OWCP‑16 Authorization for Examination & Treatment – Fillable PDF

The OWCP‑16 (Authorization for Examination and/or Treatment) is the official Department of Labor form used to request payment for medical care after a workplace injury covered by the Office of Workers' Compensation Programs (OWCP). Employers, claimants, and physicians must complete this form to ensure that medical expenses are reimbursed promptly.

What Is the OWCP‑16 Form?

OWCP‑16 authorizes the release of medical records, schedules examinations, and approves treatment costs. It is required for:

• Traumatic injuries that need immediate medical attention
• Ongoing treatment for occupational diseases
• Verification of medical necessity for procedures

Key Sections You Must Complete

Each part of the form collects essential information:

1. Claimant Information – Name, SSN, injury date, and claim number.
2. Physician/Provider Details – License number, address, and contact.
3. Authorization Statement – Specific exams or treatments being requested.
4. Signature Block – Claimant, physician, and employer signatures.

How to Fill Out the OWCP‑16 Online with Formize

Instead of downloading, printing, and scanning, you can complete the form directly in your browser:

1. Click the **"Fill out this form"** button below.
2. The Formize PDF Filler app loads automatically.
3. Enter the required data into each field. The interface highlights mandatory fields.
4. Review your entries and press **Submit** to generate a completed PDF.
5. Save or email the finished document to your OWCP representative.

Common Mistakes to Avoid

• Missing Claim Number – OWCP cannot process the request without it.
• Illegible Signatures – Use the digital signature tool; handwritten signatures are not accepted in the online version.
• Incorrect Dates – Verify the injury date and the date of the requested examination.
• Omitting Provider Details – Include full address and license number.

Where to Submit the Completed Form

After you download the completed PDF, send it to the OWCP regional office handling your claim. You can also upload it through the OWCP online portal if you have an account.

Need the original fillable file? Download the OWCP‑16 PDF directly.