An Employee's Guide on Reporting A Work-Related Injury Or Disease

Developed by the JMD Personnel Staff, DOJ Operations Group
March 2001

Table of Contents

• Traumatic Injury 
• Occupational Disease 

• Use of Form CA-16
• Use of Form CA-20
• Use of Form CA-17 or SF-78

• Issuing Form CA-1
• Issuing Form CA-2

• Continuation of Pay for Traumatic Injuries
• Controverting Continuation Of Pay
• Absences After Continuation of Pay Expires
• Absences Due To Occupational Disease 

Appendices

• Points of Contact

• Compensation Forms and Purposes

Introduction

You have been injured on the job.  What are you supposed to do?  What type of a condition is it, and what paperwork is required?  This handbook will walk you through the basic steps of getting the needed medical care, and then guide you through the sometimes complicated and confusing steps of reporting and documenting your compensation case. 

While reading through this guide, remember, you are not alone.  Anytime you have questions or need assistance in dealing with a workers' compensation issue, you can call your Injury Compensation Program Administrator for assistance and advice.  Points of contact for the program are included in Appendix A.

This guide does not cover all the details of the Federal Employee's Compensation Act or all the benefits employees may be due.  Rather, it is intended to provide quick and simple guidance that will help you through the majority of the situations you will encounter if you suffer a job-related injury or disease.

What Type Of Condition Do I Have?

Most work-related medical conditions fall into two categories:   (1) traumatic injury (Form CA-1), and (2) occupational disease (Form CA-2).  You will need to be familiar with these categories so you can help you complete the correct paperwork.  The easiest way to identify the difference between the categories is to identify how long it took the medical condition to occur.

Traumatic Injury (Form CA-1):  If the condition happened in the course of one work shift, the condition is an injury.  Examples:  cut finger; tripped and fell; hit by forklift, etc.  Sometimes the reported condition may not seem like an injury, such as mental stress or back strain.  However, if you identify the condition as occurring in the course of one work shift, the condition is still considered to be a traumatic injury.

Occupational Disease (Form CA-2):  If the condition happened because of events in more than one work shift, the condition is an occupational disease.  Examples:  back strain from unloading trucks for the past two weeks; carpal tunnel from daily use of computer keyboard, etc.

Note:  You may be suffering a recurrence of a prior injury or disease and may want to file for benefits under the prior claim.  A recurrence is defined as a return of symptoms related to the original injury or disease for no explainable reason other than there was a prior medical condition.  If a new event or series of events (e.g., bent over to tie shoes, moved boxes, etc.) causes a return in symptoms, the condition must be treated as a new injury or disease as described above even if the exact same part of the body is affected.  If symptoms do begin for no explainable reason other than the prior injury or disease, you can file for a recurrence under the prior claim.  Recurrence claims are not detailed in this guide (contact your servicing personnel office for details).

How Do I Get Medical Attention?

Regardless of the category of the medical condition, you need to determine whether you need immediate medical care.  If immediate care is required, make arrangements to go to the nearest health care facility or to your private health care provider.  You can ask your supervisor for assistance in making your transportation arrangements, or in calling for an ambulance.  Your supervisor can authorize the medical treatment by telephone to the private provider or hospital, and follow-up with the Authorization for Examination and/or Treatment (CA-16) to the medical facility within 48 hours.

If the situation is not an emergency, you will want to take time to discuss the  situation with your supervisor.  The Public Health Service (PHS) health care facilities can provide medical attention, and forms to report the work-related condition.  Remember that your supervisor cannot authorize medical treatment in occupational disease claims without prior Office of Workers’ Compensation (OWCP) approval.  Forms required to obtain medical care are:

1. Traumatic injuries within the last 48 hours.  Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider.

2. Occupational Diseases or traumatic injuries that occurred more than 48 hours ago.  Form CA-20 - Attending Physician’s Report. Because it is harder to prove that occupational diseases or injuries that are not recent were caused at work, a form that guarantees payment for something that may not be the government’s responsibility would not be appropriate.  If your claim is accepted, the medical bill will be paid even though a CA-16 was not issued.

