EMPLOYEES
• NUCLEAR WEAPONS WORKERS
• COAL MINE WORKERS
• LONGSHORE AND DBA
• Medical Bill Processing Portal
• OWCP Fee Schedules
• Federal Employees Medical Providers
• Nuclear Weapons Workers Medical Providers
• Coal Mine Workers Medical Providers
• Longshore and DBA Medical Providers
• Organization Chart
• Annual Report to Congress
• News Releases
• Procedure Manual
• Job Opportunities
• Advisory Board on Toxic Substances and Worker Health
• Federal Employees
• Nuclear Weapons Workers
• Coal Mine Workers
• Longshore and DBA
• Medical Providers
• State Workers' Compensation Programs
• Freedom of Information Act
• Report Fraud, Waste and Abuse

Medical Travel Refund Request

We have made the process of filing for medical travel reimbursement easier with two new streamlined forms.

• OWCP-957A - Medical Travel Refund Request – Mileage
• OWCP-957B - Medical Travel Refund Request – Expenses

• New Zealand
• Norfolk Island
• Australian Capital Territory
• Western Australia
• New South Wales
• South Australia
• Professional Indemnity
• Catastrophe
• Accident and Health
• Approved Insurers / Carriers
• Brokers / Intermediaries
• London Market
• Underwriting Agencies / Coverholders
• icare Insurance for NSW
• icare HBCF Claim Support
• Health and Wellbeing Program
• Advisory Services
• Return to Work Services
• GB's Injury Management Portfolio Analysis
• Injury Management Pre-Employment Screening Solutions
• Northern Territory NTPS Scheme
• Norfolk Island Workers' Compensation Scheme
• State Self Insurance Schemes
• Comcare Self Insurance Services

Make a claim

• Choose your location - Select an Answer - SA NSW VIC WA ACT TAS NT QLD
• Choose your class of insurance - Select an Answer - Workers’ compensation – employer claim Workers’ compensation – injured worker claim General insurance – property claim General insurance – liability claim General insurance – motor claim General insurance – accident and health claim Self insurance claim

Claiming travel expenses

Claiming travel expenses.

Did you know that in certain circumstances GB can reimburse you for expenses associated with attending medical and hospital appointments for your accepted work related injury or illness?

This can include:

• Private motor vehicle/public transport expenses
• Taxi travel
• Meal and accommodation expenses, and

To claim for reimbursement complete the Travel Expense Claim Form and submit it to your Case Manager. If you can’t find your Case Manager’s details you can submit it to our Payments Team .

Below we’ve outlined the different types of travel expenses you may be eligible to have reimbursed.

Private Motor Vehicle/Public Transport Expenses

If you are required to attend a medical or hospital appointment, Independent Medical Examination or Medical Panel Review as part of your accepted claim and use your own vehicle to attend, you may seek reimbursement of the distance travelled in kilometres to that appointment.  You may also claim reimbursement for parking & toll fees associated with those appointments.  If you use Public Transport in lieu of your own vehicle, you may seek reimbursement of the cost of the use of the transport.

Claims for reimbursement must be submitted in writing with the following information:

• Address of departure & arrival location
• Name of provider attending
• Date & Time of travel
• Total km’s traveled per trip (Private motor vehicle use only, reimbursed at 30c per km)
• Copies of relevant parking/toll receipts. (Please note, if the cost of the parking is less than $15, a copy of the receipt is not required).
• Cost of the ticket – Bus, Tram or Train travel. (A copy of the ticket is not required).

Taxi Travel

If you are unable to attend a medical or hospital appointment, Independent Medical Examination or Medical Panel Review by private vehicle or public transport, GB may be able to approve and reimburse you for the cost of taxi travel.  In order to approve such a request, GB would require justification in writing from your GP outlining the reasons why you are unable to travel by your own vehicle or public transport.

Claims for reimbursement of taxi expenses must be submitted in writing along with a fully detailed receipt from the taxi.

Meal and Accommodation Expenses

If you are required to attend an Independent Medical Examination or Medical Panel Review, in some instances GB can reimburse you for the cost of meal and accommodation expenses associated with that attendance.

• Meal Expenses – Can be reimbursed to you where the distance from your home to the appointment is more than 100km away and the appointment results in you being away from home at meal times
• Accommodation Expenses – Can be reimbursed to you where information has been received from your treating Dr that shows that due to your work-related injury or illness, you are unable to attend your appointment and return home on the same day.

