If you have paid out of pocket for a prescription or for getting to your doctor after a work injury, you can ask to be paid back. In New York, the form for that is the C-257, Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement. Here is what it covers, how to fill it out and where to send it.
What Form C-257 covers
The C-257 is used to request reimbursement for two kinds of expenses related to your work injury:
- Medications and supplies that a health care provider prescribed and you paid for yourself.
- Travel to and from your doctor’s office or the hospital: bus, train or cab fares, mileage if you drove, and other necessary travel expenses.
For more on which trips count and how mileage is figured, see travel expenses and mileage reimbursement.
How to fill it out
- Fill in the top of the form with your WCB case number, your name and your address.
- List each expense on its own line with the date, the amount and what it was for (for example, “round trip to orthopedist, 18 miles” or “prescription, CVS”).
- List expenses even if you don’t have a receipt, but get receipts whenever you can.
- Attach copies of your receipts and bills. Keep the originals.
- Keep a copy of the completed form for your records.
Where to send it
Send the C-257 and your receipts to the workers’ comp insurance carrier, or to your employer if it is self-insured, and to the Workers’ Compensation Board. The Board accepts it by mail at its centralized mailing address in Binghamton or by email at wcbclaimsfiling@wcb.ny.gov. Always download the current version of the form from the Board’s website.
Tips to get paid
- Keep a running log. Write down every appointment, the round-trip miles and any parking or tolls the day it happens. It is much harder to rebuild months later.
- Save every pharmacy receipt, including co-pays.
- Send it in regularly. Submitting every month or two keeps the amounts small and easier to track.
- Keep tracking if your claim is denied. If the carrier is fighting your case, keep your records. If the claim is later established, you can still ask to be reimbursed.
- Follow up if you are not paid. If the carrier ignores or denies your request, the issue can be raised with the Board.
Frequently asked questions
What is Form C-257 in New York workers’ comp?
It is the Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement. Injured workers use it to be paid back for prescribed medications and supplies they paid for, and for travel to and from medical appointments.
Where do I send a C-257?
Send it with copies of your receipts to the workers’ comp insurance carrier, or your employer if it is self-insured, and to the Workers’ Compensation Board by mail or by email at wcbclaimsfiling@wcb.ny.gov.
Can I get reimbursed for mileage to my doctor?
Yes. Mileage for driving to and from medical treatment for your work injury is one of the travel expenses you can list on the C-257, along with fares and other necessary travel costs.
What if the carrier doesn’t pay my C-257?
Keep copies of everything you sent and the date you sent it. If the carrier does not pay or objects, the issue can be raised with the Workers’ Compensation Board. A lawyer can help.
Talk to a New York workers’ compensation attorney
The Law Offices of Frank J. Dito, Jr. handles workers’ compensation claims from the office on Staten Island, for injured workers throughout the five boroughs and across New York State. If the carrier is not paying back your expenses, call us and we will help.
Call 718.701.2776 or 800.310.5520. Consultations are free. If we don’t recover money for you, we don’t get paid.
