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Form OWCP-915
Claim for Medical Reimbursement
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Form reference
Before you begin.
Use these notes as a starting point. Check the issuing agency’s current form and instructions for your client’s situation.
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Preparation: Gather Necessary Information
To fill out Form OWCP-915, ensure you have your personal information ready, including full name, OWCP File Number, and address. You'll also need documentation for any medical expenses, such as receipts or pharmacy billing forms. Having these on hand will streamline the process and ensure accuracy.
Details worth checking
Complete Personal Information
Incomplete or incorrect personal information can cause delays or rejection of your claim. Ensure your name, OWCP File Number, and address are correct. These details link your claim to your case and enable successful processing.
Supporting Documentation Included
Failing to attach necessary documents, like receipts or pharmacy billing forms, can result in denied claims. Each expense needs proof to validate reimbursement requests.
Accurate Total Reimbursement Calculation
Miscalculating the total reimbursement amount can lead to claim denials or delays. Accurate sums are crucial for processing your claim efficiently.
Shaded Area Restriction
Shaded areas on Form OWCP-915 are reserved for DOL use. Incorrectly filling these can compromise form integrity and lead to rejections.
Form Expiry Awareness
Submitting an expired form can cause processing delays or outright rejection. Ensure you use a valid version of Form OWCP-915, current until 07/31/2027.
Signature and Date Compliance
A missing signature or date can result in claim rejection. The certification statement must be signed and dated to validate your submission.
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