Claims for reimbursement for both Meal and Accommodation Expenses, must be submitted with the copies of the relevant receipts for each.

Full details of reimbursement rates can be obtained from  WorkSafe’s website .

If you are required to attend an Independent Medical Exam or Medical Panel review and the use of a private motor vehicle, public transport or taxi is not practicable, GB may be able to reimburse you for the cost of air travel.

Prior approval is required, so you must ensure that you discuss this option with your Case Manager before making any arrangements.

To claim reimbursement of Air Travel, your must submit the following:

• Copy of receipt from the airline
• Details of the attendance – name of provider/hospital, date, appointment time
• Copy of approval from GB.

What GB cannot pay for

Whilst GB can reimburse you for the above expenses, there are certain expenses that you cannot be reimbursed for.  These are as follows:

• Travel for non work-related injury or illness purposes
• Expenses (including meals/accommodation) related to anyone other than the injured worker – ie: spouse, partner, child
• Meals/Accommodation expenses not associated with an Independent Medical Examination or Medical Panel Review
• Incidental Expenses for accommodation, such as mini-bar, laundry, television hire, telephone charges and alcohol
• Motor Vehicle Hire and expenses associated to that hire
• Traffic, Public Transport or Parking Fines
• Weekly, Monthly or Annual Tickets (Public Transport)
• Commercial passenger transportation services provided by drivers who do not possess appropriate accreditation with the Victoria Taxi Services Commission
• Taxi waiting time
• Chaffeur Driven Limousines
• Charges above the standard prices for air travel.

Description goes here

• Poster Designer
• Make a Claim
• Enquire Now

Get Original Poster

Please fill the form to be able to download the original poster

• First Name *
• Last Name *
• Email Address *
• Organisation *
• Job Title *
• Your Message *

Lodge an Enquiry

• State/Territory * ACT NSW NT QLD SA TAS VIC WA
• Your message
• Yes, I’d like to subscribe to the GB Advantage Newsletter
• Email This field is for validation purposes and should be left unchanged.

Let a Gallagher Bassett expert guide you

Complete some details below and we'll get back to you with our professional recommendations.

• Comments This field is for validation purposes and should be left unchanged.

Got an idea for a poster?

• Got an idea for a poster? Let us know *
• Company Name *
• Your Email *

All Formats

Table of Contents

5 steps to write a travel reimbursement forms, 10+ travel reimbursement form templates, 1. basic travel reimbursement form, 2. detailed travel reimbursement form template, 3. simple travel reimbursement format, 4. standard travel reimbursement form template, 5. sample travel reimbursement form, 6. visitor travel reimbursement form, 7. basic travel reimbursement form, 8. professional travel reimbursement format, 9. travel reimbursement form example, 10. simple travel reimbursement layout, 11. modern travel reimbursement form template.

Be it an employee or employer, an international event host or conference attendee, a reimbursement form is required by all either to claim the expenses or to reimburse the expenses. You can use a ready-made template form or can make one. The travel reimbursement form templates and examples provided below will help you.

Step 1: Format of the Form

Step 2: what details to include in the form, step 3: types of expenses and their details, step 4: non-reimbursable expenses, step 5: travel policy and reimbursement form.

• Google Docs

More in Forms

Travel & tour bi-fold brochure template, travel brochure template, modern vacation rental tri-fold brochure template, travel sale tri-fold brochure template, travel agency bi-fold brochure template, travel & tour tri-fold brochure template, beach vacation rental bi-fold brochure template, condo apartment vacation rental tri-fold brochure template, vacation rental advertising tri-fold brochure template.

• FREE 10+ Research Data Collection Form Templates in MS Word | PDF
• 15+ Sample Registration Form Templates
• 12+ Emergency Contact Forms
• 6+ Social Work Referral Form Templates in PDF | MS Word
• 10+ Reference Check Form Templates in Google Docs | PDF | MS Word | Pages
• 5+ Recruitment Authorisation Form Templates in PDF | MS Word
• 8+ Recruitment Evaluation Form Templates in MS Word | PDF
• 10+ Recruitment Application Form Templates in PDF | MS Word
• 11+ Logistics Form Templates in PDF | MS Word
• 15+ Requisition Form Templates
• 14+ Sample Printable Registration Form Templates
• 12+ Teacher Evaluation Forms in Word | Apple Pages | PDF
• 14+ Student Enrollment Form Templates PDF | DOC
• 9+ Offboarding Workflow Templates in PDF | Word | Pages | Google Docs
• 10+ Onboarding Process Templates in Excel | Word | Numbers | Pages | PDF | Google Docs

File Formats

Word templates, google docs templates, excel templates, powerpoint templates, google sheets templates, google slides templates, pdf templates, publisher templates, psd templates, indesign templates, illustrator templates, pages templates, keynote templates, numbers templates, outlook templates.

