Oregon reimbursement 2026

1. Click ‘Get Form’ to open the Oregon Reimbursement Request Form in the editor.
2. Begin by checking the appropriate box for your request type: Initial, Correction, Additional, or Amended.
3. Fill in the Worker Information section. Enter the worker's legal name, Social Security number, date of birth, and date of injury.
4. Complete the Employer Information section with the employer's legal name, address, policy number, and WCD employer number.
5. In the EAIP Information section, specify the start and end dates of the EAIP period and any concurrent injuries if applicable.
6. Provide details in the Wage Subsidy Information section regarding transitional work days and their respective dates.
7. List any purchases made under EAIP or worksite modifications along with their costs in the Purchase Information section.
8. Calculate total reimbursements requested based on wages paid and itemized purchases before signing off on certifications.

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