Get Worker Supply And Services Claim Form

This guide provides clear instructions on completing the Worker Supply And Services Claim Form online. It aims to assist users in understanding each section and ensuring that all necessary information is accurately submitted for reimbursement of approved medical supplies and services.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the Worker Supply And Services Claim Form and open it in your preferred online editor.
2. Begin by entering the worker’s last name in the designated field. This information is essential for identifying the claim.
3. Next, fill in the worker’s first name in the appropriate field below their last name. Ensure accurate spelling to avoid processing delays.
4. Provide the WorkSafeBC claim number in the specified area. This is crucial for linking the reimbursement request to the correct claim.
5. Enter the worker's personal health number (e.g., BC CareCard) in the corresponding field.
6. Indicate the date of injury in the format yyyy-mm-dd. This date helps in processing your claim correctly.
7. Complete the mailing address for payment, including the city, province/state, and postal code/zip code.
8. Select whether the address has changed by marking 'Yes' or 'No'.
9. Attach copies of receipts, ensuring that they are not the originals. Write the worker’s first name, last name, and claim number on each copy submitted.
10. Enter the date of service or purchase in the specified format (yyyy-mm-dd). This should reflect when the services were rendered or supplies purchased.
11. Add the fee code related to the service in the appropriate field, referencing page 2 of the form for options.
12. Indicate the type of expense or supply in the designated field by providing a clear description (e.g., splint, massage therapy).
13. State the quantity or number of service units in the next field, allowing for accurate reimbursement amounts.
14. Fill in the amount paid, including taxes, for the service or supply to ensure complete reimbursement.
15. Provide the name of the provider or subscriber of the supply/service if applicable.
16. Certify the accuracy of the information by signing the form and including the signature date.
17. Review all entries for completeness and accuracy. When satisfied, you may save changes, download, print, or share the completed form as needed.

Complete your documents online to ensure a smooth submission process for your claims.