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owcp travel reimbursement form

OWCP 957 Medical Travel Reimbursement

View and Print Travel Reimbursement

OWCP-957 Form

Questions? Call us at (800) 718-5658

How to get reimbursed for travel

Traveling to doctors’ appointments, testing appointments, and picking up medication can get expensive quickly. Luckily, EEOICPA “white card” holders can get reimbursed for any mileage related to medical travel by filling out an OWCP 957 Form .

Medical travel eligible for reimbursement includes:

  • Doctor or Clinic Appointments
  • Medical Testing or Procedure Visits
  • Prescription Pick-up
  • Long-Distance Medical Travel

OWCP 957 medical travel reimbursement

For travel under 200 miles round-trip, you can request reimbursement for:

For travel over 200 miles round-trip, pre-approval of expenses is necessary. Typically, you can request reimbursement for:

  • Mileage/Tolls/Parking
  • Travel Companion Expenses
  • Taxi, Bus, Airfare
  • Other expenses upon pre-approval

**If you’re planning a major medical travel event you must contact EEOICP Medical Billing and talk to your Medical Benefits Examiner for approval prior to finalizing travel arrangements.

Where to mail:

All OWCP-957 forms should be sent to:

U.S. Department of Labor

Energy Employees Occupational Illness Compensation Programs

PO Box 8304

London, KY 40742-8304

Keep in mind:

  • For pharmacy trips check “home” in boxes 5c and 5d. Under “e. Medical Facility Name and Address” make sure to list the pharmacy name and full address including zip code.
  • Only submit mileage reimbursement for appointments related to your “accepted illness.” If you aren’t approved for diabetes treatment, then you won’t be able to expense travel related to that illness.
  • The Dept. of Labor will also reimburse for medical transport services.
  • Include your case/claim number on all submitted pages.
  • All travel reimbursement requests must be submitted within 1 year of the expense.
  • The OWCP-957 form is used to submit all travel expenses. Up to 3 trips can be expensed on one form.
  • Doctor’s signature is only required for Black Lung patients.

More questions? Call us at (800) 718-5658

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FORM OWCP-957

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FORM OWCP-957:  MEDICAL TRAVEL REFUND REQUEST

About Form OWCP-957

More Resources

OWCP pays for transportation to obtain medical treatment.  The employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized medical services, appliances or supplies.  To determine what is a reasonable distance to travel, OWCP will consider the availability of services, the employee’s condition, and the means of transportation.  Generally, 25 miles from the place of injury, the work site, or the employee’s home is considered a reasonable distance to travel.  The standard form designated for Federal employees to claim travel expenses should be used to seek reimbursement under this section.  Your physician obtains ACS Web Bill Processing Portal approval from OWCP for your office visit, Schedule Award exam, medical report, test, surgery, etc.  Your physician gives you a copy to attach to your Form OWCP-957 as proof that your doctor visit, test or surgery was approved and therefore should be reimbursed as medical travel.

General Guidelines

Under 50 Miles round trip: File After Your Office Visit

File Form OWCP-957: Medical Travel Refund Request.

  • Attach your physician’s ACS Web Bill Processing Portal approval.

Over 50 Miles round trip: File Before Your Office Visit (OK to try after your visit)

  • Fax Transportation and Travel Authorization Request.
  • To get the form Google > “Authorization - Travel and Transportation 04-23-10"
  • Or go to http://owcp.dol.acs-inc.com/portal/main.do

1. Click > Forms and Links

2. Click > Federal Employees’ Compensation Act (FECA)

3. Click > Medical Authorization - Transportation and Travel

Complete the OWCP-957: Medical Travel Refund Request form to request reimbursement for your transportation/mileage expenses.  Write your name and OWCP claim number on the top right side of the form.  You may record 3 trips on each form.  The section requiring a Doctor's signature for each trip does not apply to OWCP claimants.

Mail the completed OWCP-957 to:

U.S. Department of Labor

Office of Workers' Compensation Programs

PO Box 8300

London, KY 40742-8300

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What Is Form OWCP-957?

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Form OWCP-957 Medical Travel Refund Request

  • United States Legal Forms
  • United States Federal Legal Forms
  • U.S. Department of Labor
  • U.S. Department of Labor - Office of Workers' Compensation Programs

This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on June 1, 2022 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2022;
  • The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application .

