WebDepending upon your agency, start by filing OSHA's Form 301, then file a claim using either form CA-1 (for traumatic injury) or form CA-2 (for occupational disease). After you have received an official FECA case number, you may also file form CA-7 (Claim for Compensation). Need to upload a document? Webmy knowledge and belief. I am aware that any person who knowingly makes any false statement or misrepresentation to obtain reimbursement from OWCP is subject to civil …

Federal Employees

WebDec 31, 2016 · Form OWCP-957 Rev. Aug 2003 Instructions (Form OWCP-957) 1. Enter claimant's full name: last name, first name, middle initial. 2. Enter claimant's claim/case file number. 3. Enter payee's full name (if person other than the claimant is to be reimbursed): last name, first name, middle initial. http://owcpmed.dol.gov/portal/resources/forms-and-references/dfec harvey bishop music

Mileage Reimbursement for Travel in a Workers

WebOWCP UB 04 (Institutional) Form -standard claim form that an Institutional provider can use for the billing of medical and mental health claims rendered to an OWCP claimant. American Dental Association (ADA) Form- provides a common format for reporting dental services to a patient's dental benefit plan. WebDFEC: 1-844-493-1966 Select Option 2 (for Provider) and then select 3. Provider Bills Health Insurance Claim Form (OWCP-1500) Uniform Health Insurance Claim Form (OWCP-04) ADA Dental Claim Form Authorization Templates Medical Authorization - Durable Medical Equipment Medical Authorization - General Medical WebThe 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 … harvey bivins