Commonly Used OWCP Forms (PDF free download)
Forms referenced below can also be downloaded by Googling them by form numbers.
|
|
CA-1 Federal Employee's Notice of
Traumatic Injury and Claim for
Continuation of Pay/Compensation
|
If you are disabled for work as a result of this injury and filed CA-1 within thirty days of the
injury, you may be entitled to receive continuation of pay (COP) from your employing agency.
COP is paid for up to 45 calendar days of disability, and is not charged against sick or
annual leave. If you elect sick or annual leave you may not claim compensation to
repurchase leave used during the 45 days of COP entitlement.
|
CA-7 Claim for Compensation
|
If the employee does not quality for continuation of pay (for 45 days), the form should be
completed and filed with the OWCP as soon as pay stops. The form should also be
submitted when the employee reaches maximum improvement and claims a schedule
award. If the employee is receiving continuation of pay and will continue to be disabled after
45 days, the form should be filed with OWCP 5 working days prior to the end of the 45-day
period. The CA-7 also should be used to claim continuing compensation, when a previous
CA-7 claim has been made.
|
If your Agency fails to process
your claim, report to:
|
|
U.S. Department of Labor
DFEC Central Mailroom
PO Box 8300
London, KY 40742-8300
Failure to process a valid claim is violation of law.
|
|
Appeal Rights
|
|
CA-2 Notice of Occupational
Disease and Claim for
Compensation.
To file when you have a new injury.
|
The employee fills out items 1 - 18 and submits the form to the supervisor along with the
statement and medical reports relating to history and cause of injury/illness (see
"Instructions" attached to the form). Make sure to obtain receipt from your supervisor when
submitting the form to him/her. At the time the form is received from the employee, the
supervisor is to complete the Receipt of Notice of Disease or Illness and give it to the
employee. The supervisor is also to complete items 19 through 34 and must fill in the
proper codes in shaded boxes a, b, c on the front of the form. If medical expense or lost
time is incurred or expected, the completed form must be sent to OWCP within ten working
days after it is received from the employee.
|
CA-2a Notice of Recurrence
To file if your initial injury claim was
approved by OWCP. Otherwise, file
CA-1 or CA-2 on any new injuries not
already reported to and approved by
OWCP.
|
A Recurrence of the Medical Condition is the documented need for additional medical
treatment after release from treatment for the work-related injury. Continuing treatment for
the original condition is not considered a recurrence.
A Recurrence of Disability is a work stoppage caused by: 1) a spontaneous return of the
symptoms of a previous injury or occupational disease without intervening cause; 2) a
return or increase of disability due to a consequential injury (defined as one which occurs
due to weakness or impairment caused by a work-related injury); or 3) withdrawal of a
specific light duty assignment when the employee cannot perform the full duties of the
regular position. This withdrawal must have occurred for reasons other than misconduct or
non-performance of job duties.
If a new injury or exposure to the cause of an occupational illness occurs, and disability or
even if the new incident involves the same part of the body as previously affected.
If you worked for the Federal Government at the time of the recurrence, submit Form CA-2a
to your employing agency. If you no longer work for the Federal Government, complete
Parts A and C of this form and submit all materials directly to the Office of Workers'
Compensation Programs (OWCP). Click here for OWCP District Office locations
nationwide.
If you are claiming a recurrence of disability for an occupational illness, or if all 45 days of
continuation of pay (COP) have been used, you may claim wage loss on Form CA-7. The
OWCP will pay compensation if the claim is approved.
Arrange for your attending physician to submit a detailed medical report. The report should
include: dates of examination and treatment; history as given by you; findings; results of
x-ray and laboratory tests; diagnosis; course of treatment; and the treatment plan. The
psysician must also provide an opinion, with medical reasons, regarding causal
relationship between your condition and the original injury. Finally, the physician should
describe your ability to perform your regular duties. If you are disabled for your regular work,
the physician should edintify the dates of disability and provide work tolerance limitations.
|
CA-35 Evidence Required in Support
of a Claim for Occupational Disease
|
This form is a check list (organized by type of injury you sustained) of information required
to be submitted with Form CA-2. Return the checklist with your statement attached. Check
off each item as it is completed or let OWCP know when you can expect to submit items you
are in the process of obtaining.
|
CA-20 Attending Physician's Report
|
|
CA-91 5 Claimant Medical
Reimbursement Form
|
|
