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FAX 10. Type of Practice a* c* Address State Zip 9 digits Individual b. Facility For Individual or Facility complete indicated sections below Group Please see reverse for completion of group enrollment Provider Type Individual or Facility 11a* Provider Type Code 11c* If you select Other Provider 96 or Non-Medical Vendor 53 please explain 12. Tax ID EIN SSN 13. Medicare Number required for hospitals only License and Certification Individual for M. D. and D. O. only 14a* Name 14b. License / Stat ...
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DoL OWCP-1168 2020 4.8 Satisfied (90 Votes)
DoL OWCP-1168 2015 4.4 Satisfied (63 Votes)
DoL OWCP-1168 2009 4.4 Satisfied (64 Votes)
DoL OWCP-1168 2004 4.3 Satisfied (46 Votes)
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The CA-7 must be filed within one year of the dates claimed, or the date your claim is accepted, whichever is later.
DFEC | Office of Workers' Compensation Programs. Office of Workers' Compensation Programs.
If you are claiming a traumatic injury, your employing agency may have issued you a Form CA-16 so that you could obtain medical treatment right away. This authorization covers non-surgical treatment and continues for up to 60 calendar days from the date of injury.
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.
INSTRUCTIONS FOR THE INJURED WORKER/ EMPLOYING AGENCY If the claim is for occupational disease, filed on Form CA-2, a medical report as described in the instructions accompanying that form is required in most cases. The employee should bring these requirements to the physician's attention.

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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.
\u25cb Form CA-16 is valid for up to sixty days from date of issuance, and may be terminated earlier upon written notice from OWCP to the provider. It should not be used to authorize a change of physicians after the initial choice is exercised by the employee.
Form CA-7, Claim for Compensation: This form is used by a federal employee to claim compensation for employment-related disability. The form must be filed with one's employing agency.
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.
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.

Related links

Federal Employees Health Benefits Program - Wikipedia

The FEHB program allows some insurance companies, employee associations, and labor unions to market health insurance plans to governmental employees.

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Information for Medical Providers | U.S. Department of Labor

To enroll, please complete and submit the Provider Enrollment Form (OWCP-1168). Additional information on provider enrollment is available on the OWCP Web Bill ...

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Form 5500 Datasets | U.S. Department of Labor

The datasets below contain structured data from Form 5500 and Form 5500-SF forms and ... 2004 Form 5500 ... An agency within the U.S. Department of Labor.

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