It is recommended that you take with you a form CA-17 - Duty Status Report, or your position description and SF-78 - Certificate of Medical Examination, along with a light duty availability letter to give to  the physician. These forms inform the doctor of the type of physical requirements for your position; inform the physician that your employer can accommodate light and/or part-time duty; and provide the doctor with a means to communicate to your supervisor what you can safely do; when you can return to light duty work; and when you can resume regular duty. You may object to reporting for medical care; however, if you are offered an opportunity for care and you refuse to go, your supervisor must document the refusal with your claim.

I've Got Medical Care, Now How Do I File The Claim?

You should report all work-related conditions to your supervisor and file the CA-1 or CA-2,  even if there is no lost time or medical expense.  The Department of Labor (DOL) considers claims to be ‘allowable’ if they are reported within three years; however, it will be easier for you to prove your case if paperwork is submitted as soon as possible after the injury or disease occurs. 

Traumatic Injuries:  Use Form CA-1.  The front side of the form must be completely filled out and signed by you.  If the injury is so severe that you cannot fill out the report, a supervisor, family member, or friend can fill it out and sign it.  The reverse side of the form must be completely filled out and signed by the immediate supervisor.

Occupational Disease:  Use Form CA-2.  The front side of the form must be completely filled out and signed by you.  The reverse side of the form must be completely filled out and signed by the immediate supervisor.

NOTE:  In many instances, some of the blocks on Forms CA-1 and CA-2 will not apply to your situation.  Rather than leave them blank (which will result in them being returned to you and delaying your claim), indicate “N/A”.

Compensation paperwork must be processed through your immediate supervisor, the servicing personnel office, and to the DOL within 10 workdays from the day that you submit the paperwork to your supervisor.  Upon giving the documents to your supervisor, ask that he/she fill out and return the receipt portion to you.  It is then your supervisor's responsibility to promptly forward the original claim form(s) to your servicing personnel office within the allotted time frame.  Your servicing personnel office will complete agency coding, process the case file, and forward claims to the DOL.  Submit any additional paperwork (CA-16, CA-17, CA-20, witness statements, etc.) to your supervisor with the claim or as soon as they become available.

You may submit medical updates, bills, etc., to your supervisor after the original claim has been sent off.  All these original documents must be submitted by your supervisor to your servicing personnel office to be included in the agency case files and to be processed through the DOL.

How Is My Absence Covered?

Benefits to cover absences differ based on whether you suffered a traumatic injury or an occupational disease.  We’ll cover each separately.

Traumatic Injury

Continuation Of Pay (COP):  You may be eligible for uninterrupted pay beyond the date of injury without charge to leave.  This benefit is called continuation of pay and is granted if all the following conditions are met:

1. You suffered a traumatic injury and filed form CA-1 within 30 days from the date of the injury.

2. You have provided your supervisor with valid medical documentation to show that the inability to work in any capacity is due to the injury.

3. The absences due to the injury began within 90 days from the date of injury.

4. Your absences do not exceed a total of 45 calendar days of COP.  COP counts in whole day increments.  If you work partial days, but are entitled to COP for the remainder of the work day, the few hours of COP count as a whole day of the 45 day entitlement.

5. If you return to work, but have a recurrence of disability within  the 90 days, you may receive COP for any of the remaining 45 day period that you have not yet expended, even if the disability extends beyond the 90 day period.

Denial Of COP:  COP can only be denied based on the following reasons (if COP already began, it will be terminated) :

1. The disability is caused from an occupational disease rather than a traumatic injury.

2. You are not a U.S. citizen or a resident of the U.S. or Canada.

3. The injury occurred off government premises and you were not involved in official “off premise” activities.

4. The injury was caused by your willful misconduct.

5. The injury was not reported on CA-1 within 30 days following the injury.

6. Work stoppage first occurred 45 days or more after the injury.

7. You initially reported the injury after your employment was terminated.

8. You are enrolled in the Civil Air Patrol, Peace Corps, Job Corps, Youth Conservation Corps, Work Study Program, or other similar groups covered by special legislation.

9. You are a volunteer working without pay or for nominal pay or you are a person appointed to the staff of a former President.

