1. MANAGING THE PAPERWORK Yvette Talley and Mark Baumann

2. OBJECTIVES Identify the forms required for filing an injury or illness Discuss the appropriate responses on the supervisor portion of the claim form Discuss the importance of communication with the Workers’ Compensation Staff Identify documents used to authorize medical treatment and duty status reports

3. ENTITLEMENTS Right to file a CA-1 (injury) and CA-2 (illness), to apply for compensation Entitlement includes the option to receive medical treatment by either the VA Occupational Health Unit or their primary care provider Authorized to designate representation

4. DEFINITIONS FECA- Federal Employees’ Compensation Act OWCP-Office of Workers’ Compensation Programs Employer or Agency - refers to officers and employees of an employer having responsibility for the supervision, direction and control of employees Representative-An individual or law firm properly authorized by a claimant in writing to act for the claimant in connection with a claim

5. CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation

6. CA-1 (cont) Employee must give notice in writing using form CA-1 Review page one of the form ensuring it includes a detailed description of the injury Complete and sign page two of the form within 2-3 days Complete Receipt of Notice attached to CA1 and provide to employee

7. CA-1 (cont) Submit completed form to Workers’ Compensation Office Medical care authorized if appropriate Advise the employee if COP will be controverted Advise the employee of their responsibility to submit Prima Facie medical evidence of disability within 10 calendar days

16. Additional Forms Completed With the CA-1 Release of Information Election of Physician First Script Card Employee Responsibilities 10.330

26. CA-2, Notice of Occupational Disease and Claim for Compensation

27. CA-2 (cont) Review page one of the form ensuring it includes a detailed description of condition and relationship to employment Complete and sign page two of the form within 2-3 days Complete Receipt of Notice attached to CA2 and provide to employee Submit completed form to Workers’ Compensation Office

32. CA-35, Evidence Required in Support of a Claim for Occupational Disease

34. CA-35 Checklists Occupational Disease (generic) Work-Related Hearing Loss Asbestos-Related Illness Work-Related Coronary/Vascular Condition Work-Related Skin Disease Work-Related Pulmonary Illness (not asbestosis) Work-Related Psychiatric Illness Work-Related Carpal Tunnel Syndrome

35. CA-2a, Notice of Recurrence Recurrence of Medical Condition Documented need for additional medical treatment after release from treatment for the work-related injury. Recurrence of Disability Spontaneous return of the symptoms of a previous injury or occupational disease without an intervening cause.

36. CA-2a (cont) Employee completes and signs page one of the form Supervisor will review employee’s portion of the form and complete page two Treated the same as a CA2 in that it is not considered work-related unless DOL accepts the recurrence.

42. CA-6, Official Superior’s Report of Employee’s Death

45. CA-5 and CA-5b, Claim for Compensation by Widow, Widower, and/or Children, Parents, Brothers, Sisters, Grandparents, or Grandchildren

46. CA-5 and CA-5b (cont) Benefits may be paid to eligible dependents of an employee whose death results from an injury sustained in the performance of duty.

55. CA-7 Claim For Compensation

68. CA-16, Authorization for Examination and/or Treatment Complete the form with 4 hours of request May refuse to issue if more than a week has passed since the injury

73. CA-17, Duty Status Report To obtain interim medical reports Issued with the CA-16 Supervisor completes the agency portion of the form May send to the physician at reasonable intervals Monitor employee’s medical status and ability to return to limited or full duty

80. Work Statements and Limited Duty Job Assignments

84. Continuation of Pay Memorandum

86. OWCP Decision on Denied Claim-Agency Email Notification

89. QUESTIONS?

90. Yvette Talley Robley Rex VAMC Louisville, KY yvette.talley@va.gov 1-502-287-6175 Mark Baumann James H. Quillen VAMC Mountain Home. TN mark.baumann@va.gov 1-423-926-1171, ext 7168