2-2. Traumatic Injury
A traumatic injury is defined as a wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable by time and place of occurrence and member of the body affected; it must be caused by a specific event or incident or series of events or incidents within a single day or work shift.
Traumatic injuries also include damage to or destruction of prosthetic devices or appliances,including eyeglasses, contact lenses, and hearing aids, if they were damaged incidental to a personal injury requiring medical services. (Personal property claims can be made only under the Military Personnel and Civilian Employees' Claims Act, 31 U.S.C. 240.)
A. Notice of Injury--Form CA-1.
When an employee sustains a traumatic injury in the
performance of duty, he or she should file a written report on Form CA-1. The form should be
given to the supervisor as soon as possible, but not later than 30 days from the date of injury. If the employee is incapacitated, this action may be taken by someone acting on his or her behalf, including a family member, union official, or representative. (The supervisor may provide such notice as well.) The form must contain the original signature of the person giving notice. The supervisor should:
(1) Review the front of the form for completeness and accuracy, and assist the
employee in correcting any deficiencies found;
(2) Complete and sign the reverse of Form CA-1, including a telephone number in
case OWCP staff have questions about the injury. Also, insert the appropriate codes on both the front and back of the form. Codes should be included for occupation, type and source of injury, agency identification, and location of duty station by zip code. (Appendix B of this publication describes the type and source of injury codes and their use.)
(3) Sign and return to the employee the receipt attached to Form CA-1 and give a
copy of the entire form to the employee;
(4) Authorize medical care if needed in accordance with paragraph (C) below;
(5) Inform the employee of the right to elect continuation of regular pay (COP),
(discussed in detail in Chapter 5), or annual or sick leave if time loss will occur;
(6) Advise the employee whether COP will be controverted, and if so, whether
pay will be terminated. The basis for the action must be explained to the employee.
(Controversion is discussed in Chapter 5-3; the reason for controverting a claim must always be shown on Form CA-1.)
(7) Advise the employee of his or her responsibility to submit prima facie medical
evidence of disability within 10 working days or risk termination of COP (see Chapter 5-8).
B. Disposition of Form CA-1.
If the employee incurs medical expense or loses time from work beyond the date of
injury, the supervisor should send Form CA-1 to the district office with supporting information as soon as possible but no later than 10 working days after receipt of Form CA-1 from the employee. If the employee is examined or treated at the agency's medical facilities or by medical providers under contract to the agency, and this examination or treatment occurs during working hours beyond the date of injury, the supervisor should add the words "first aid" to the upper right corner of the agency's portion of Form CA-1 and submit it to OWCP.
"First aid" injuries also include those requiring two or more visits to a medical facility for examination or treatment during non-duty hours beyond the date of injury, as long as no leave or continuation of pay is charged and no medical expense is incurred.
If the employee obtains no medical care, or obtains only agency-sponsored care on the
date of injury, and no time loss is charged to either leave or continuation of pay, the supervisor should place Form CA-1 in the worker's Employee Medical Folder (EMF) instead of sending it to OWCP.
C. Medical Treatment--Form CA-16.
If an employee requires medical treatment for the
injury, the supervisor should complete the front of Form CA-16 within four hours of the request, whenever possible. If the supervisor doubts whether the employee's condition is related to the employment, he or she should so indicate on the form. Where there is no time to complete a Form CA-16, the supervisor may authorize medical treatment by telephone and send the completed form to the medical facility within 48 hours. Retroactive issuance of Form CA-16 is usually not permitted under other circumstances.
(1) Delayed Report of Injury. If an employee reported an injury several days after
the fact, or did not request medical treatment within 24 hours of the injury, the supervisor may still authorize medical care using Form CA-16. Agency personnel are encouraged to use
discretion in issuing authorizations for medical care under such circumstances, but employees
should not be penalized for short delays in reporting injuries. The supervisor may, however,
refuse to issue a CA-16 if more than a week has passed since the injury on the basis that the need for immediate treatment would become apparent in that period of time. An employee may not
use Form CA-16 to authorize his or her own treatment.
(2) Choice of Physician. The employee is entitled to select the physician who is
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to provide treatment. The provider must meet the definition of "physician" under the FECA and
must not have been excluded from payment under the program (refer to Chapter 6 for guidance
in authorizing providers). Physicians employed by or under contract to the agency may examine
the employee at the agency's facility in accordance with OPM regulations. However, the
employee's choice of physician must be honored, and treatment by the employee's physician
must not be delayed for the purpose of obtaining an agency-directed medical examination.
(3) Obtaining Treatment. Along with Form CA-16, the supervisor should give the
employee Form OWCP-1500, which is used for billing (this form is discussed in Chapter 6).
The physician should complete the reverse of Form CA-16 and the OWCP-1500 and forward
them to OWCP; the supervisor may ask the physician for a copy of the report as well. The
employee may be furnished transportation and/or reimbursed for travel and incidental expenses.
