To claim reimbursement for out-of-pocket medical costs under a federal workers’ compensation program, you use Form OWCP-915, the Department of Labor’s Claim for Medical Reimbursement. There is no “Form 1069” on the DOL’s list of claim forms; the correct document is OWCP-915, administered by the Office of Workers’ Compensation Programs and available through the DOL website or a DEEOIC resource center.1U.S. Department of Labor. Online Forms Learning how to fill out Form OWCP-915 for medical expense reimbursement comes down to two things: matching each expense to a covered condition, and attaching the right supporting paperwork for the type of expense you paid. The form covers three federal programs — the Federal Employees’ Compensation Act, the Black Lung Benefits Act, and the Energy Employees Occupational Illness Compensation Program Act.2U.S. Department of Labor. Claim for Medical Reimbursement The instructions below apply to EEOICPA claims.
What Expenses You Can Claim
Under EEOICPA, the government pays for medical services, appliances, and supplies that a qualified physician prescribes for a covered illness and that are likely to cure, relieve, or shorten the period of that illness.3Office of the Law Revision Counsel. 42 USC 7384t – Medical Benefits In practice, DEEOIC reimburses a wide range of costs:
- Office visits, specialist consultations, and emergency room visits
- Diagnostic testing, lab work, imaging, and radiology
- Prescription drugs, brand-name and generic
- Durable medical equipment and supplies, such as oxygen equipment, monitors, and bandages
- Home health aides and skilled nursing when medically necessary
- Inpatient, outpatient, and ambulatory surgical center charges
- Ambulance services
- Home and vehicle modifications tied to your accepted condition
Every expense must relate to the specific diagnosis DEEOIC has accepted on your claim.4U.S. Department of Labor. DEEOIC Medical Benefits Routine wellness care and treatment for conditions unrelated to your covered illness cannot be reimbursed through this form.
Filling Out the Form
Download OWCP-915 from the DOL’s EEOICPA online forms page or pick one up at a resource center.1U.S. Department of Labor. Online Forms Print clearly. Write your OWCP case file number on every page of every document you submit, since that number is how the claims examiner links your paperwork to your file.2U.S. Department of Labor. Claim for Medical Reimbursement
File a separate OWCP-915 for each provider you paid. If you paid a pharmacy and a specialist in the same week, that is two claims, each with its own OWCP-915 and its own attachments.
The form asks for your name, address, and case file number, the provider’s information, and a certification statement where you confirm you personally paid the expenses for treatment of your covered condition. The form itself is short. The work is in the attachments.
Supporting Documents You Have to Attach
For Prescription Medications
Attach both of the following to your OWCP-915 for each prescription:
- A pharmacy billing form or itemized printout that shows the pharmacy’s name, address, and phone number; the pharmacy provider number; the prescription number; your name; the date of purchase; the 11-digit National Drug Code; whether the fill was new or a refill; the quantity dispensed; and the amount you paid.
- Proof of payment: a cash register receipt, canceled check, or credit card slip showing you paid the amount you are claiming.
You do not create the pharmacy billing form yourself. Ask the pharmacist for an itemized receipt or printout that includes every field listed above.2U.S. Department of Labor. Claim for Medical Reimbursement
For Physician Visits, Hospitals, and Other Care
For any non-prescription expense, you need proof of payment plus a billing form the provider fills out:
- Physicians and individual providers, including physical therapists and specialists, complete Form OWCP-1500.
- Hospitals, ambulatory surgical centers, and skilled nursing facilities submit their charges on Form OWCP-04.
The provider completes the OWCP-1500 or OWCP-04, but getting a fully completed copy and attaching it to your OWCP-915 is on you. Without it, OWCP will not process the reimbursement.2U.S. Department of Labor. Claim for Medical Reimbursement The provider’s form has to show the amount you paid and use the correct CPT procedure codes. Bad coding delays or kills the claim.5U.S. Department of Labor. Health Insurance Claim Form
Travel Is a Different Form
Mileage, tolls, parking, taxis, bus fares, lodging, and meals do not go on the OWCP-915. Mileage for driving your own vehicle goes on OWCP-957 Part A; other travel costs go on OWCP-957 Part B. Travel exceeding 200 miles round trip requires pre-authorization from the Medical Benefits Adjudication Unit before you travel, and the bill processing agent will not pay long-distance travel claims without that authorization.6U.S. Department of Labor. EEOICPA Bulletin 08-17 – Medical Expense Reimbursement for Extended Travel Call 1-866-272-2682 to request it.
Where to Send It
Mail the completed OWCP-915 and all attachments to:
DEEOIC
PO Box 8306
London, Kentucky 40742-8306
You can also file electronically through the Energy Document Portal.2U.S. Department of Labor. Claim for Medical Reimbursement If you mail a physical package, use a trackable service and keep a full copy of everything. Lost documents mean starting over.
Set Up Direct Deposit First
Before your first claim, set up Electronic Funds Transfer using Standard Form SF-1199A, the Direct Deposit Sign-Up Form, from the Treasury Department or the DOL forms page. DEEOIC strongly encourages EFT, and payments can be delayed without banking information on file. Paper checks are available only under limited circumstances and require a written request.4U.S. Department of Labor. DEEOIC Medical Benefits
How Long Payment Takes
DEEOIC processes a properly completed reimbursement request within 30 days of receipt. That clock assumes complete paperwork. A missing pharmacy printout, an incomplete OWCP-1500, or absent proof of payment sends you back to the start. With EFT on file, approved funds deposit directly. If you receive a paper check, the Treasury issues it separately from the Remittance Voucher, and it usually arrives within about 14 days after the voucher.4U.S. Department of Labor. DEEOIC Medical Benefits You can track status through the Medical Bill Processing Portal after enrolling at owcpconnect.dol.gov.7Office of Workers’ Compensation Programs. OWCP Connect
If Your Claim Is Denied
When reimbursement is denied as part of a recommended decision, you have 60 calendar days from the date of the decision to file written objections or to request an oral hearing. A hearing request must be in writing and postmarked within that window. If you do not request a hearing, the Final Adjudication Branch conducts a Review of the Written Record using everything in your file, including any objections you filed. After a final decision, you have 30 days to request reconsideration, which will be assigned to a FAB staff member who had no prior involvement in your case.8U.S. Department of Labor. What Happens After an EEOICPA Recommended Decision
If you are unsure which attachments a specific expense needs, or whether a cost even qualifies, call your nearest DEEOIC resource center before you submit. Fixing a paperwork problem on the front end is much faster than fixing a rejection on the back end.9U.S. Department of Labor. Resource Center