Form CA 5 Claim for Compensaion by Widow, Widower, and or Children 2026

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4.8 out of 5

25 votes

The document is a claim form (Form CA-5) for compensation by the widow, widower, or children of a deceased employee under the Federal Employees' Compensation Act (FECA). It includes sections for personal information about the deceased, the claimant, and any dependents. The form outlines eligibility requirements for benefits, necessary documentation, and instructions for filing the claim. Additionally, it provides details on compensation rates, funeral/burial allowances, and privacy notices regarding the handling of personal information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the name of the deceased employee in the first field. Ensure you include their last, first, and middle names.
Fill in the date of birth of the deceased employee. Use the format (Mo., day, year) for accuracy.
Provide the date of death in the specified format. This is crucial for processing your claim.
Complete sections regarding your relationship to the deceased, including your own date of birth and marriage details.
List all children who may be entitled to compensation, ensuring you include their names, relationships, and dates of birth.
Review all entries for accuracy. If any item does not apply to you, indicate this by writing 'NA'.
Once completed, save your form and utilize our platform's signing feature to sign electronically before submission.

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See more Form CA 5 Claim for Compensaion by Widow, Widower, and or Children versions

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Versions	Form popularity	Fillable & printable
2016	4.3 Satisfied (41 Votes)
2013	4.8 Satisfied (25 Votes)
1997	4 Satisfied (35 Votes)

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What is a CA 5 form?

CA-5* Claim for Compensation by Surviving Spouse and/or Children. CA-5b* Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren.

What not to say to a workers comp doctor?

What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.

Who fills out the CA 16 form?

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.

What is a CA 7 form from the USPS?

CA-7: Claim for Compensation. This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease.

What is a CA 2a form?

The CA-2a is used when an employee has an existing claim, but the claim has been administratively closed because the employee either has not treated with a doctor for 18 months or has previously returned back to full duty work and now has disability. The CA-2a is also referred to as a recurrence claim.

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What is the most common workers comp claim?

Overuse. This is the most common claim for workers compensation. Overuse or overexertion happens when a person strains or pulls a muscle or joint or slips a disk from overextending to lift, pull, push, or turn an item.

What is a CA 2 claim?

This form is used if the employee has sustained an occupational disease as a result of job duties. Occupational Disease - A condition produced in the work environment over a period longer than one work day or shift.

Form CA 5 Claim for Compensaion by Widow, Widower, and or Children 2026

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