Filing a traumatic injury claim on a CA-1 is the first step in getting a claim approved by the Office of Workers’ Compensation Programs (OWCP). The Federal Employees’ Compensation Act (FECA) defines a traumatic injury as:
A wound or other condition of the body caused by external force, including stress or strain, which is identifiable as to the time and place of occurrence and member or function of the body affected. The injury must be caused by a specific event or incident or series of events or incidents within a single work day or work shift.
Traumatic injuries are those caused by an event or incident during one work day or shift. If your injury occurred over a period of time, then you should timely file an occupational disease claim, on a CA-2. Regardless of whether you suffered a traumatic injury or occupational disease, to establish the essential elements of a claim, the injured federal worker must provide evidence showing that:
- you filed for benefits in a timely manner;
- you are a civil employee;
- the injury occurred as reported and in the performance of duty; and
- your resulting condition or disability is medically related to the work injury.
The latter two elements are established through medical evidence. It is your obligation to ensure that your physician provides a diagnosis of your medical condition, and his or her rationalized medical opinion about the relationship between the diagnosed condition and the work event or incident that caused the injury. It is important that the physician identify all objective test results that support the diagnosis.
If you suffer an on-the-job traumatic injury, you should immediately notify your supervisor and request authorization for medical treatment and obtain a Form CA-16. You should identify the physician of your choice to provide medical treatment for the injury: Do not assume that your employing agency will direct you to a doctor that will provide medical care that is in your best interest. Postal workers suffering traumatic injuries might, in non-emergent situations, be required to be examined by a Postal Medical Office (PMO) or contract equivalent, prior to obtaining initial medical treatment. This examination must in no way interfere with the employee’s right to seek prompt treatment from the employee’s physician of choice. If possible, you should take the CA-16 with you when you first go to the doctor. The employing agency may also provide you with a CA-17 (Duty Status Report) and a HCFA-1500 (Health Insurance Claim Form) for your physician to complete.
Once you have obtained proper medical attention, you will need to complete a Form CA-1 (Federal Employees’ Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation). You should submit a completed CA-1 within 30 days of the date of injury in order protect your eligibility for continuation of pay (COP). Make sure your keep your signed receipt from the CA-1 and request a copy of the completed CA-1 from your supervisor.
After OWCP receives the CA-1 from the employing agency, it will send written notification of your OWCP case file number. You should receive this number approximately two weeks after the OWCP receives your CA-1. Make sure to include this number on all documents submitted to OWCP. Instruct your doctor and other medical providers to include this case file number on all bills or other correspondence sent to OWCP.
Good practice is to file the CA-1 within 30 days of the date of injury; however, under FECA an injured federal worker has three years to file the claim from the date of injury.
If the OWCP accepts your claim, then the injured federal worker will receive an approval letter from the OWCP that identifies what conditions have been accepted as being work related. The acceptance notice usually provides information about your benefits and obligations. Make sure that your physician agrees that the accepted conditions accurately reflect the diagnosed conditions caused by the work incident. If the accepted conditions are not consistent with your diagnosed conditions, then your physician must notify the OWCP of the discrepancy.
If you need legal counsel to discuss your rights under the Federal Employees’ Compensation Act (FECA) you should contact OWCP Attorney Gregory A. Hall to schedule a consultation.