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Forms | U.S. Department of Labor - DOL

    https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms
    Claim For Medical Reimbursement. Form OWCP-915 replaces CA-915 . OWCP-957* Medical Travel Refund Request. OWCP-1168. ... Longshore; Medical Providers; Office of Workers' Compensation Programs. An agency within the U.S. Department of Labor. 200 …

Claim for Medical Reimbursement U.S Department …

    https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-915.pdf
    U.S Department of Labor Office of Workers' Compensation Programs. Claim for Medical Reimbursement. Provide all information requested below. DO NOT FILL IN SHADED …

Basic Information on New Claims | U.S. Department of …

    https://www.dol.gov/agencies/owcp/FECA/regs/compliance/Basic-Information-on-New-Claims
    Automated information is available 24 hours per day at 1-866-335-8319 or on the OWCP web bill portal. The medical authorization fax line is 1-800-215-4901. If you, your doctor, …

Medical Reimbursement through EFT | U.S. Department …

    https://www.dol.gov/agencies/owcp/energy/regs/compliance/news/MedReimbursement_EFT
    Starting October 1, 2015, reimbursement for out of pocket expenses, such as qualified medical bills and medical travel expenses, is available for deposit directly into your …

Information for Injured Workers and their …

    https://www.dol.gov/agencies/owcp/FECA/regs/compliance/infoinjuredwrkers
    Case specific correspondence other than reimbursement claims and claim forms may either be mailed to U.S. Department of Labor, OWCP ... by a copy of the OWCP …

FILLING OUT YOUR CLAIM FORM - DOL

    https://owcpmed.dol.gov/portal/Billing%20Tips/Filling%20Out%20a%20Claim%20Form.pdf
    Uniform Health Insurance Claim Form (OWCP-04) Block 60 . The Claimant ID number must be listed here. Note: The Claimant ID is the number assigned to an injured worker by the …

Home | U.S. Department of Labor - DOL

    https://www.dol.gov/
    Family and Medical Leave Act (FMLA) Grants. Fair Labor Standards Act (FLSA) Workplace Posters. Minimum Wage. Guidance for Visitors to DOL National Office. Apprenticeship Finder. Worker rights and …

Forms | U.S. Department of Labor - DOL

    https://www.dol.gov/general/forms
    CM-972 - Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor; CM-981 - Certification by …

Fillable Claim for Medical Reimbursement U.S …

    https://fill.io/Claim-for-Medical-Reimbursement-U-S-Department-of-Labor-c5285e5b
    The Claim for Medical Reimbursement U.S Department of Labor (Department of Labor) form is 1 page long and contains: 0 signatures; 0 check-boxes; …



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