Form 382-A - Application For Reimbursement Of Expenses

ADVERTISEMENT

APPLICATION FOR REIMBURSEMENT OF EXPENSES
• Travel Expenses • Medication • Meals and Accommodation • Clothing • Other Expenses
Occupational health and safety
Please read carefully before filling in form. In order to be reimbursed, the worker must have notified the CNESST, using the Worker’s
INSTRUCTIONS:
Claim form, of the incident giving rise to this application for reimbursement.
• Québec City:
IMPORTANT
Taxi
to a maximum of $106 per night
Provided that the worker has CNESST authorization and a medical
• Hull, Laval, Longueuil, Lac-Beauport, Lac-Delage:
Fill out the appropriate section(s) based on the type of expenses for
certificate stating that he or she is unable to use public transport,
to a maximum of $102* per night
which you are claiming reimbursement.
• Elsewhere in Quebec:
the cost of the taxi fare is reimbursed upon presentation of receipts.
to a maximum of $83* per night
Attach originals of all receipts and prescriptions (essential for
Parking and tolls
reimbursement). Securely attach them to the form, ensuring that the
Parking and tolls are reimbursable on an actual cost basis.
-
Allowance granted for each day of travel requiring hotel
CNESST file number is indicated on each document.
accommodation: $5.85.
Travelling more than 100 kilometres from home
-
Lodging with a relative or friend: $22.25 per night.
If the person accompanying the worker because of the worker’s state
If you decide to travel more than 100 kilometer from your home
The maximum amounts for hotel accomodation do not include the
of health is claiming expenses, he or she must properly fill out section
for treatment that is available closer, contact us before you
goods and services tax (GST), the Québec Sales Tax (QST) and the
2 and provide the information required concerning the worker. The
undertake such a trip. We may authorize the trip if it is the most
tax on lodging which, when applied, should be reimbursed.
medical prescription authorizing the accompanying person must also
economical appropriate solution. Otherwise, you would be entitled
be attached to the form.
to be reimbursed for the equivalent of a 200 kilometer round trip.
* Between June 1 and October 31 of each year, the $126, the $102
and the $83 maximums are increased to $138, to $110 and to $87
If the CNESST has granted an advance on travel expenses, the
respectively.
amount of the advance must be entered in space provided.
MEDICATION
CLOTHING
For quick processing, forward the claim to the CNESST regional
Clearly indicate the name of each drug and the name of the
office handling the file.
prescribing physician. Attach all supporting documents.
Briefly describe any damage to your clothing at the time of the
accident.
Claims for travel, meals or accommodation expenses must be made
MEALS AND ACCOMMODATION EXPENSES
Specify the type of expenses incurred (cleaning, repair, replacement)
within 6 months of the date on which the expenses were incurred.
and attach the bills. When claiming replacement of clothing, indicate
For medication expenses, the period is three years.
Meals
the purchase price of the damaged item.
As a general rule, meal expenses are reimbursed only if the
destination is more than 16 kilometres from the worker’s home.
Note. Under the Act, cleaning, repair, or replacement of clothing
TRAVEL EXPENSES
Meals actually taken will be reimbursed upon presentation of original
is not fully reimbursable. In this case, reimburement is subject to a
receipts and under the following conditions:
deductible amount, amended on January 1 of each year.
Public transport
-
If the worker must leave home before 7:30 a.m., breakfast
Travel by public transport (bus, subway, train, ferry) is reimbursed
is reimbursed up to $10.40;
OTHER EXPENSES
on an actual cost basis. Attach receipts if the carrier issues one as
-
If the worker must leave home before 11:30 a.m., and
a matter of practice.
return home after 1:30 p.m., lunch is reimbursed up to $14.30;
Use section 7 to claim all other expenses incurred as a result of the
-
If the worker must leave home before 5:30 p.m., and
work-related accident, and which are not mentioned elsewhere in
Personal vehicle
return home after 6:30 p.m., dinner is reimbursed up to
the form.
The costs of using a personal vehicle are reimbursed at a rate of
$21.55.
For reimbursement of expenses for services, clearly indicate the
$0.145 per kilometer.
following:
Accomodation
-
the period during which the service was provided;
Provided that the worker has CNESST authorization and a medical
Expenses for staying in a hotel or with a relative or friend must be
-
the supplier’s name;
certificate stating that he or she is unable to use public transport,
authorized by the CNESST. These expenses are reimbursed upon
-
the type of service;
the cost of using a personal vehicle is reimbursable at the rate of
presentation of receipts according to the following rates:
-
the number of children (in the case of childcare services);
$0.43 per kilometer.
-
the amount of the expenses incurred (amount claimed)
-
Hotel Accomodation
Attach the original medical prescription, if any, and all receipts.
• Montreal:
Contact your local CNESST office if you require further information.
to a maximum of $126* per night
3 8 2 - A
(2017-07)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 4