Ca 16 fillable 2025

Get Form
ca 16 fillable Preview on Page 1
See details
4 out of 5
33 votes
The document outlines the rights and responsibilities of employees who are injured at work under the Federal Employees' Compensation Act (FECA). It details the process for filing a workers' compensation claim, obtaining medical treatment, and receiving benefits such as Continuation of Pay (COP) and compensation for wage loss. The document also explains the requirements for medical reports, payment procedures for medical bills, light duty availability, leave buy-back options, and penalties for false claims. Additionally, it emphasizes the importance of privacy regarding workers' compensation records.
DocHub Reviews
44 reviews
DocHub Reviews
23 ratings
15,005
10,000,000+
303
100,000+ users

Here's how it works

01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out ca 16 fillable with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the ca 16 fillable in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, employee ID, and contact details.
  3. In the section for medical treatment authorization, specify the name of your preferred physician and their contact information.
  4. If applicable, indicate whether this is an emergency situation that requires immediate attention.
  5. Review all entered information for accuracy before submitting. Ensure that any required signatures are included.
  6. Once completed, save your form and submit it electronically through our platform for processing.

Start using our platform today to streamline your form completion process for free!

Fill out ca 16 fillable online
It's free
Start now
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
If an employee requires medical treatment for a traumatic injury, a supervisor should complete the front of Form CA-16, within four hours of request whenever possible; however, if the supervisor doubts whether employees condition is related to employment, they should not issue Form CA-16.
Only Forest Service Workers Compensation (FS-WC) personnel or the following incident personnel: Compensation Unit Leader (COMP), or a Finance Section Chief (FSC) are authorized to issue Form CA-16 for Federal Government and Administratively Determined (AD) employees.
The FROI serves as the official notification to the employer, insurance carrier, and relevant regulatory authorities about the occurrence of a work-related injury or illness and triggers the investigation, evaluation, and administration of the workers compensation claim.
The Form CA-16 is valid for 60 calendar days from the date of issuance. The original treating physician may wish to refer the employee for more specialized treatment or for further testing.
ECOMP is a free web-based application hosted by the Office of Workers Compensation Programs (OWCP) that provides Federal agencies with an electronic system for recording workplace injuries and illnesses, and processing claims under the Federal Employees Compensation Act (FECA).

Related Searches

CA-16 PDF CA-17 form CA-16 form Department Labor CA-16 form usps CA-1 form CA-16 Form 2025 Printable CA-7 form Printable CA-17 form pdf

People also ask

A CA-16 can be issued up to 48 hours after the employee has been treated. If the employee provides a medical report within 48 hours or treatment indicating the condition is work-related, a CA-16 can be issued with supervisory approval.
Contact HRM Contact Center with 48 hours after medical treatment or on the next business day, for issuance of CA-16 by FS WC to the medical provider.

Related links

RESPONSIBILITY STATEMENT FOR SUPERVISORS OF A

Title 16, California Code of Regulations (16 CCR) section 1833.1 requires any qualified licensed mental health professional who assumes responsibility for

Learn more
FL-160 Property Declaration - California Courts - CA.gov

Property Declaration (form FL-160) is a multipurpose form, which may be filed with the court as an attachment to a. Petition or Response or served on the

Learn more
Forms

All of the Federal Employees Programs online forms (with the exception of Forms CA-16 and CA-27) are available to print and to manually fill and submit.

Learn more

Try more PDF tools

Edit & Annotate
Edit PDF
Add Fillable Fields
Create PDF
Insert and Merge
Add Page Numbers
Rotate Pages
Delete Pages
Convert
Word to PDF
TXT to PDF
HTML to PDF
CSV to PDF
PPT to PDF
RTF to PDF
JPG/JPEG to PDF
PNG to PDF
Collaborate & Share
Add Comments
Fax
PDF Status
Sign & Send
Sign a PDF
Send for Signing
Protect PDF
Set PDF password
Readable PDF
Certify PDF
PDF Audit Trail
Others
Search for PDF
Export
Download
Flatten Fields
Print out
If you believe that this page should be taken down, please follow our DMCA take down process here
support@dochub.com
17 Station St., Ste. 303 Brookline, MA 02445
Google Play App Store
© 2025 DocHub, LLC
All Rights Reserved.
Products
PDF Editor
Forms & Templates
Sign Documents
Server Status
Pricing
Forms Library
Features
Functions
Company
About
Terms of Service
Privacy Notice
Legal Hub
E-Signature Compliance
Support
Release Notes
Bug Bounty Program
Resources
pdfFiller
US Legal Forms
SignNow
WorkFlow
Instapage
DocHub Mobile App
What's New
New
DocHub v6.6.0 - @mentions, AI assistant and more
Contact us
support@dochub.com
17 Station St., Ste. 303 Brookline, MA 02445
Google Play App Store
© 2025 DocHub, LLC
All Rights Reserved.
This site uses cookies to enhance site navigation and personalize your experience. By using this site you agree to our use of cookies as described in our Privacy Notice. You can modify your selections by visiting our Cookie and Advertising Notice.... Read more...Read less
Accept