Get Wsib Medication Reimbursement Form

Filling out the Wsib Medication Reimbursement Form online is a straightforward process that ensures you receive reimbursement for any medications related to your claim. This guide will walk you through each section of the form, providing detailed instructions to help you complete it accurately.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to download the Wsib Medication Reimbursement Form and open it in your chosen document editor.
2. Begin by providing your personal information in Section A. Include your last name, first name, current address, city, province, postal code, home phone, and work phone. If you have a new address, indicate that with 'yes' and provide the new address details.
3. Proceed to Section B, which is dedicated to medication information. Print clearly in black ink as you fill out the necessary fields. You will need to complete sections A, B, and C in full. Be sure to send all original pharmacy receipts along with this form, as photocopies are not accepted.
4. List your claim number, date of accident, and date of birth in the specified format. For each medication you are claiming, provide the prescription number, drug name, Drug Identification Number (DIN), pharmacy name, and the prescribing physician's name. Repeat this process for all medications you are claiming.
5. For each medication listed, fill in the details regarding the amount paid, cost of drugs, quantity dispensed, frequency of dosage, and dispensing date. Ensure that you provide the total cost including the dispensing fee and the total amount you paid to the pharmacy.
6. In Section C, sign and date the form, certifying that the information provided is true and complete. Remember to keep all original receipts and make sure you do not request reimbursement from any other insurers for the same expenses.
7. Once you have completed the form and reviewed all the information for accuracy, save your changes. You can then download or print the completed form. Make sure to submit the original receipts and the form to your local WSIB office.

Complete your Wsib Medication Reimbursement Form online today to ensure your claims are processed smoothly.