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Form OWCP-915 can be used to seek reimbursement for expenses in regard to medical treatment, prescription medication and medical supplies. Please submit a separate reimbursement claim for each provider where an out of pocket expense was incurred. Please print clearly and legibly.
Submit forms online through the Employees' Compensation Operations and Management Portal (ECOMP). On the ECOMP site you can register for an account, initiate a claim, upload documents, submit forms, and access your case. OWCP's Federal Employees Program has made a variety of forms available online. These forms are only available in PDF format.
These forms are only available in PDF format. To view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation.
INSTRUCTIONS FOR USE OF FORM CA-91 5 USE OF THIS FORM: This form is used to seek reimbursement for medical expenses (other than travel) incurred in the treatment of the condition(s) accepted by OWCP as work-related under the Federal Employees’ Compensation Act. INFORMATlON REWIRED FOR REIMBURSEMENT OF MEDICAL EXPENSES: 1. Pharmacy drugs:
The OWCP-915 is used to seek reimbursement for out-of-pocket medical expenses pertaining to the treatment of an accepted condition including (but not limited to) medical treatments, prescription medications and medical supplies. Please submit a separate reimbursement form for each provider where an out of pocket expense was incurred.
30 maj 2024 · Form OWCP-915 can be used to seek reimbursement for expenses in regard to medical treatment, prescription medication and medical supplies. • Please submit a separate reimbursement claim for each provider where an out of pocket expense was incurred. • Please print clearly and legibly.
Claim for Medical Reimbursement. (This form is available at. http://www.dol.gov/esa/owcp/dfec/regs/compliance/OWCP-915.pdf.)
