CA-1: Notice of Traumatic Injury and Claim for Continuation of Pay / Compensation
CA-2: Notice of Occupational Disease and Claim for Compensation
CA-2A: Notice of Recurrence
CA-7: Claim for Compensation
CA-7 in a Traumatic Injury Claim (Form CA-1
CA-7 in an Occupational Disease Claim [Form CA-2]
CA-7 when requesting payment of a Schedule Award
CA-16: Authorization for Examination And/Or Treatment
CA-17: Duty Status Report
CA-20: Attending Physician’s Report
CA-915: Claimant Medical Reimbursement Form
CA-1: Notice of Traumatic Injury and Claim for Continuation of Pay / Compensation.
Form CA-1 is you way of notifying your employer of a:
(1) traumatic injury, and
(2) is your claim for Continuation Of Pay [COP] & compensation.
Form CA-1 must be filed with your employing agency within 30 days from the date of your injury.
A traumatic injury is an injury that occurs during the course of one workday or work shift.
Examples of traumatic injuries include: lifting, tripping, falling; crush injuries, burns, short term chemical exposure occurring in one workday, slipping, a motor vehicle accident, physical assault, sexual assault, even repetitive activity performed in one work day, e.g., engraving metal tags with a vibrating tool, carrying a box of mail or moving a box of files to a new office space.
Example #1: Lifting one box, in one workday, which causes a “pop” in your back, requiring medical attention, is a traumatic injury claim, and you would file a Form CA-1.
Example #2: Lifting 20 boxes, in one workday, which causes a “burning sensation” in your lower back, requiring medical attention, is a traumatic injury claim, and you would file a Form CA-1.
Example #3: One day at work, you are exposed to the combination of ammonia and bleach, mixed together by the facility janitor, causing you to suffer lung damage, you would file a Form CA-1.
Example #4: You are a dental technician, one day you are specially assigned the job of using a vibrating tool to engrave metal tags, you engrave 100 tags in one workday, but you suffer numbness and lack of co-ordination in your hands, wrists and forearms, as well as carpal tunnel nerve damage, you would file a Form CA-1.
Example #5: You are an Air Traffic Controller when a plane you have control over crashes, even though there are no injuries, the incident causes you disabling emotional distress, you would file a Form CA-1.
CA-2: Notice of Occupational Disease and Claim for Compensation.
Form CA-2 is your way of claiming:
- you have suffered an “occupational disease” and wage loss compensation.
There is no Continuation of Pay (COP) in an Occupational Disease claim.
An occupational disease is defined as a condition that occurs because of activity or exposure over more than one workday.
Form CA-2 should be filed within 30 days from when you knew or should have known the injury was caused or aggravated by workplace activity or exposure.
Examples include: constant lifting of tubs of mail, or the file boxes mentioned under the CA-1 example above, over 2 or more work days, working in a “sick building” for 2 or more work days, being emotionally distressed because of weeks, months or years of a high pressure job, or abuses of discretion in handling administrative or personnel matters by your supervision [commonly known as “harassment”].
Example #1: If you have keyboarded change of address labels for the USPS for 8 hours per day, for 6 years, and this accumulated keyboarding has caused repetitive motion syndrome, you would file a Form CA-2.
Example #2: If your regularly assigned work duty is to lift tubs of mail, and this activity, performed for weeks, months or years has caused acceleration of a degenerative disc disease condition, you would file a Form CA-2.
Example #3: If you have worked for weeks, months or years in a “sick” building, and have developed sinus or lung conditions because of the “sick” building,” you would file a Form CA-2. An environmental survey of the building would be very helpful in this situation.
Example #4: If you have moved your office and engaged in lifting and carrying of desks, chairs, cubicle dividers, and boxes of files for more than one workday, and your knee is swollen, clicking and giving way because of the accumulated activity of moving your office over more than one workday, you would file Form CA-2
Example #5: If you work for more than one day under pressure to meet deadlines – such as a lawyer is required to do, or you work overtime nearly everyday, you work with deadly diseases, you are an Air Traffic Controller with life and death decisions to make every day, or a supervisor makes repetitive sexual overtures toward you on more than one day, you would file Form CA-2
Example #6: You have been a USPS letter carrier for 17 years, have used a mail bag with a shoulder strap, and the accumulated wear and tear on your shoulder caused by the shoulder strap has caused an injury to the rotator cuff in your shoulder, you would file a Form CA-2.