• Skip to navigation
• Skip to content

Westfield Bondi Junction Critical Incident

• Accessibility

Login Menu Opened

Type a minimum of three characters then press UP or DOWN on the keyboard to navigate the autocompleted search results

Forms and resources for employers

Select the Forms or Resources tab to browse employer documents and links listed from A–Z.

• Share this page on Facebook (external link)
• Share this page on LinkedIn (external link)
• Share this page on Twitter (external link)
• Email this page
• Print this page
• Apply for workers insurance
• Cancel your policy
• Calculating pre-injury average weekly earnings: injuries on or after 21 October 2019
• Calculating pre-injury average weekly earnings: injuries prior to 21 October 2019
• Declare your wages
• EFT claims form
• Employer or third party representative lodgement form
• Exclusion from grouping request
• Grouping registration form
• Make a claim
• Update your claim or claim a reimbursement
• Pay your premium now
• Report a fatality or make a fatality claim
• Request a certificate of currency
• Request for exemption from return-to-work coordinator training
• Sports Insurance application form
• Upload supporting documents for your claim
• Update your policy details

Injury Management Programs

• icare Injury Management Program
• DXC Injury Management Program
• EML Injury Management Program
• GBS Injury Management Program
• GIO Injury Management Program
• QBE Injury Management Program

Injury Management Programs from our other Claims Service Providers will be available here soon.

• At work you can recover better flyer
• Apprentice incentive scheme
• Calculating pre-injury average weekly earnings (PIAWE)
• Certificate of Currency
• Claims Performance Adjustment Rates
• Communicating with General Practitioners
• Crystalline silica - Frequently Asked Questions
• Direct Debit Service Agreement
• Employer Obligations Checklist – Worker Wage Information
• Employer Lookup
• icare response to WIRO annual report
• Industry hub
• Lung screen brochure
• Net Promoter Scores
• New claims employer checklist
• Policy Terms and Conditions
• Pre-injury average weekly earnings (PIAWE) fact sheet: How to set up weekly payments for injured workers
• Premium forms definitions
• Premium payments for workers insurance
• Recover at work plan
• SIRA Workers insurance market practice and premium guidelines
• Wage audit process FAQs
• Wages Definition Manual
• NSW Workers Compensation Industry Classification (WIC) and premium rates
• Work Health and Safety Regulation 2017
• Work Health and Safety (Mines and Petroleum Sites) Regulation 2022
• Workers Insurance statement of product
• Workplace rehabilitation fact sheet
• Workers Insurance

Related content

News 25 Apr

April 2024 update on icare's payment remediation activities

icare has continued to progress payment remediation activities to injured workers impacted by indexation underpayments for claims made between October 2012 and October 2019.

News 28 Nov

icare publishes new performance data on Claims Service Providers

New performance data on the icare website to help eligible employers to choose their provider.

News 10 Oct

Improve the health of your small business

October is Small Business Month in NSW and as an official collaborative partner, icare is hosting face-to-face and virtual events to support workplace health and safety for small businesses across NSW.

Events 01 Aug

Simplifying Workers Compensation in 30. Brokers and Accountants Premium Calculation Webinar

Mobile Engagement Team employer event: recorded October 2023

Our website and other digital products use free online language translation services to automatically translate our content into a number of community languages. The automatic translation provided is quick and convenient, however is a guide only and icare does not guarantee that the information is translated accurately. If you provide information via one of our digital products, it may go abroad to be translated. We do not recommend using this feature especially if your information is of a sensitive nature.

Need assistance?

We are here to help, chat with one of our team now

Make a workers compensation claim (ACT)

• New South Wales
• Western Australia
• Northern Territory
• Make a payment & manage a policy
• Training courses
• Tools & resources

Duty of Care to Your Injured Employees

As an employer you have an obligation to ensure that your employees are protected from health and safety risks arising out of their work activities.

In the event that one of your employees sustains a workplace injury or illness it is your responsibility to assist the injured worker with seeking first aid or medical treatment.

An injured worker is entitled to nominate their own treating doctor or medical practitioner who will be responsible for a medical assessment of their injury, providing them with a medical certificate and medical treatment if required.

