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This form should be used for medically related travel covered by the Federal Employees' Compensation Act and the Energy Employees Occupational Illness Compensation Program Act of 2000. For travel expenses reimbursement under the Black Lung Benefits Act (30 USC 901; 20 CFR 725.406 and 725.701) use the Form OWCP-957 Part B OMB No. 1240-0037
You can calculate mileage reimbursement in three simple steps: Select your tax year. Input the number of miles driven for business, charitable, medical, and/or moving purposes. Click on the "Calculate" button to determine the reimbursement amount.
17 lut 2024 · Effective February 17, 2024, you must use and complete the new Medical Travel Refund Request- Expenses, OWCP-957B form, to obtain reimbursement for mileage cost, and other expenses for travel related to medical treatment for your covered Black Lung condition.
3 mar 2020 · The workers’ compensation insurer has 15 days to provide reimbursement after you’ve submitted documentation of mileage, meals, and lodging. If the insurer doesn’t pay within this timeframe, it can be subject to a late penalty. Download FREE Medical Mileage Reimbursment Form.
Attention OWCP Claimants: Effective Feb 17, 2024, new OWCP-957 Medical Travel Refund Request forms will be available for mileage (957A) and expenses (957B).
REQUEST FOR MILEAGE REIMBURSEMENT. CLAIM NUMBER: EMPLOYER: DATE OF ACCIDENT: CLAIMANT: DATE OF TRIP ADDRESS FROM. DESTINATION PARKING/TOLLS (Receipt must be includ; ed) NUMBER OF ... Author: Travelers Subject: Workers Compensation Request for Mileage Reimbursement Keywords: Workers Compensation Request for Mileage Reimbursement Created Date:
20 mar 2024 · The employee uses the form to record mileage to receive reasonable and necessary medical treatment for the covered work-related injury or illness. The mileage is then reimbursed to the employee as part of the workers’ compensation benefit.