Note:  If you are eligible for COP, but the claim is later denied, DOL will direct the Department of Justice to recoup the COP and change the COP absences to leave or leave without pay.  Also, COP can be terminated if you refuse a job within your restrictions and limitations, or if you fail to respond to a job offer.

After COP Expires:  If you were eligible for COP, but are absent beyond the 45 day limit or do not become disabled within the 90 day window, you have two options:

1. You can use sick or annual leave to continue uninterrupted pay, or:

2. You can elect to go on Leave Without Pay and submit form CA-7 - Claim for Compensation on Account of Traumatic Injury or Occupational Disease to request wage loss payments from the DOL.  Form CA-7 alerts the DOL that you are not receiving any income and initiates wage loss pay.  Form CA-7 is also used to claim absences at 2-week intervals if the absences continue beyond the period claimed on the initial form CA-7.  You have the responsibility to submit medical documentation to support that the ongoing absences are related to the work-injury and should anticipate at least a 3-4 week delay before you receive pay from DOL.  The delay can be longer if a claim is incomplete or controversial.  Employees who elect to use their own leave can later repurchase the leave with their compensation benefits. 

Occupational Disease:  COP is not a benefit for occupational disease.  If you cannot work due to the claimed condition, two options are available:

1. Use sick or annual leave to continue uninterrupted pay or:

2. Elect to go on Leave Without Pay and submit forms CA-7 to request wage loss benefits from the DOL.  Form CA-7 initiates wage loss pay, and  continues wage loss at bi-weekly intervals if the absences continue beyond the initial period claimed on the form CA-7.  You have the responsibility to submit medical documentation (Form CA-20 and CA-20a) to demonstrate that the absences are related to the claimed work condition.  Because occupational disease claims take longer to adjudicate, it can take several weeks or even several months before you can expect to receive pay from the DOL.  As a result, most employees elect to use their own leave and then later repurchase the leave with their compensation benefits. 

Note:  If disability continues beyond the date shown on the initial CA-7, subsequent Form CA-7s should be submitted 5 to 7 days before the end of the period claimed on the last claim form submitted.  Form CA-20a (Attending Physician’s Supplemental Report) should be filed with the subsequent CA-7.

Appendix A

Points Of Contact For Workers’ Compensation Questions/Issues

Appendix B

Compensation Forms And Purposes

The following  compensation forms information has been provided for only those forms you are likely to use.

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.  Use for occupational disease or illness claims - medical condition developed over more than one workday (i.e. carpal tunnel, skin disease).

CA-2a - Federal Employee’s Notice of Recurrence of Disability and Claim for Pay/Compensation.  Use for recurrence of injury or occupational disease - medical condition has flared up for no other explainable reason other than a previous work-related condition.

CA-3 - Report of Termination of Disability and/or Payment by OWCP. Notifies OWCP that disability from injury has terminated, and/or that the employee has returned to work.

CA-7 - Claim for Compensation on Account of Traumatic Injury or Occupational Disease.  Used for the following purposes:

1. To claim lost wages when continuation of pay expires on a traumatic injury, and to claim wage loss on occupational disease claims.



2. To initiate leave buy backs.



3. To claim a scheduled award (employee has reached maximum medical improvement but has suffered a permanent loss or impairment to a part of their body).



4. To keep compensation for wage loss coming in on a regular basis for employees on leave without pay.

CA-16 - Authorization for Examination and/or Treatment.  This form guarantees the physician payment for care provided to the injured employee.

CA-17 - Duty Status Report.  This form allows the physician to keep your supervisor updated on your work restrictions and/or duty status.

OWCP will only work with original forms.  Send originals to your servicing personnel office as soon as possible.

Failure to submit claim forms in a timely manner by you (30 days) jeopardizes your benefits.  Failure to submit claim forms in a timely manner by your supervisor (10 days) can result in a fine and/or imprisonment (20 CFR 10.16). 

Incomplete forms cause unnecessary delays and causes complications at your servicing personnel office and at OWCP.  Look at and address every block.  Indicate "N/A" if information is not pertinent.  Call your servicing personnel office if you need assistance.

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Last Updated March 2, 2001
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