Download a fillable version of Form OWCP-957 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.

Other Revision

Download form owcp-957 medical travel refund request, linked topics.

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owcp travel reimbursement form

Mileage Reimbursement from DOL-OWCP Program

Under the Federal Employees’ Compensation Act (FECA), federal employees who are injured on the job or suffer from a work-related illness may be eligible for compensation for various expenses, including medical treatment and travel costs associated with their treatment. If a federal employee needs to travel to receive medical treatment for their work-related injury or illness, they may be able to receive reimbursement for mileage from the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) .

To be eligible for mileage reimbursement, the travel must be related to medical treatment for the work-related injury or illness. The OWCP will generally only reimburse for the distance traveled between the employee’s residence or work location and the medical provider’s office or facility where the treatment is being received. If the medical provider is located outside the employee’s local area, the OWCP may also reimburse for lodging and meals, but these expenses must be reasonable and necessary.

To request mileage reimbursement, the injured federal employee must complete a Form OWCP-957, which is available on the OWCP website or from their employing agency’s workers’ compensation coordinator. The form requires the employee to provide information about their injury or illness, the medical provider they are seeing, and the dates and locations of the appointments. The employee must also provide documentation of the mileage traveled, such as a map or odometer reading, and any receipts for lodging or meals if applicable.

Once the OWCP receives the completed OWCP-957 form and all necessary documentation, they will review the request and determine if the mileage is reimbursable under FECA. If approved, the OWCP will reimburse the employee at the current federal mileage rate, which is currently 58 cents per mile. Reimbursements are typically made by check and can take several weeks to process.

It is important for injured federal employees to keep accurate records of their medical appointments and travel expenses related to their work-related injury or illness. This includes keeping receipts for lodging and meals, as well as documenting the dates, times, and locations of all medical appointments. In some cases, the OWCP may require additional information or documentation to support a request for mileage reimbursement, so it is important to keep all records organized and easily accessible.

In addition to mileage reimbursement, injured federal employees may be eligible for other types of compensation under FECA, including wage replacement for time missed from work due to the injury or illness, payment for medical treatment and supplies, and vocational rehabilitation services to help them return to work. It is important for injured federal employees to work closely with their employing agency’s workers’ compensation coordinator and medical providers to ensure that they are receiving all of the benefits they are entitled to under the law.

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Federal Employees' Compensation Program

We also have FAQs on our Medical Authorization and Bill Pay processes for Injured Workers , Medical Providers , and Employing Agencies .

I was injured on the job. How do I file a claim?

You need to complete either form CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation" or form CA-2 "Notice of Occupational Disease and Claim for Compensation". A traumatic injury is one that can be pinpointed to have occurred during one particular work shift – falling down the steps for example. An occupational disease is a medical condition that has developed due to work activities performed over more than one work shift. 20 C.F.R. §§ 10.100-10.101 .

Forms can be submitted electronically via the Employees' Compensation Operations and Management Portal (ECOMP). Visit the ECOMP site to register for an account and initiate a claim.

If you are submitting a CA-2, you should also review the appropriate CA-35 "Evidence Required in Support of a Claim for Occupational Disease" form/checklist. There are several of these detailing the different sorts of documentation to be submitted depending on the type of occupational disease.

Be sure to keep a copy of everything for your records. Your agency will complete their portion of the CA-1 or CA-2 and submit the entire packet to the Office of Workers' Compensation Programs (OWCP) office. OWCP will advise you of the claim number which has been established. The office will review the information submitted and will determine if there is sufficient information to adjudicate the claim. If there is insufficient information to adjudicate the claim, they will send you a letter advising of the additional information needed.

Is there a timeline for filing a claim?

The Federal Employees' Compensation Act (FECA) provides that a claim for compensation must be filed within 3 years of the date of injury. For a traumatic injury, the statutory time limitation begins to run from the date of injury. For a latent condition, it begins to run when an injured employee with a compensable disability becomes aware, or reasonably should have been aware, of a possible relationship between the medical condition and the employment. Where the exposure to the identified factors of employment continues after this knowledge, the time for filing begins to run on the date of the employee's last exposure to those factors. If a claim is not filed within 3 years, compensation may still be paid if written notice of injury was given within 30 days or if the employer had actual knowledge of the injury within 30 days after it occurred. There is nothing to prohibit you from filing the claim. Timeliness is determined by the OWCP office as part of the adjudication process. 5 U.S.C. § 8122; 20 C.F.R. §§ 10.100-10.101.

