Workers' Compensation Forms

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Commonly Asked Questions about Workers' Compensation Forms

When should I file CA 7?

Form CA-7 should be submitted by an injured worker (IW) every two weeks while disabled and in a LWOP status, unless the IW has been placed on the periodic roll. For traumatic injury cases, Form CA-7 should be completed before the end of the COP period, if disability will continue.

What is a CA-17 form?

Injured postal workers are required to fill in form CA-17, which is a form which outlines information from a doctor forbidding an injured federal employee from carrying out certain activities due to their inherently physically taxing nature.

What is a qualified injured worker in California?

QIW means an employee who, as the result of his/her injury, whether or not combined with the effects of any other medical condition, cannot return to his/her usual customary occupation or job at time of injury.

What is a CA 17 form used for?

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 workers medical restrictions and entitlement to wage-loss compensation benefits.

How to file workers comp in CT?

To file a workers compensation claim in Connecticut, you must complete Form 30C, send the original to your employer, and send a copy to the Workers Compensation Commission District Office.

Who fills out a CA 7 form?

Form CA-7 should be submitted by an injured worker (IW) every two weeks while disabled and in a LWOP status, unless the IW has been placed on the periodic roll.

What is a 5020 form workers compensation?

The Employers Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.

Do you get paid if you get injured at work in California?

As a general rule, TD pays two-thirds of the gross (pre-tax) wages you lose while you are recovering from a job injury. However, you cannot receive more than the maximum weekly amount set by law.