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Commonly Asked Questions about Workplace Compensation Forms

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.
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 employees condition is related to employment, he/she should so indicate on Form CA-16.
DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers compensation benefits and the Medical Provider Network (MPN) in California.
Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.
(b) The Form CA-16 should be issued within four hours of the claimed injury. If the employer gives verbal authorization for such care, he or she should issue a Form CA-16 within 48 hours. The employer is not required to issue a Form CA-16 more than one week after the occurrence of the claimed injury.
The CA-2 Notice of Occupational Disease form should be used if you have sustained an occupational disease injury on the job.
C-4.3. Use this form: 1. When rendering an opinion on MMI and/or permanent partial impairment; or 2. In response to a request by the Workers Compensation Board to render a decision on MMI and/or permanent partial impairment.

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