Office of Workers' Compensation Program (OWCP) Forms

Commonly Used OWCP Forms:

➤ 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.

➤ 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 physician 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 identify 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-915  Claimant Medical Reimbursement Form

Failure to process a valid claim is a violation of law.

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     

Appeal Rights:

Other OWCP resources and information:

OWCP Instruction Relating To Representative Fee Applications - OWCP does not recognize any contract or agreement between representatives and clients for payment of a fee for services on a contingency basis.  Such contract or agreement will result in the denial of the fee request  A fee will not be approved merely on the basis of a percentage of the amount of compensation awarded. All fees claimed for services rendered must be calculated on an hourly basis.  Application for approval of the fee should be submitted along with submitting the final evidence necessary for adjudication of the client's claim. A fee application must be accompanied by a statement signed by the claimant indicating agreement with the amount charged.  Claimant must acknowledge that she is aware that she must pay the fee and that OWCP is not responsible for paying or reimbursing the fee. Where a fee application is accompanied by a signed statement indicating the claimant's agreement with the fee, the application will be deemed approved, per 20 C.F.R. §10.703(b). Fees collected prior to OWCP approval may constitute a misdemeanor under 18 U.S.C. § 292.

For more information on light duty and reasonable accommodation, disability discrimination, constructive discharge, disability retirement and Workers' Comp. click the button below:

Disclaimer: Forms herein were obtained from various government websites, including OWPC's and are provided herein by courtesy of EEO 21, LLC for your own peril.