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Form CA-1 Rev. Apr. 1999 Indicate which retirement system the employee is covered under. 19) Employers Retirement Coverage. If you are disabled for work as a result of this injury and filed CA-1 within thirty days of the injury, you may be entitled to receive continuation of pay (COP) from your employing agency. COP is
acting on his/her behalf, must file Form CA-1 within 30 days following the injury; however, to avoid possible interruption of pay, the form should be filed within 2 working days.
The injured employee may choose the physician who provides initial medical care. Generally, 25 miles from the place of injury, place of employment, or employee's home is a reasonable distance to travel for medical care. An employee may use sick or annual leave rather than LWOP while disabled.
The WC Group is to submit employee claims to OWCP using electronic claims submission for Forms CA-1, CA-2, and CA-7 via DOL's WC Employees' Compensation Operations and Management Portal case tracking system.
A CA-1 or CA-2 shall be completed within 48 hours of the date of injury. If an eSafety generated CA-1 is completed at the incident, the CA-16, any available medical reports, and Casual Hire Forms (if AD) should be faxed with the CA-1 to WC.
(1) Continuation of pay for disability resulting from traumatic, job-related injury, not to exceed 45 calendar days. (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
The CA-1 form is used if the employee has sustained a Traumatic Injury on the job. Traumatic Injury - A wound or other condition of the body caused by external force, including stress or strain.
