OWCP Form 957

Here’s information about OWCP Form 957, along with a visual of the form:

What it is:

OWCP Form 957 is the Medical Travel Refund Request form used to request reimbursement for travel expenses related to medical treatment for a work-related injury or illness covered by the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP).

When to use it:

• Submit this form if you’ve incurred travel expenses for:
• Traveling to and from medical appointments
• Mileage for using your personal vehicle
• Lodging
• Meals
• Other necessary travel-related costs

Key sections of the form:

• Claimant Information: Your name, claim number, contact details.
• Trip Information: Date of travel, destination, purpose, mode of transportation, mileage (if applicable).
• Expense Details: Itemized breakdown of expenses (lodging, meals, etc.).
• Physician Certification (for Black Lung cases only): Requires a physician’s signature to confirm the medical necessity of the travel.
• Payee Certification: Your signature certifying the accuracy of the OWCP claim information provided.

How to submit:

• Online: Complete and submit the form through the OWCP Web Bill Processing Portal (WBPP).
• Mail: Download and print the OWCP form, then mail it to the address specified on the form.

Additional notes:

• Reimbursement rates: OWCP has specific reimbursement rates for mileage and other travel expenses.
• Deadlines: Submit your OWCP mileage reimbursement request within 30 days of the travel date.
• Multiple trips: You can record up to 3 trips on a single form.

Questions: Contact OWCP for assistance if you have any questions about federal workers compensation or need help completing the OWCP form 957.