Workers' Comp FormsDepartment of Labor
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People also ask
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How to file CA-1 online?
To file a new Form CA-1, click the NEW CLAIM link in the top menu. Next, select your government organization and click FILE CA-1 OR CA-2 button. Click FILE A CLAIM button. If your employing agency has enabled Form OSHA 301 filing in ECOMP, you will need to file that form before filing Form CA‐1.
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How long does it take to fill out CA1?
To be eligible for COP, you must submit a CA-1 within 30 days of the injury.
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Who files the CA-1 form?
(To be eligible for continuation of pay, the employee, or someone acting on his/her behalf, must file Form CA-1 within 30 days following the injury and provide medical evidence in support of disability within 10 days of submission of the CA-1.
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What is the difference between a CA-1 and a CA-2?
CA-1 - Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. Use for traumatic injury - employee was hurt because of a single event or within one workday. CA-2 - Notice of Occupational Disease and Claim for Compensation.
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Who fills out the CA 20 form?
If you are not a physician, a physician must co-sign and date the form as well. Under the FECA, medical evidence must be submitted by a qualified physician. Nurse practitioners and physician assistants are not considered qualified physicians under the FECA unless the medical report is countersigned by a physician.
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What is a form CA 17?
The CA-17 was designed to provide the doctor with an accurate description of the physical work requirements of the injured letter carrier. The CA-17 is a legal document that determines both an injured worker's medical restrictions and entitlement to wage-loss compensation benefits.
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What is the CA16 form?
Medical Treatment - Form CA-16. • If an employee requires medical treatment for a traumatic injury, supervisor should complete front of Form CA-16, within four hours of request whenever possible. • If supervisor doubts whether employee's condition is related to employment, he/she should so indicate on Form CA-16.
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How do I fill out a CA-1 form?
Form CA-1 must be complete in a detailed manner; that is, you are expected to describe how you sustained your injuries, what you were doing and so on, or how you fell sick. You are also required to input the date, or, if you gradually became sick, indicate the time period.
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