CoreFlexx Restorative Health Services

DOL-OWCP FORMS

Initial and subsequent medical reports for
claim acceptance/development

Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of pay/Compensation
Notice of Occupational Disease and Claim for Compensation
Notice of Employee’s Recurrence of Disability and Claim for Pay/Compensation
Claim for Compensation on Account of Traumatic Injury or Occupational Disease
Time Analysis Form
Leave Buy-Back (LBB) Worksheet/Certification and Election
Authorization for Examination and/or Treatment
Duty Status Report
Attending Physician’s Report
Claim for Medical Reimbursement

OWCP-957A

Medical Travel Refund Request – Milage

OWCP-957B

Medical Travel Refund Request – Expenses