FORM OWCP-957

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FORM OWCP-957:  MEDICAL TRAVEL REFUND REQUEST

About Form OWCP-957

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