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Click ‘Get Form’ to open the CA-17 in the editor.
On Side A, enter the employee's name, date of injury, and OWCP file number if known. This section is crucial for identifying the employee and their case.
Next, provide details about the employee's occupation and how the injury occurred. Be specific about the parts of the body affected to ensure accurate reporting.
Switch to Side B for the physician's section. Here, they will confirm whether the history of injury corresponds with what was reported by the employee.
The physician should complete clinical findings, diagnosis, and any other disabling conditions. Ensure all fields are filled accurately to avoid delays.
Finally, have the physician sign and date the form before submitting it back to your agency and sending a copy to OWCP as instructed.
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Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation), and (2) occupational disease (Form CA-2, Notice of Occupational Disease and Claim for Compensation).
What is a CA 7A form?
Instructions for Completing Form CA-7A Time Analysis. General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave.
Who fills out a CA 17?
There are two sides to the CA-17: Side A is completed by the employees supervisor and Side B is completed by the employees physician. A properly completed CA-17 should give the doctor an accurate picture of a workers daily work duties so that accurate work restrictions can be noted.
What does CA 7 mean?
Form CA-7 is used to claim compensation for wage loss while in a leave without pay (LWOP) status due to disability or absence to obtain medical treatment (after continuation of pay (COP) period for traumatic injury cases).
What is a CA-17 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.
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