An employer must notify  WorkSafe ACT  as soon as practicable on 02 6207 3000 or 02 6205 0200 if they are given notice of a serious event in the workplace that:

• requires or could require the employee to be hospitalised
• involved the death of a worker
• resulted in a worker being incapable of work for more than 7 days

Early Claims Notification Requirements

It is important that you notify GIO of any work-related injury or illness within 48 hours of you becoming aware of it.

To notify a work injury to GIO, you can either:

• Notify us online  or
• Complete the Injury Notification to GIO Form and email it to [email protected] or
• Complete the Injury Notification to GIO Form and fax it to 1300 725 840 or
• Phone 02 6281 8806

If an employee suffers a serious injury or death, your company must also notify WorkSafe ACT immediately on 02 6207 3000 or 02 6205 0200.

How to Lodge an Insurance Claim

To lodge a workers compensation claim you need to:

• Complete an  Employers Report of Injury Form
• Ensure your worker completes an  ACT Workers Compensation Claim Form  and you obtain an authorised Medical Certificate from the injured worker.
• Forward the completed ACT Workers Compensation Claim Form, authorised medical certificate and GIO Employers Report of Injury Form to GIO within 7 working days from when your injured worker submitted you with the signed and dated ACT Workers Compensation Claim Form.

A  Statement of Witness  form will also need to be completed if this applies.

Please refer to the Forms section of this site for other forms you may be required to complete when lodging a claim by either:

• Fax: 1300 725 840
• Mailed: ACT Workers Compensation Underwritten Claims, PO Box 47, Woden ACT 2606

GIO will respond, in writing, within 5 days from the date that the claim is lodged and will notify you about whether the claim is accepted or rejected within 28 days.

We encourage you to maintain contact with your injured worker and GIO to ensure all parties work together to achieve a successful outcome.

If you require additional assistance or support, please visit our  help and support page .

Claim Forms

Employer's Report of Injury

Employee's Claim Form

Initial Notification of Injury

Wages Reimbursement Schedule

Treatment Request Template

Witness Statement Summary

Digital Claim Forms

Compensation Reimbursement Invoice

Travel Reimbursement form

Frequently asked questions for Workers Compensation

Reporting a claim within the required timeframe can make a significant difference to the cost of a claim, and may also reduce your premium.

A common law claim is a claim for damages in which it is necessary for the worker to prove 'fault' in the form of negligence or breach of statutory duty on the part of the employer.

More Workers Compensation FAQs

Claims notification

Please notify us of a work injury and we will be in touch with you within 3 business days.

* = Mandatory fields

Time of Injury*

Time of first seek medical attention.

Please email documents to wcclaimstas@gio.com.au

Please note that this is not a claim lodgement form. Completion and submission of claim forms are still required if a claim is lodged.

Please note a claim form will need to be completed in certain circumstances after lodgement of the claim. We will notify the parties involved to further provide this information.

By lodging this claim online, you agree with GIO’s Online Terms .

• GIO PRODUCTS
• Car Insurance Products
• CTP Green Slip
• MAI Insurance
• Home Insurance Products
• Business Insurance
• Agency Stores
• Sponsorships
• Accessibility
• Cookie & Data Policy
• MY GIO INSURANCE CENTRE
• Get a quote
• Retrieve a quote
• Make a payment
• View/manage policy
• Make or track a claim
• Find your policy
• Policy documents
• Our Repair Partners
• Ways to save
• Emergency Response
• Identify scams
• Customer Care
• Customer Relations & Complaints

Website Feedback

COOKIE AND DATA POLICY

We use cookies and other related technologies to improve and tailor your website experience. See our Cookie and Data Policy . This policy provides information about how GIO collects and uses data related to your online activity, and how you can choose to remain anonymous. This content is current for Home Building, Home Contents, Landlord, Strata, Car, Motorcycle, Caravan and Boat Insurance policies with a start or renewal date on or after 22 March 2021.

AAI LIMITED TRADING AS GIO

In NSW, AAI Limited ABN 48 005 297 807 trading as GIO is an agent for the Workers Compensation Nominal Insurer ABN 83 564 379 108/003, also known as icare workers insurance. In WA, ACT, TAS & NT, insurance is issued by AAI Limited ABN 48 005 297 807 trading as GIO. Registered Office, Level 23, 80 Ann Street, Brisbane QLD 4000. In accessing the GIO site you agree to the Online terms and Conditions .

Need assistance?

Chat online now