OWCP generally considers 25 miles from the agency or the employee's home a reasonable
distance to travel for medical care unless appropriate care is not available within that radius.
(4) Further Referral. The original treating physician may wish to refer the
employee for additional testing or specialized treatment. He or she may do so on the basis of the Form CA-16 already issued; it is not necessary to issue additional authorizations for treatment. Both the original physician and any physician to whom the employee is referred is guaranteed payment for 60 days from the date of issue of Form CA-16 unless OWCP terminates this authority at an earlier date. Treatment may continue at OWCP expense if the claim is approved. Should the employee wish to change physicians after the initial choice, he or she must contact OWCP in writing for approval and include the reasons for requesting the change.
D. Medical Reports--Forms CA-20 and CA-17.
In cases sent to OWCP, a medical report
from the attending physician is required. This report may be made on Form CA-16 or on Form
CA-20, which is attached to Form CA-7. It may also be made in narrative form on the
physician's letterhead stationery, or in the form of a hospital or health plan summary. The report should bear the physician's signature or signature stamp. The supervisor should supply Forms CA-20 to the employee as often as needed.
The original reports should be sent to OWCP. Agency personnel should use Form CA-17, Duty Status Report, to obtain interim medical reports about the employee's fitness for duty; it may be issued initially with Form CA-16. The supervisor should complete the agency's portion of the form by describing the physical requirements of the employee's job and noting the availability of any light or limited duty. The physician should send the original Form CA-17 to the agency and a copy to the district office.
The supervisor may send Form CA-17 to the physician at reasonable intervals (but not more
often than once a week) to monitor the employee's medical status and ability to return to light or full duty. (Agency offers of light or limited duty during the COP period are discussed in Chapter 5.)
E. Wage Loss/Permanent Impairment--Form CA-7.
If disability is anticipated at the time
of injury, the employee may elect to use leave or COP (which is discussed in Chapter 5) on Form CA-1. An employee who cannot return to work when COP ends, or who is not entitled to
receive COP, may claim compensation for wage loss on Form CA-7. In controverted cases
where pay is terminated, Form CA-7 should be submitted with Form CA-1.
(1) When to File. If it is not clear whether the employee will remain disabled
after the 45 days of COP are used, he or she should initiate a claim for compensation.
Supervisors should carry employees who have filed claims in LWOP status. If an employee
returns to work after Form CA-7 has been filed, the supervisor should notify OWCP by
telephone (so as to prevent overpayments), and later provide written confirmation of return to
duty.
(2) Completion of Form. If compensation is to be claimed, the supervisor should
give Form CA-7 to the employee on the 30th day of COP with instructions to complete the front
and return the form to the agency within one week. (If the employee has not returned it by the
40th day of COP, the supervisor should contact him or her by telephone and ask for its submittal as soon as possible). The supervisor should also show the address of the district office in the box on the reverse of the Form CA-20 which is attached to the claim form.
When the form is returned, the supervisor should complete the reverse of the
form, including the name and the telephone number of an agency official with direct knowledge
of the claim.
The employee should arrange to provide medical evidence to support the period
of disability claimed; this evidence may be submitted with the Form CA-7 or sent to OWCP
separately.
(3) Submittal of Form. After completing the form, the supervisor should send it
to OWCP along with any new medical evidence in the agency's possession. OWCP will use the
pay data supplied by agency personnel to determine the rate at which compensation is to be paid. (Submittal should not be delayed for computation of shift differential, Sunday or holiday pay, or other incremental pay. These elements, which are discussed in Chapter 8, may be computed and submitted separately.) The dates of compensation claimed should represent the period of disability supported by the medical evidence or the interval until the employee's next medical appointment.
(4) Leave Repurchase. An employee who uses sick or annual leave to avoid
interruption of income may repurchase that leave, subject to agency concurrence, if the claim is approved. Form CA-7 (along with Forms CA-7a and CA-7b) are used for this purpose. The
employee and supervisor should supply the factual and medical evidence described above, and
the supervisor should also provide a detailed breakdown of leave used, showing the number of
hours charged for each day claimed and whether sick or annual leave was used. (The
relationship between COP use and leave use is discussed in Chapter 5-2.)
(5) Lost Wages for Medical Treatment. An employee who has returned to work
but still requires medical treatment during work hours may claim compensation for lost wages
while undergoing or traveling to and from the treatment. For a routine medical appointment, a
maximum of four hours of compensation is usually allowed. Such a claim may be made on
Form CA-7, and it should be accompanied by a statement from the supervisor showing the exact
period of time and the total amount of wages lost due to the treatment, the rate of pay and the number of hours or days the employee would have worked if available.
Form CA-7 is also used to claim continuing compensation for wage loss. During
the period of disability, a new Form CA-7 should be submitted every two weeks absent other
instructions from OWCP. Finally, Form CA-7 is used to claim schedule awards for permanent impairment. (Entitlement to such awards is discussed in Chapter 7-1.)