How do I claim compensation for the wages lost due to my injury?

If you have a loss of wages (following any Continuation of Pay (COP) received for a traumatic injury, if applicable) and are in Leave Without Pay (LWOP) status as a result of the accepted condition(s) on your claim, you need to file a CA-7 "Claim for Compensation" with your agency. If the period claimed on the CA-7 is intermittent, you need also to complete a CA-7a "Time Analysis Form". You may file the forms on the ECOMP site . You need to provide medical documentation supporting any periods of disability claimed. Your agency will complete their portion of the CA-7 and submit it and the medical documentation to OWCP. OWCP will determine if there is sufficient information on file to pay compensation for the periods claimed or if further information/development is needed. 20 C.F.R. §§ 10.102, 10.400-10.403.

How do I buy back the leave I took for my injury?

If you used leave to cover period of disability resulting from the accepted injury, you can apply to your agency to buy back your leave. Each agency establishes its own rules for whether they allow leave buy back (LBB), timelines for submission, etc. If your agency does allow leave buy back, to request a LBB, you need to complete a complete a CA-7 and check box B in section 2. You also must sign form CA-7b "Leave Buy Back (LBB) Worksheet/Certification and Election," after it has been completed by your employing agency. If the period you claimed was intermittent (not a solid block of full days), you also need to complete a CA-7a "Time Analysis Form". Each of these forms is available through ECOMP. The agency will complete their portion and forward them to OWCP for processing. There needs to be medical documentation in the OWCP file supporting your inability to work as a result of your accepted medical condition for any period where LBB is claimed.

OWCP pays compensation at 66 2/3% of your pay rate (if you have no eligible dependents) or at 75% (if you have at least one eligible dependent), while official leave is paid at 100% of your pay rate. To buy back your leave, you have to pay your agency the difference between what you were paid and what you would have received for compensation. For example, if you have at least one eligible dependent and your pay rate was $1000 per week, OWCP would pay you $750 in compensation ($1000 x .75) if you took a week of leave. To buy back your 40 hours of leave, you need to pay your agency $250 ($1000 - $750).

How can I find out about the status of the CA-7 I filed for wage loss compensation?

Injured workers and their representatives may access information regarding case status and wage loss compensation payments by contacting the Federal Employees Program . Injured workers should have their 9-digit case file or claim number and social security number when calling.

The Claimant Query System (CQS), now part of ECOMP , also provides injured workers with 24-hour access to their case file status; accepted conditions; address of record and; compensation payments and tracking.

How do I receive my compensation payment via direct deposit?

To receive compensation payments via Electronic Funds Transfer (EFT), please complete form SF-1199a "Direct Deposit Sign-Up Form." The SF-1199a is available on our forms page .

You may upload the form to your file via ECOMP . Click the button "Access Case and Upload Document" and enter the identifying information for your case.

How do I claim a Schedule Award?

When an injured worker has permanent loss of use of certain body parts or organs, s/he may request a schedule award by submitting a CA-7 Claim for Schedule Award and an impairment rating completed by her/his treating physician. 20 C.F.R. §§ 10.103, 10.404. The impairment rating can only be completed after maximum medical improvement has been reached and must be in accordance with the 6th Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment , referencing the appropriate tables, and citing the date of maximum medical improvement. Impairment ratings may be done in a narrative format. There is not a form for the physician to complete for the impairment rating unless the Claims Examiner has provided one in response to incomplete medical documentation previously submitted.

You may file the form on the ECOMP site . Your agency will complete their portion and forward the CA-7 to OWCP.

How are Schedule Awards processed?

Once the completed CA-7 and the impairment rating have been received, reviewed, and determined to appear complete by the claims examiner, s/he forwards it to the district medical advisor (DMA) for review. In some situations, the Claims Examiner must develop the claim by contacting the claimant, employer, or rating physician for additional information. In some cases, the claimant must be referred to a second opinion medical examination to obtain a complete impairment rating.

What office do I call about my claim?

A listing of the offices and their contact information is available on our contacts page .

How do I learn my claim number?

