OWCP-957 PDF Template

[toc] The OWCP-957 PDF form is an official form put out by the United States Department of Labor, specifically the Office of Workers’ Compensation Programs. It is used to request refunds for medical travel. You should use this form when you’ve needed to travel for medical-related purposes and require reimbursement for the costs.

OWCP stands for Office of Workers’ Compensation Programs. This is a division of the United States Department of Labor. The office is responsible for the administration of four disability compensation programs. These programs provide vocational rehabilitation, medical treatment, and wage replacement benefits to certain workers who qualify.

The 957 PDF form is one of many OWCP forms that an injured or disabled worker might need to fill out. If you’ve needed to travel for medical-related purposes, such as to visit an out-of-town specialist or hospital, this is the form you use to denote your expenses. If you qualify for OWCP programs, you should be reimbursed for the expenses after you file the form.

OWCP will provide reimbursement for the medical expenses of injured workers. You can find out if you’re eligible for any of the programs through the OWCP processing portal. Before you can file any claims for reimbursement, you need to make sure you meet the eligibility requirements.

This form is part of the Office for Workers’ Compensation Program. If a worker becomes injured or disabled, OWCP is designed to reimburse medical expenses and alleviate financial hardship. Injured workers are the ones responsible for filling out eligibility information and reimbursement documentation. Employers don’t have a responsibility to do so, but they can help their injured workers by encouraging them to use the OWCP website.

If an injured worker does not have access to the internet, the employer should step in to help them with their OWCP forms. They should also educate their injured workers about the bill paying process, the accepted condition information, and how to use te online web portal.

The OWCP portal is also the best resource for people to check on their eligibility status for the programs. You’ll be able to find out what accepted conditions will make you eligible for compensation.

The form should be filled out if an OWCP-qualifying person has travel expenses for their medical care. This form is convenient because it notes travel expenses separately from medical expenses. Travel expenses often go unnoticed, but you can use this form to make sure you receive adequate compensation.

You should pay attention to your travel expenses so that you have the relevant information for the form. Keep receipts from transportation such as buses, taxis, and meals. Additionally, if you need to pay for overnight lodging, you should keep the receipt. The form even has a place to note the money spent on tolls and parking.

You aren’t legally required to fill out a Medical Travel Refund Request, so you won’t suffer any legal consequences if you fail to do so. However, you’ll only be reimbursed for your travel expenses if you fill out and file this form. Suffering an injury is stressful enough already; you don’t want to have unnecessary expenses on top of that. You shouldn’t be financially punished for something that isn’t your fault.

While you’re traveling, make sure you keep track of all of your expenses. Keep the receipts or write the totals down as you go. Expenses include taxi fare, bus and train ticket costs, tolls and parking fees, lodging costs, and meals.

Fill out the basic information with the claimant’s name, payee’s name, and claim number.

Fill out the information about travel and expenses by checking the appropriate boxes and filling in amounts on the appropriate lines.

Ignore the column that says “DOL USE ONLY,” as this will be filled out by the Department of Labor.

If you are seeking treatment for black lung, have your physician fill out the “For Black Lung Use Only” portion of the form and sign.

Sign the form at the bottom, on the line labeled “Claimaint’s/Payee’s Signature.” Then write the date.

Mail your completed form to the Office of Workers’ Compensation Programs.

If any of the specific checkboxes confuse you, the document comes with step-by-step instructions for each part. Refer to page 2 of the PDF for detailed information on each box.[pdf-embedder url=”https://cdn-prod-pdfsimpli-wpcontent.azureedge.net/pdfseoforms/pdf-20180219t134432z-001/pdf/owcp-957.pdf”]

United States. Department of Labor DFEC Central Mailroom PO Box 8300 London, Kentucky 40742-8300