2-3. Occupational Disease
An occupational disease is defined as a condition produced in the work environment over a
period longer than one workday or shift. It may result from systemic infection, repeated stress orstrain, exposure to toxins, poisons, or fumes, or other continuing conditions of the workenvironment.
A. Notice of Occupational Disease--Form CA-2.
The injured employee, or someone
acting on his or her behalf, should give notice of occupational disease on Form CA-2. (Such
notice may be provided by the supervisor as well.) The supervisor should issue to the employee
two copies of the appropriate checklist, Form CA-35a-h, for the disease claimed. (To facilitate
submittal of evidence, specific checklists have been devised for various conditions--see
Appendix C.)
The supervisor should also explain the need for detailed information to the
employee and advise him or her to furnish supporting medical and factual information requested
on the checklist. If possible, this information should be submitted with the form. Upon
receiving Form CA-2, the supervisor should:
(1) Review the front of the form for completeness and accuracy, and help the
employee to correct any errors or omissions;
(2) Complete and sign the reverse of Form CA-2, and include a telephone number
in case OWCP staff have questions about the claim. Also, show the codes for occupation, type
and source of injury, agency identification, and location of duty station by zip code. (Appendix
B describes the type and source of injury codes and their use.)
(3) Sign and return to the employee the receipt attached to Form CA-2 and give a
copy of the entire form to the employee;
(4) Review the employee's portion of the form and provide comments on the
employee's statement;
(5) Prepare a supporting statement to include exposure data, test results, copies of
reports of previous medical examinations, and/or witness statements, depending on the nature of
the case. The checklist may be used to coordinate compilation of material by agency personnel,
including compensation specialists and safety and health officers;
(6) Advise the employee of the right to elect sick or annual leave or leave without
pay, pending adjudication of the claim. The supervisor should submit completed Form CA-2 to
the district office within 10 working days of receipt from the employee. It should not be held for
receipt of supporting documentation.
B. Medical Treatment--Form CA-16.
Only rarely may employers authorize medical care
in occupational disease claims. The supervisor must contact OWCP before issuing a Form
CA-16.
C. Wage Loss/Permanent Impairment--Form CA-7.
Form CA-7 is used to file a claim for
compensation because of pay loss. The claim should be filed within 10 days after pay stops or
when the employee returns to work, whichever occurs first.
(1) Leave Repurchase. The employee may use sick or annual leave pending
adjudication of the claim. If this is done, the employee may initiate repurchase of this leave,
subject to agency concurrence, using Form CA-7 (along with Forms CA-7a and CA-7b). The
supervisor should certify the amount and kind of leave used for each day claimed, and the
employee should arrange to submit medical evidence supporting the period of repurchase
requested.
(2) Lost Wages for Medical Treatment. An employee who has returned to work
but still needs medical treatment during work hours may claim compensation for lost wages
while undergoing or traveling to and from the treatment. For a routine medical appointment, a
maximum of four hours of compensation is usually allowed. Such a claim may be made on
Form CA-7, and it should be accompanied by a statement from the supervisor showing the exact
period of time and the total amount of wages lost due to the treatment, as well as the rate of pay.
Form CA-7 is also used to claim continuing compensation and to initiate a claim for
schedule award for permanent impairment resulting from occupational disease. Chapter 7-1
addresses entitlement to schedule awards.
2-4. Recurrence of Disability
A recurrence of disability is defined as a spontaneous return or increase of disability due to a
previous injury or occupational disease without intervening cause, or a return or increase of
disability due to a consequential injury (defined in Chapter 3-5). A recurrence of disability
differs from a new injury in that with a recurrence, no event other than the previous injury
accounts for the disability.
A recurrence of medical condition is defined as a documented need for further medical treatment
after release from treatment for the accepted condition or injury when there is no accompanying
work stoppage. Continuous treatment for the original condition or injury is not considered a
"need for further medical treatment after release from treatment," nor is an examination without
treatment.
A. Claim for Recurrence of Disability--Form CA-2a.
If a recurrence of disability develops, the employee and supervisor should complete Form CA-2a and submit it to OWCP. If
the employee was entitled to use COP and the 45 calendar days of COP have not been exhausted,
he or she may elect to use the remaining days if 45 days have not elapsed since first return to
duty (see Chapter 5-7 for detailed information). Otherwise, the employee may elect to use sick
or annual leave pending adjudication of the claim for recurrence.
The employee should arrange
for submittal of the factual and medical evidence described in the instructions attached to the
form, paying particular attention to the need for "bridging" information which describes his or
her condition and job duties between the original injury and the recurrence.
B. Medical Treatment.
Ordinarily, no medical treatment is authorized at OWCP expense
until a claim for recurrence is accepted. At its discretion the district office may, however,
authorize an emergency medical examination without Form CA-2a.
C. Continuing Claim for Wage Loss--Form CA-7.
Form CA-7 is used to file a claim for
continuing compensation due to a recurrence. During the period of disability, a new Form CA-7
should be submitted every two weeks absent other instructions from OWCP.