When a case is created, a letter is mailed to the injured worker which includes the claim number and basic information about available benefits. You may also learn your claim number by calling the office with jurisdiction over your claim. Provide your name, SSN, DOB, and date of injury. The office will be able to provide you with the claim number.

If you filed your claim electronically via ECOMP, your claim number will be shown on your employee dashboard page once a case has been created.

Who can I contact for information about the status of my FECA claim?

The OWCP office that services your claim is generally the best place to contact if you have questions about the status of your claim. You may upload correspondence to your file via ECOMP . Click the button "Access Case and Upload Document" and enter the identifying information for your case.

You may also contact that office by phone or in writing. When you mail a document to the Central Mailroom, the document is scanned into the case record based on the claim number written on it. The information is made available in the computer system to the claims examiner assigned to your claim. When you call the office your call will be routed to an individual who can assist you with your concerns.

Can I communicate with my claims examiner by email?

Pursuant to policy established by the Department of Labor, Office of Workers' Compensation Programs, Division of Federal Employees' Compensation, email communication on case specific inquiries is not allowed due to security concerns. Therefore, in order to protect the identities and personal information of claimants under the Federal Employees' Compensation Act and to allow better tracking of incoming communications, we do not use email with claimants and representatives.

To correspond with OWCP, you may also upload correspondence to your file via ECOMP . Click the button "Access Case and Upload Document" and enter the identifying information for your case.

You may also send mail to U.S. Department of Labor, OWCP/DFEC, PO Box 8311, London, KY 40742-8311. As is the case with anything you send to OWCP, please note your claim number on every page, send only single sided copies, and be sure to keep a copy for your records.

Please do not send CDs, Flash Drives, DVDs, or other electronic media. We are unable to access these for security reasons. Either print and send or follow the instructions to upload the documents to ECOMP.

How do I change my address with OWCP?

To change your address with OWCP, you may upload correspondence regarding a change of address via ECOMP . Click the button "Access Case and Upload Document" and enter the identifying information for your case.

You may also send a signed letter/statement to OWCP at U.S. Department of Labor, OWCP/DFEC, PO Box 8311, London, KY 40742-8311 advising of your new address. A telephone contact is not sufficient for the OWCP to change an address. Another acceptable document for an address change is the form SF-1199a used to elect receipt of compensation payments by electronic funds transfer (EFT). As is the case with anything you send to OWCP, please note your claim number on every page, send only single sided copies, and be sure to keep a copy for your records.

Why is it so important that my claim number be on every page of anything I send to OWCP?

When mail is received in our Central Mailroom in London, KY, it is scanned into the appropriate file in our computer system based on the claim number listed on the incoming documentation. When there is no claim number, efforts are made to determine the correct claim based on other identifying information in the incoming correspondence. This can take some time, and, in many instances, mail can never be scanned into a claim because of lack of identifying information. To assure that correspondence you sent to OWCP is scanned into your claim in a timely fashion, it is imperative that you list your OWCP claim number on every page you send. Be sure to provide your claim number to all parties submitting documentation on your behalf.

What form do I use to let OWCP know that I have named someone as my authorized representative?

There is no form used for naming someone as an injured worker's authorized representative. You may upload correspondence authorizing a representative to your file via ECOMP . Click the button "Access Case and Upload Document" and enter the identifying information for your case.

If you wish to name someone (spouse, union rep, attorney, etc.) as your authorized representative, you need to send OWCP a signed statement naming that person as your authorized representative. 20 C.F.R. §§10.700-10.703. This statement needs to list your claim number and should be sent to U.S. Department of Labor, OWCP/DFEC, PO Box 8311, London, KY 40742-8311. As is the case with anything sent to OWCP, you need to note your claim number on every page, send only single sided copies, and keep a copy for your records.

How do I get a copy of my OWCP file?

You can now view, print, and/or save your complete case at – ECOMP . There, you can access the ECOMP Dashboard provided to injured workers.

Step 1 - Registration : For help registering for an ECOMP account, hover your mouse pointer over the “HELP” icon found at the top right- hand corner of the ECOMP website, and then click on the “INJURED WORKER” link found under the “USER GUIDES” column in the middle.

Step 2 - ID Verification : To access information about your FECA claims, you must verify your identity in ECOMP after you register for an account. The “IDENTITY VERIFICATION” tab under the “INJURED WORKER” user guide includes information on identity verification. You will only have to do this one time. Once your identity has been verified you will be able to sign in with only your username (email address) and password in the future. Identity verification grants you access to your complete case, so we encourage you to verify your identity in ECOMP.

