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IMPORTANT FORMS FOR INJURED FEDERAL WORKERS

Below are links to key forms that injured federal workers may need to complete in regards to their workers’ compensation claim.

When in doubt about your claim, contact Benjamin Zvenia for expert advice. There is never a charge for an initial consultation.

These files are in PDF format, readable by the majority of computers. If you don’t have Adobe Acrobat® Reader™ installed on your computer, click below to download the program. The program is free and contains no viruses.

Form Ca1: Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
This form must be filed within 30 days of the occurrence.

Form Ca2: Notice of Occupational Disease and Claim for Compensation
This form should be filed within three years of your awareness of a compensable condition.

Form Ca2a: Notice of Recurrence
This is a difficult form to complete. Be careful to determine whether the condition is really a recurrence or a new claim.

Form Ca7: Claim for Compensation
This form begins a claim for compensation, but will not be sufficient by itself. Applicants will need to provide narrative and appropriate medical records.

Time Analysis Form
This form is used for claiming compensation, including repurchase of paid leave.

Leave Buy Back (LBB) Worksheet/Certification and Election

Form Ca20: Attending Physician’s Report
The form alone is not sufficient. The employee will need to provide substantive, reliable, and probative evidence from his/her doctor. A PA or NA or nurse may not sign the form or report.

Form OWCP-957: Medical Travel Refund Request

This form is used to obtain reimbursement for travel expenses to and from the doctor. Make sure you make a copy because OWCP does not make reimbursements promptly.

Work Capacity Evaluation Psychiatric/Psychological Conditions

Work Capacity Evaluation Cardiovascular/Pulmonary Conditions

Work Capacity Evaluation for Musculoskeletal Conditions