Form 25T: North Carolina Itemized Statement of Charges for Travel

Form 25T PDF Details

The use of this form is required under the provisions of the Workers' Compensation Act.

Travel: employees are entitled to reimbursement provided they travel 20 miles or more roundtrip.

Totally disabled: special consideration will be given to employees who are totally disabled.

Medications: no reimbursement is allowed for trips to purchase medications or supplies unless medically necessary.

Commission: it is not necessary to submit bills to the Commission for approval.