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Injured Worker Travel Card Authorization Log Instructions Internal use only CSS/DMC/CAT nurse must verify the following prior to authorizing the prepayment of injured worker travel expenses:Treatment
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How to fill out injured workers travel card

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How to fill out injured workers travel card?

01
First, gather all the necessary information such as the injured worker's name, employee ID, and contact details.
02
Then, carefully read the instructions provided on the injured workers travel card form.
03
Fill in the required fields on the form, including the date of the injury, the location where it occurred, and the nature of the injury.
04
Provide details about the medical treatment received, including the name of the healthcare provider, the dates of treatment, and any prescribed medications.
05
If applicable, include information about any witnesses to the incident, their contact details, and a brief description of their observations.
06
Review the completed form for accuracy, ensuring all sections are filled out correctly and legibly.
07
Obtain any necessary signatures, such as those from the injured worker, supervisor, or designated company representative.
08
Submit the filled-out injured workers travel card form to the appropriate department or authority as instructed.

Who needs injured workers travel card?

01
Injured workers who have suffered work-related injuries or illnesses require an injured workers travel card.
02
This card is necessary for documenting the details of the injury, medical treatment received, and any potential witnesses or evidence related to the incident.
03
Employers and the medical personnel involved in managing the worker's injury or illness may also require access to the information documented on the injured workers travel card.
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The injured workers travel card is a document that provides compensation to employees who have been injured on the job and need to travel for medical treatment or vocational rehabilitation.
Employers are required to file the injured workers travel card on behalf of their eligible employees.
To fill out the injured workers travel card, employers need to collect information about the injured employee's travel expenses, such as transportation costs, accommodation, and meals. This information must be accurately entered in the designated fields of the card.
The purpose of the injured workers travel card is to provide compensation to injured employees for their travel expenses related to medical treatment or vocational rehabilitation.
The injured workers travel card requires information such as the employee's name, date of injury, travel destination, purpose of travel, dates of travel, and detailed expenses for transportation, accommodation, and meals.
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Related Links

U.S. Department of Labor - Office of Workers' Compensation ...
Information for Injured Workers and their Representatives ... Complete the OWCP -957 "Medical Travel Refund Request" form to request reimbursement for your ...
OhioBWC - Worker - Form: (BWC Forms) - Injured Worker Forms ...
A-21 EBT - Electronic Benefit Card Enrollment Application: Injured workers ... Injured workers use this form to request reimbursement for travel expenses ...
Injured Worker Workers' Compensation Forms
Commonly Used Injured Worker Forms available for printing and mailing to the ... C-257 Claimant's Record of Medical and Travel Expenses and Request for ... by injured employee when employer who is not part of a PPO or ADR program wishes .... DD-1 (5/15), Direct Deposit and Debit Card Authorization Form, A claimant ...

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