Get Oh Bwc-1178 1999-2025

The OH BWC-1178 form, also known as the Injured Worker Statement for Reimbursement of Travel Expense, serves as a crucial document for individuals seeking reimbursement for travel expenses related to their workers' compensation claims. This guide will walk you through the process of completing this form online efficiently and accurately.

Follow the steps to complete the OH BWC-1178 online successfully.

1. Click the ‘Get Form’ button to access the OH BWC-1178 form and open it for editing.
2. Fill in the injured worker's information. Provide your last name, first name, middle initial, social security number, and address, including the city, state, and nine-digit ZIP code.
3. Enter your claim number in the designated field.
4. Input the dates for your travel in the format month/day/year, ensuring to use four digits for the year.
5. Indicate the travel details by specifying the cities you traveled from and to for each trip.
6. For car mileage, enter the total miles traveled per day, making sure the round trip exceeds 50 miles. If applicable, note that mileage over 400 miles must have prior authorization.
7. Complete the section for other types of travel, including any transportation methods used (bus, taxi, train, air) and include meal and lodging expenses. Remember, meals require a minimum travel distance of 100 miles for reimbursement.
8. Detail other expenses such as parking and tolls in the miscellaneous section, ensuring you have receipts for these claims.
9. Finally, sign and date the form to certify that all the provided information is accurate.
10. Once all fields are complete and reviewed, save the changes. You can then download, print, or share the completed OH BWC-1178 form as required.

Start your reimbursement process by filling out the OH BWC-1178 online today!