The OWCP CA-1 form is the official form used to report an employee’s traumatic injury (meaning the injury occurred during an incident on a particular shift. It serves as the initial notification to the employer of the injury and begins the process of filing for workers’ compensation benefits. The form collects essential information about the employee, the injury, and the circumstances surrounding it. This is not a repetitive injury or injury that happened over time – that would qualify as a CA-2.
Here’s a general outline of what information is typically included on an OWCP CA-1 form:
- Employee Data: This section collects details about the injured employee, such as their name, address, Social Security number, date of birth, job title, pay grade, and contact information.
- Description of Injury: Here, the employee describes the details of the injury or illness, including the date, time, and location of the incident, as well as a brief description of how it occurred.
- Employee Signature: It is in this section where you will want to check box a. Continuation of regular pay (COP). This will ensure that you continue to get paid for 45 calendar days – after the first 3 days, which the federal worker is responsible for. You may also choose to use your Sick and/or Annual Leave by selecting box b.
- Witness Information: If there were any witnesses to the injury, their names and contact information may be included on the form, along with their statement. A witness’ statement is always recommended when applicable.
- Supervisor’s Report: The employee’s supervisor may choose to provide information about their observations of the incident and any actions taken following the injury.
- Employee’s Statement: The injured employee may provide a statement detailing their account of the incident and any relevant information about the injury.
- Certification: Both the employee and the supervisor typically sign and date the form to certify the accuracy of the information provided. NOTE: Some supervisors believe that signing this form is them admitting to something. It is not. It simply means they are acknowledging that you have reported an injury and they are essentially allowing for further investigation to begin.
- Always keep a copy of the CA-1 and make sure the date is correct! before have this form filed. An incorrect date can create big delays in the processing of your case/claim.
- CA-16 Form: Make sure to request a CA-16 form from your supervisor! It will pay for your medical care for 60 days! Save yourself the out of pocket expense. They must provide you one within 4 hours of your request. However, if you do not get the CA-16 form within 7 days of your injury, you don’t get one! This form is overlooked, but can save you a lot of stress.
Submitting a completed OWCP CA-1 form initiates the process for the employee to receive workers’ compensation benefits, including medical treatment, wage replacement, and other assistance as needed for their recovery from a traumatic injury. Remember – don’t forget your CA-16!