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S.C. 552a authorizes OWCP to ask you for information needed in the administration of the FECA Black Lung and EEOICPA programs. O. Box/Apt No. FOR DOL USE ONLY City State Zip Code PROVIDER INFORMATION Name of Doctor s Office Hospital Pharmacy or Medical Supply Company where expense was incurred. A separate OWCP-915 must be filed for each provider Description of Charge Medical appointment name of prescription drug description of medical product/ supply Date of Service MM/DD/YYYY From Amount Paid b ...

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What does OWCP mean?

Office of Workers' Compensation Programs.

What is the difference between ca1 and ca2?

Form CA-1 is used for a traumatic injury (a medical condition resulting from an incident or activity occurring during one work shift). Form CA-2 is for an occupational disease (a medical condition resulting from an incident or activity occurring over more than one work shift).

How long do I have to submit a CA-1?

To be eligible for COP, you must submit a CA-1 within 30 days of the injury. If disabled and claiming COP, you must submit medical evidence supporting your disability to your employing agency within 10 workdays.

What is a CA 16 used for?

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.

What is ca1?

Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. The Form CA-1 was developed to ensure regulatory compliance and to be more customer friendly. The form must be completed by the injured employee, a witness, and the injured employee's supervisor.

915 form

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What is the difference between a ca-1 and a Ca 2?

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 worker's medical restrictions and entitlement to wage-loss compensation benefits.

What is a ca7a form?

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. Instructions for Employee: Blocks 1, 2, and 3: Self-explanatory.

What is a CA-1 form USPS?

(To be eligible for continuation of pay, the employee, or someone acting on his/her behalf, must file Form CA-1 within 30 days following the injury and provide medical evidence in support of disability within 10 days of submission of the CA-1.

How long do I have to file a Ca 2?

With the CA-2 form, the deadline is three years from when you first became aware of the medical condition.

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