Form C-17 (BWC-1122) Request for Injured Worker Outpatient Medication Reimbursement - Ohio

What Is Form C-17 (BWC-1122)?

This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form C-17 (BWC-1122)?
A: Form C-17 (BWC-1122) is a Request forInjured Worker Outpatient Medication Reimbursement form in Ohio.

Q: Who can use Form C-17 (BWC-1122)?
A: Injured workers in Ohio who have received outpatient medication can use Form C-17 (BWC-1122) to request reimbursement.

Q: What is the purpose of Form C-17 (BWC-1122)?
A: The purpose of Form C-17 (BWC-1122) is to request reimbursement for outpatient medication expenses incurred by injured workers in Ohio.

Q: What information is required on Form C-17 (BWC-1122)?
A: Form C-17 (BWC-1122) requires information such as the injured worker's name, claim number, medication details, and medical provider information.

Q: Are there any deadlines for submitting Form C-17 (BWC-1122)?
A: Yes, you must submit Form C-17 (BWC-1122) within one year from the date of service for the outpatient medication.

Q: How long does it take to process a Form C-17 (BWC-1122) request?
A: The processing time for a Form C-17 (BWC-1122) request can vary, but the Ohio Bureau of Workers' Compensation aims to process requests within 30 days.

Q: How will I receive the reimbursement for my outpatient medication expenses?
A: If your Form C-17 (BWC-1122) request is approved, the reimbursement will be issued by check or direct deposit, depending on your preference and the method you choose.