Fill Out Your Owcp 957 Form

What is Form OWCP-957 used for?

Form OWCP-957 is a Medical Travel Refund Request used by individuals seeking reimbursement for travel expenses related to medical treatment under the Federal Employees' Compensation Act, the Black Lung Benefits Act, or the Energy Employees Occupational Illness Compensation Program Act. This form must be completed and submitted to obtain repayment for eligible expenses incurred while traveling for medical care.

Who is eligible to use Form OWCP-957?

This form is intended for claimants who have sustained work-related injuries or illnesses and require medical treatment. Specifically, it is for those who wish to be reimbursed for travel costs associated with their medical appointments. In some cases, a payee may be designated to receive reimbursement on behalf of the claimant.

What information do I need to provide on the form?

Necessary information includes the claimant’s name, case number, travel details (dates, locations), and itemized expenses for each trip. Receipts for all claimed expenses must also be included. If a payee is involved, their details and relationship to the claimant must be clarified.

Are there any special instructions for lodging reimbursement?

Yes, for lodging reimbursement, special approval is required. Requests will only be honored if you are traveling more than 100 miles one way or 200 miles round trip. Approval must come from the relevant district office, which you can contact directly for guidance.

What types of expenses can I claim?

You can claim various medical travel-related expenses, including taxi, bus, train fares, tolls, parking costs, lodging, and meals. Each type of cost must be itemized clearly on the form, along with the total amount spent for each expense type.

What if the claimant is not the one being reimbursed?

If the reimbursement is intended for someone other than the claimant, the payee's details must be provided. Additionally, you need to describe the relationship between the claimant and the payee and provide reasons for requesting reimbursement. Authorization is necessary for this process.

What is required for verification by a physician?

The form mandates a physician’s signature or facsimile for verification when the claim pertains to Black Lung treatment. This signature must confirm the date and type of services rendered during the visit related to the medical travel being claimed.

What might happen if inaccurate information is provided?

Providing false information on Form OWCP-957 can have serious consequences. It may lead to civil, administrative, or even criminal penalties. Inaccurate claims can result in a denial of reimbursement, and ongoing fraud can jeopardize future OWCP benefits.

Filling out the OWCP 957 form can be a straightforward process, but mistakes can delay your reimbursement for medical travel expenses. One common error is failing to provide complete and accurate information regarding the claimant's name. This section requires the last name, first name, and middle initial. Omitting a part of the name or getting the order wrong can cause complications in processing your claim.

An additional mistake comes from misunderstanding the case or claim number. Every submission should include a valid claim number, and if it's missing or incorrect, it can lead to delays in reimbursement. Ensure you double-check this information against any correspondence you’ve received regarding your claim.

Many people forget to include the payee’s name, sometimes assuming it’s the same as the claimant's. If a different individual is to receive reimbursement, it's essential to provide their full name and the reason for the change. Ignoring this requirement can lead to issues when trying to process the claim.

Another area where errors frequently occur is in the address section. Using a Post Office Box or an attorney's address instead of a physical residence address can result in immediate rejection of the form. Always provide a complete physical address as specified in the instructions or risk delays.

When reporting travel information, it’s important to complete separate blocks for each medical facility visited, especially on the same day. Failing to do this can create confusion about your travel and expenses. Furthermore, be sure to mark one box for each travel type accurately. If multiple visits are involved, make sure to document every detail clearly.

Another common issue is neglecting to attach all necessary receipts. Each expense listed should have an accompanying original receipt that includes the claimant's name and Social Security number. Remember, claims without these receipts may be denied.

People also overlook the requirement of a physician's signature for certain claims, particularly those related to Black Lung. This detail is crucial for verification. Missing this signature can lead to an automatic denial of the claim.

In addition, some individuals forget to sign the certification section, which confirms that all information provided is accurate. This oversight may result in processing delays or outright rejection of the application.

Lastly, miscalculating travel expenses can be a costly mistake. It’s essential to accurately total the expenses associated with each component of the trip. Even minor miscalculations can affect the amount you are eligible to receive.

By avoiding these common pitfalls, the processing of your OWCP 957 form can proceed more smoothly, allowing you to receive the reimbursement you deserve in a timely manner.

The OWCP-957 form is an essential document for those seeking reimbursement for travel expenses related to medical care under the Federal Employees' Compensation Act, the Black Lung Benefits Act, and other programs. Besides the OWCP-957, a few additional forms and documents are often utilized in conjunction with it to ensure a smooth claims process. These documents help provide necessary information to facilitate reimbursement and clarify the details of the claim.

• OWCP-5 Form: Known as the "Work Capacity Evaluation," this form is often required for individuals claiming benefits because it assesses their ability to work after an injury or illness. This information helps in determining eligibility for continued compensation.
• OWCP-1 Form: This is the "Federal Employees' Claim for Compensation." It serves as the initial claim form for federal employees to report injuries that occurred while on the job. It lays the groundwork for any further reimbursement claims, including travel expenses.
• Medical Treatment Authorization: This document authorizes healthcare providers to deliver medical treatment related to the claimant’s work injury. It often goes hand-in-hand with the reimbursement process, as treatment must be pre-approved for costs to be covered.
• Receipts and Invoices: Original receipts and invoices are crucial for documenting all travel expenses claimed on the OWCP-957. They serve as proof of payment and must include the claimant's name and Social Security Number for validation.
• Physician's Report: This report details the medical treatment provided, along with any necessary follow-ups related to the injury. A physician’s signature can be required to confirm the legitimacy of the services tied to the incurred travel expenses.

