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Click ‘Get Form’ to open the oc 400 1 form in the editor.
Begin by entering the WCB Case Number and Claimant's Name at the top of the form. Ensure accuracy as this information is crucial for processing your request.
Fill in the Claimant's Social Security Number and Representative's Identification Number, if applicable. This helps in identifying the claimant and their representative.
In Section A, list all services rendered on behalf of the claimant. Include dates, descriptions, time spent, and any disbursements incurred. This section is vital for justifying your fee request.
If applicable, complete Section B regarding any substitution of attorney or representative. Indicate whether there was a previous attorney and provide their details if necessary.
For Section C, if the claimant is not present at the hearing, affirm that a copy of this application was mailed to them and include the date.
Finally, ensure all signatures are completed at the bottom of the form before submitting it through our platform for processing.
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After signing into ECOMP with your email address and password, your Employee Dashboard will be displayed, which lists all forms you have filed in ECOMP. Information about filing a claim on form CA-1 or CA-2 will be displayed. Click File a CA-1 or CA- 2 to proceed.
How to file a CA 1 form?
Email to the Boards centralized email address, wcbclaimsfiling@wcb.ny.gov; Mail to the Boards centralized mailing address, P.O. Box 5205, Binghamton, NY 13902-5205; or. Fax to the Boards centralized fax number, (877) 533-0337.
Who fills out a CA-1?
As the supervisor, it is your responsibility to complete this form. However, if you have any reason to believe that the information provided by the employee is not correct, there are sections of the CA-1 where additional information should be provided: Section 28: Was the employee injured in the performance of duty?
How to file CA-1 form?
Form CA-1 is made of two parts: one, which you fill in, and the other, which your supervisor completes. This form must be handed over to your supervisor to be sent over to the OWCP offices within 30 calendar days from the injury date.
How long does it take to file a CA-1?
For traumatic injuries, file Form CA-1 within 30 days following the injury, and for occupational disease claims, file Form CA-2.
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