How do I request a change of physician?

To request a change of physician, put the request in writing, detail the reason why you wish to change physicians, include the new physician's name, specialty, and contact information, and sign the request. You may upload correspondence regarding a change of physician via ECOMP . Click the button "Access Case and Upload Document" and enter the identifying information for your case.

This may also be mailed to U.S. Department of Labor, OWCP/DFEC, PO Box 8311, London, KY 40742-8311. Your claims examiner will review the request and advise you whether the change is approved. As is always the case, please be sure to include your claim number on every page you send. You will receive written notice of the approval of your request.

Can I receive my medical transportation and mileage reimbursement payments via direct deposit?

No. At this time, these payments are issued via paper check.

Will OWCP reimburse me for lunch or other meals when I have to travel for medical treatment?

OWCP reimburses for travel based on the Federal Travel Regulation (41 C.F.R. 300-304). Per diem reimbursement is covered in Chapter 301-11.1.c. which specifies that you must be in a travel status for more than 12 hours to be eligible for per diem reimbursement (either actual cost or per diem).

What is the mileage reimbursement rate for travel to medical appointments?

Travel to medical appointments is reimbursed according to the rate determined by the General Services Administration (GSA) for privately owned vehicles (POV). Therefore, the amount reimbursed by OWCP is subject to change should GSA change the POV mileage reimbursement rate. To view the current mileage reimbursement rate, please visit the GSA website .

Where can I get copies of OWCP forms?

Our forms page contains many forms that you would need to initiate yourself. There are some forms (a CA-1032, for example) that are issued by a claims examiner. If you've been sent a form to complete, have misplaced it, and can't find it at our forms website, please call your office with jurisdiction over your claim to request a replacement.

Why isn't the CA-16 on the web? How do I get a copy?

The CA-16 is not available on our website because it guarantees payment of medical expenses. We limit access to the form as it is to be issued by the employing agency and may only be used in certain circumstances.

If you are the injured worker, your agency will provide this form if it is appropriate.

If you are the supervisor of an injured worker, please contact your Workers' Compensation Unit for this form.

If you are with the Workers' Compensation unit, your Headquarters should have a supply of these forms. Even if a supply is unavailable, they should be able to provide you with one CA-16 that you can copy as needed.

Authorized employing agency users of the Agency Query System (AQS) may access an electronic version of the CA-16 for download through the AQS website.

If Form CA-1 is electronically filed via ECOMP, employing agency users may obtain a copy of Form CA-16 in electronic format after completing the supervisor review step.

Where is the AB-1 form I can use to file an appeal with the ECAB?

The AB-1 form is available on the Employees' Compensation Appeals Board (ECAB) site . The form is in the library of links on the right side of the page.

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COMMENTS

  1. PDF Medical Travel Refund Request U.S. Department of Labor

    This form is for medically related travel covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act and the Energy Employees Occupational Illness Compensation Program Act of 2000. It requires claimant's and payee's information, travel details, medical facility names and addresses, and physician's signatures or facsimiles.

  2. OWCP-957A

    This is a mileage only reimbursement form. If you need other travel expenses reimbursed, complete Form OWCP-957 Part B Medical Travel Refund Request - Expenses. Enter claimant's full name: last name, first name, middle initial (M.I.). Enter claimant's claim/case file number.

  3. PDF DFEC

    DFEC - Travel DFEC Travel Authorization Request (Fax # 1-800-215-4901) Please read the instructions carefully before completing authorization request. Complete all applicable fields. All Prior Authorization requests must either be faxed on this template or be submitted through the Web Bill Processing Portal (https://owcpmed.dol.gov).

  4. PDF OWCP-957 Medical Travel Refund Request

    Title: OWCP-957 Medical Travel Refund Request Author: U.S. Department of State Subject: OWCP-957 Medical Travel Refund Request Created Date: 8/19/2008 4:58:04 PM

  5. Information for Injured Workers and their Representatives

    Case specific correspondence other than reimbursement claims and claim forms may either be mailed to U.S. Department of Labor, OWCP/DFEC, PO Box 8311, London, KY 40742-8311 or uploaded to the case electronically on the ECOMP website.