Using the aforementioned documents along with the OWCP-957 can significantly expedite the reimbursement process. Properly filling out and submitting all required forms ensures that claimants receive the benefits they deserve in a timely manner. Understanding what is needed not only simplifies the journey but can provide peace of mind during what can often be an overwhelming process.

• OWCP-1500: This form is also used for reimbursement of medical expenses. Like the OWCP-957, it collects information on medical services rendered and expenses incurred, allowing claimants to detail the treatment received and the costs associated with that treatment.

• Form CA-1: This is a Notice of Injury form used for filing a claim under the Federal Employees’ Compensation Act. Similar to the OWCP-957, it initiates the claim process, allowing employees to document the circumstances surrounding their injury or illness.

• Form CA-2: This form is for filing a claim for occupational disease. It collects information on how the disease occurred, aligning with OWCP-957's focus on medical matters and costs related to a specific condition.

• Form CA-7: This form is used to apply for compensation for wage loss. Like the OWCP-957, it is essential for the claims process, providing a way to document the financial impact of work-related injuries or illnesses.

• Form OWCP-5: This form requests a continuation of pay for employees who suffer a work-related injury. Much like the OWCP-957, it details the circumstances around the injury and the associated financial implications.

• Form OWCP-21: The application for survivor benefits requires information about the deceased's work-related injury or illness. Similar to OWCP-957, it focuses on seeking financial support arising from medical and travel expenses tied to treatment.

• Form EBCA 25-1: Employed for medical bills and expenses reimbursement, this form focuses specifically on documenting the costs incurred, much like the OWCP-957, which prioritizes travel purchase documentation related to medical services.

• Form OWCP-1168: This form pertains to obtaining a second opinion on an accepted injury or illness. Like the OWCP-957, it ensures proper documentation of medical evaluations and associated expenses, playing a vital role in the claims process.

• Form SF 95: This is a claim for damage, injury, or death. It also requires supporting documentation establishing the basis for the claim, similar to how OWCP-957 requires detailed accounts of medical travel expenses.

• Form OWCP-915: This form is used for the informational request regarding medical services or treatments. It facilitates the collection of necessary information to support claims, akin to the purpose of the OWCP-957 in documenting travel reimbursement.

Things to Do

• Enter the claimant's full name accurately: last name, first name, and middle initial.
• Provide the correct claim or case number.
• If applicable, include the payee's full name, relationship to the claimant, and reason for reimbursement.
• Use the correct format for the mailing address, including all components: Street/RFD, City, State, and Zip Code.
• Complete separate blocks for each medical facility visited if traveling multiple times on the same day.

Things to Avoid

• Do not use a P.O. Box as the address; provide a physical home address.
• Avoid submitting forms without physician signatures for Black Lung claims.
• Do not neglect to attach all original receipts; the claimant's full name and Social Security Number must appear on each one.
• Refrain from requesting reimbursement for non-medical travel expenses.
• Do not bypass the requirement to mark only one box for each travel expense claimed.

• Misconception 1: The OWCP-957 form is only for federal employees.

  Many people believe that only federal employees are eligible to submit the OWCP-957 form. In reality, this form can also be utilized by individuals covered under the Black Lung Benefits Act and those participating in the Energy Employees Occupational Illness Compensation Program.

• Misconception 2: Submission of the OWCP-957 form guarantees reimbursement.

  It is important to understand that while the form is designed for reimbursement requests, submission alone does not guarantee that reimbursement will be granted. The claim must meet the eligibility requirements, and all necessary documentation, including receipts, must be included.

• Misconception 3: All travel expenses are reimbursable.

  Not all travel expenses can be claimed through the OWCP-957 form. Expenses related to travel for picking up medicine or equipment, for example, are specifically not reimbursable. Applicants must carefully review which costs are eligible before submission.

• Misconception 4: A simple signature is sufficient for the form to be valid.

  Some think that merely signing the form is enough. However, it is crucial that certain sections, particularly those needing a physician's signature or verification, are completed accurately. Failing to do so can lead to delays or denial of the claim.

• Misconception 5: Anyone can be designated as a payee.

  While it is possible for someone other than the claimant to be designated as a payee, there are specific requirements. An authorization must be included, and the relationship to the claimant must be explained. Thus, it is essential to comply with these rules to avoid issues.

• Misconception 6: The OWCP-957 form does not require detailed information.

  Some people underestimate the need for thoroughness in filling out the OWCP-957 form. Detailed records of expenses, travel dates, and accurate addresses for medical facilities must be provided. Incomplete information could hinder the processing of a reimbursement request.

Here are some essential points to keep in mind when filling out the OWCP 957 form:

• The form is designed for requesting reimbursement for medically related travel expenses.
• You must enter your full name: last name, first name, and middle initial accurately.
• Ensure your claim number is included; this helps identify your case.
• If someone other than you, the claimant, is to be reimbursed, you must provide the payee's full name and relationship to you.
• The address provided must be the actual residence, not a P.O. Box or attorney's address.
• Each visit to a medical facility on the same day requires a separate block to be completed.
• Attach original receipts for the costs listed on the form for successful reimbursement.
• Be aware that lodging or travel exceeding specified distances may need special approval.
• The physician's signature is required for Black Lung-related claims.
• Submitting false information can lead to severe penalties including the loss of benefits and possible criminal prosecution.

Following these guidelines will help ensure your reimbursement request is processed smoothly.