CA-2A Notice of Recurrence.
The first thing to notice about this form is the word “recurrence” it is not “re-occurrence.” OWCP has its own definition of a “recurrence” which may not be what you think it is. Read on.
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:
- A spontaneous return of the symptoms of a previous injury or occupational disease without intervening cause;
- 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
- 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 THE NEED FOR MEDICAL CARE RESULTS, A NEW FORM CA-1 or CA-2 SHOULD BE FILED.
What does this all mean?
In reality, a Recurrence of Medical Condition rarely occurs because most people return to some form of work activity, even light or limited duty, and therefore have been exposed to new or further work activities, resulting in a new injury or disease, or an aggravation to a pre-existing injury or disease, due to those intervening work activities.
One specific Recurrence of Medical Condition may occur when surgery is authorized by OWCP, but not performed for months or even years. On the date the surgery is actually performed, the injured employee may be considered to have suffered a Recurrence of Medical Condition, and/or a Recurrence of Disability – which may entitle you to wage loss compensation – even if you have been separated from your employing agency, unless your separation was for misconduct or non-performance of job duties.
The Recurrence of Disability is the most common type of Recurrence this office has seen. More to the point, if you are performing a specific light duty assignment because your OWCP-accepted condition prevents you from performing the full duties of your regular position, and your work restrictions and limitations are still valid, and the light duty assignment is withdrawn, you have suffered a Recurrence of Disability.
In this case you file a Form CA-2a to claim wage loss compensation.
OWCP takes withdrawal of a specific light duty assignment very seriously because they work very hard to get you back to work, and don’t like employing agencies undoing all their work by withdrawing your limited duty job.
In these cases, OWCP is usually very quick to reinstate payment of wage loss compensation – in fact, faster than in other type of case this office has seen.
This office has seen multiple cases where OWCP paid 6-8 years of past due compensation once it was determined the employing agency withdrew a specific light duty assignment, sent the employee home and told him or her to wait for a phone call to return to work. Despite those employees making repeated efforts to return to light duty work, their employing agencies refused to allow them to return to work.
CA-7 Claim for Compensation.
Form CA-7 is filed to claim wage loss compensation. The first CA-7 is usually submitted to request wage loss payments when the injured worker is unable to return to work.
CA-7 in a Traumatic Injury Claim (Form CA-1).
When you suffer a traumatic injury and file your Form CA-1, you should receive Continuation Of Pay (COP) for the first 45 days. If during this time frame you realize you will not be returning to work at the end of the 45 days, you should file a Form CA-7 requesting wage loss compensation from OWCP for lost work time. It is best if you file this Form CA-7 two (2) weeks before the end of your COP.
CA-7 in an Occupational Disease Claim (Form CA-2).
If you suffer an Occupational Disease, and are not able to go to work, you should file Form CA-7 at the same time you file the Form CA-2.
Remember, Continuation Of Pay (COP) is not paid in an Occupational Disease claim, so you will not be paid until your claim is accepted – which can take weeks, months, or even longer.
Form CA-7 is used when requesting payment of a Schedule Award.
When claiming a Scheduled Award, Form CA-7 is filed along with your rating physician’s report.
As mentioned under the section on Schedule Awards, the OWCP’s Medical Advisor will review your physician’s rating report, and you may be sent for a second opinion regarding the rating by your physician.
Form CA-16 Authorization for Examination And/Or Treatment.
Form CA-16 is a controlled document because it authorizes payment for medical treatment needed to care for a traumatic injury.
Form CA-16 requires the OWCP to pay for your doctor visits and diagnostic testing, e.g., X-Rays, MRI’s, CAT scans, etc., performed on you for the first 60 days after the form is issued.