  6. OWCP

    Medical or Travel reimbursement forms must be mailed to OWCP/DFELHWC-FECA, P.O. Box 8300, London, KY 40742-8300. UPLOAD DOCUMENTS Medical Providers: Only medical reports can be submitted in ECOMP. Do not upload bills in ECOMP as they will not be processed.

  7. PDF Medical Travel Refund Request U.S. Department of Labor

    Instructions (Form OWCP-957) Enter claimant's full name: last name, first name, middle initial. Enter claimant's claim/case file number. Enter payee's full name (if person other than the claimant is to be reimbursed): last name, first name, middle initial. payee other than the claimant must have special authorization.

  8. OWCP 957 Reimbursement for Medical Travel

    OWCP 957 Reimbursement for Medical Travel - EEOICPA View and Print Travel Reimbursement OWCP-957 Form Questions? Call us at (800) 718-5658 How to get reimbursed for travel Traveling to doctors' appointments, testing appointments, and picking up medication can get expensive quickly.

  9. PDF U.S. Department of Labor

    Instructions (Form OWCP-957) Enter claimant's full name: last name, first name, middle initial. Enter claimant's claim/case file number. Enter payee's full name (if person other than the claimant is to be reimbursed): last name, first name, middle initial. payee other than the claimant must have special authorization.

  10. 20 CFR 10.315 -- Will OWCP pay for transportation to obtain medical

    If the medical evidence shows that the employee is unable to use these means of transportation, OWCP may authorize travel by taxi or special conveyance. ( b) For non-emergency medical treatment, if roundtrip travel of more than 100 miles is contemplated, or air transportation or overnight accommodations will be needed, the employee must submit ...

  11. OWCP-957B

    Instructions - Form OWCP-957 Part B - Medical Travel Refund Request - Expenses Enter Claimant's full name: last name, first name, middle initial (M.I.). Enter Claimant's claim/case file number. Enter payee's full name (if person other than the claimant is to be reimbursed): last name, first name, middle initial.

  12. Procedure Manual

    c. OWCP-957 (Travel Voucher). This form should be used for all medical travel reimbursement and replaces the SF-1012. d. OWCP-915 ... The completed Form OWCP-915, Claim for Medical Reimbursement. (2) HCFA-1500 or UB-92 for services provided by a physician or other healthcare provider. The bill must be completed in its entirety as if it were ...

  13. Doc Explains Fed Work Comp (OWCP-957)

    Complete the OWCP-957: Medical Travel Refund Request form to request reimbursement for your transportation/mileage expenses. Write your name and OWCP claim number on the top right side of the form. You may record 3 trips on each form. The section requiring a Doctor's signature for each trip does not apply to OWCP claimants.

  14. OWCP

    OWCP - U.S. Department of Labor - DOL

  15. Form OWCP-957 Medical Travel Refund Request

    Download Fillable Form Owcp-957 In Pdf - The Latest Version Applicable For 2024. Fill Out The Medical Travel Refund Request Online And Print It Out For Free. Form Owcp-957 Is Often Used In U.s. Department Of Labor - Office Of Workers' Compensation Programs, Refund Request Form, Travel Expense Form, U.s. Department Of Labor, Workers Compensation Forms, United States Federal Legal Forms ...

  16. PDF Claim for Medical Reimbursement U.S Department of Labor

    Form OWCP-915 can be used to seek reimbursement for expenses in regard to medical treatment, prescription medication and medical supplies. Please submit a separate reimbursement claim for each provider where an out of pocket expense was incurred. Please print clearly and legibly. Reference your OWCP file number on all documentation.

  17. Mileage Reimbursement from DOL-OWCP Program

    To be eligible for mileage reimbursement, the travel must be related to medical treatment for the work-related injury or illness. The OWCP will generally only reimburse for the distance traveled between the employee's residence or work location and the medical provider's office or facility where the treatment is being received.

  18. Medical Travel Refund Request U.S. Department of Labor

    While you are not required to respond, this information is required to obtain reimbursement for travel expenses. The method of collecting information complies with the Freedom of Information Act, the Privacy Act of 1974 and OMB Circ. 108.

  19. Federal Employees' Compensation Act

    You need to complete either form CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation" or form CA-2 "Notice of Occupational Disease and Claim for Compensation". A traumatic injury is one that can be pinpointed to have occurred during one particular work shift - falling down the steps for example.