You should receive a Form CA-16 from your supervisor on the day of your injury.
You cannot make a copy of a blank Form CA-16, nor can you download a copy of Form CA-16 from the Internet. If you do, and try to use it for medical treatment, or improperly sign [falsify the signature] on a Form CA-16 you can go to jail.
Form CA-17 Duty Status Report.
This is one of the first OWCP documents your doctor will be asked to complete. The left side, Side A, is completed by your supervisor, who should enter your usual work requirements as requested by Section 7 on that form. Your supervisor should accurately describe the physical activities and environmental characteristics of your job. This description should conform to your official job description, and the actual circumstances under which you perform you job.
You should review this side for accuracy, as supervisors have been known to make mistakes when completing Side A of this form.
Obviously, Side B is completed by your treating physician, after she has reviewed Side A and examined you, and reviewed any diagnostic testing completed to better diagnose your medical condition. If your doctor believes you are not able to perform the activities he should complete Side B delineating the work activities you can perform.
Every time your physician examines you, she should complete another Form CA-17 documenting any changes in your condition, diagnosis, restrictions or limitations.
These are OWCP’s descriptions of physical demand requirements:
Bending/Stooping: Bending the body downward and forward by bending spine at the waist, requiring full use of the lower extremities and back muscles;
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs or hands and arms. Body agility is emphasized.
Kneeling: Bending legs at knees to come to rest on knee or knees.
Operating a motor vehicle at work: Driving any vehicle during the performance of one’s duties.
Reaching: Extending hand(s) and arm(s) in any direction, including overhead reaching or reaching above the shoulder.
Repetitive movements of elbows (handling): Seizing, holding, grasping, turning, or otherwise working with hand or hands using the whole arm.
Repetitive movements of wrists (fingering): Picking, pinching, or otherwise working primarily with fingers and wrists rather than the whole arm as in handling.
Squatting (crouching): Bending body downward and forward by bending legs and spine.
Twisting: Turning, twisting, contorting, or flexing the torso in any direction towards the right or left.
Form CA-20 Attending Physician’s Report.
This form overlaps somewhat with Form CA-17.
Of special note, Item #8 of this form asks if the physician believes the diagnosed condition was caused or aggravated by your employment activity.
If your physician answers yes, then he should have no problem attaching this form to a report to the OWCP stating that he believes, on a more likely than not basis (a 51/49 weighing of the injury event coupled with the medical evidence) that the diagnosed condition was caused or aggravated by your employment activity.
The CA-20 requests more detailed information than Form CA-17 about any hospitalization you may have undergone, as well as a more detailed discussion of your partial or total disability.
When coupled with the Form CA-17, your doctor can explain his examination of you, discuss his clinical and diagnostic findings regarding your medical condition, explain the causal connection between the injury event and diagnosed condition while providing OWCP and your employing agency with restrictions and limitations when you are able to return to work.
Form CA-20 also provides a place for your doctor to provide OWCP with information regarding any referral she has made, or would like to make, for more specialized consultation and/or treatment.
Form OWCP-915 Claim for Medical Reimbursement.
- This form is used to claim reimbursement for out of pocket payments you have made to doctors’ offices, hospitals, pharmacies, or medical supply companies.
- A separate OWCP-915 must be filed for each care provider.
- This form must be completed with great detail and accuracy.
- Read the instructions carefully and be sure to include copies of the documentation delineated by the form.
- Do not use Form OWCP-915 to claim travel reimbursement.
- Claims for travel reimbursement should be submitted on OWCP-957.
NEVER SEND YOUR ORIGINAL OR YOUR ONLY COPY OF ANY DOCUMENT TO ANYONE:
- NOT TO OWCP
- NOT TO YOUR EMPLOYING AGENCY
- NOT TO YOUR DOCTOR
- NOT TO YOUR INSURANCE COMPANY
- NOT EVEN TO YOUR ATTORNEY
- EVEN IF I AM YOUR ATTORNEY !