Workers Compensation Forms - 10 Most Common Forms

Workers Compensation Forms

- 10 Most Common Forms

No one expects to get injured when at work. But the bitter truth is that injuries sometimes happen, and it might happen to anyone. Whenever a worker is injured when on duty, he or she should get compensated. In order to be compensated, the injured employee must complete and file the relevant workers' compensation form. Before filing this form, the injured individual should report the incident first to the supervisor. The supervisor will issue the victim with an official accident report form.

Workers Compensation Forms - Introduction

Workers' compensation system is elaborate and clear. It provides various workers compensation forms that injured workers are supposed to fill. It's important to understand that there are several workers' compensation forms. Each form is meant for specific work-related injury or death. For you to claim your compensation, you must fill the correct workers' compensation form. Most Common injuries at the workplace and what for the compensation Claims Workers' compensation is simply a type of insurance. It is intended to help workers recover from various work-related injuries. Every state in U.S has its own laws regarding workers' compensation programs. Some of the benefits provided to injured employees may include the following:

  • Rehabilitation services
  • Medical expenses
  • Lost wages
  • Death benefits

Most states require that any business that employs any paid individual must carry this form of insurance. Of course, great measures are usually put in place to prevent injuries at workplaces. However, injuries still happen sometimes.

Here are some of the most common injuries that employees face at work

  • Overexertion
  • Trip or Slip and Falls
  • Falls to Lower Level
  • Bodily Reaction
  • Struck By Object
  • Struck Against By Object
  • Highway Incident
  • Machinery Accident
  • Repetitive Motion
  • Workplace Violence

There are some important documents in the workers' compensation system. One of them is a personal injury demand letter. This letter is a very important document in any work-related injury claim process. To receive claim benefits, you should have a clear personal injury demand letter. Sometimes, an employer may file a worker's compensation exemption so that they don't pay the benefits. In such a case, a personal injury demand letter can help you a great deal. Another important document is an indemnification agreement. This document ensures that the employer pays the benefits for work-related injuries or deaths. Incident report is also very important. When claiming compensation, a work incident report and other relevant documents can support your claim. Be sure to ask your supervisor for a workplace accident report after reporting the incident.

About the Compensation form

The Division of Federal Employees' Compensation (DFEC) of OWCP has made different types of forms obtainable online. All these forms are available only in PDF format. You need to have the latest version of PDF viewer for you to view or print these forms. You can complete these forms manually or electronically. There are 2 types of forms. They include:

  • Printable forms

    Apart from Forms CA-27, CA-26 and CA-16, all other DFEC's forms available online are printable. You can be able to print and fill and submit manually. Find the appropriate and use the provided print button and print it. Type or write the information needed on the hard copy. After which, authorize it. A completed form is then faxed or mailed to the office of the DFEC.
  • Fillable Forms

    Forms that you may fill electronically are marked with(*) asterisk. To fill these forms, you need to select the appropriate form and then click on it. Next, use the keyboard of your computer to fill the form. Use your mouse or the key to navigate between the form fields. Using the Print button near or on top of that particular form, print out the form. Authorize the form and then fax or mail the completed form to the office of the DFEC. For any assistance, simply send your question to the DFEC. You can do this through the e-mail by simply clicking the DFEC-FormsAssist.

10 most common Compensation forms

As mentioned earlier, there are several workers compensation forms. Even though you don't want to appear like you are anticipating for an injury, you should know these forms. In this post, we have discussed 10 workers' compensation forms. It is worth noting that these are the most common claim forms. They are common because the injuries associated with them are the most common ones.

1. CA-1*: Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation

This is the form that you need to complete and file for the traumatic injury compensation claim. The injury must be as a result of a specific incident or event. For instance, the injury maybe caused when you are picking up some heavy object. You may have fallen or slipped down when picking the object. This is a specific incident that may cause an injury to your legs or lower back pain. So, the specific event is ‘picking up some heavy object'. This form was developed with an aim of ensuring regulatory compliance. The CA-1 form must be completed and filed by the injured worker, his or her advisor, and a witness. Indicate the cause of injury. You must describe clearly why and how the injury happened. Provide appropriate details of how the accident occurred.

CA-1*Form link: https://www.dol.gov/owcp/regs/compliance/ca-1.pdf

2. CA-2*: Notice of Occupational Disease and Claim for Compensation

This is the workers' compensation form that you need to complete to claim medical treatment. It is designed for employees of the Unites States Government employees. You need to file this if you have an occupational disease. This is a body condition that happens as a result of events in at least two work shifts. Some of the examples include:

  • Carpal tunnel resulting from the everyday use of the computer keyboard
  • Back strain resulting from lifting heavy objects for the last one month
  • Chest pain from offloading trucks of cement for the past three weeks

You are supposed to report any job-related conditions to your supervisor. You should then file this form even if there are no any medical expenses. In case any block on the form doesn't apply to your case, just indicate N/A or not applicable. If you leave any block blank, the form maybe returned back to you.

CA-2*Form link: https://www.dol.gov/owcp/regs/compliance/ca-2.pdf

3. CA-2A* Notice of Occupational Disease and Claim for Compensation

This form is filled when there is a recurrence of occupational disease or job-related injury. It is filled in situations where the medical condition has erupted due to previous job-related condition. Do not make any false statement when filing this form. Doing so will make you guilty of a crime. This may result into imprisonment or you might be subjected to heavy fines or both.

CA-2A*Form link: https://www.dol.gov/owcp/regs/compliance/ca-2A.pdf

4. CA-5*: Claim for Compensation by Surviving Spouse and/or Children

For Compensation by Surviving Spouse and/or Children, you are required to fill CA-5* forms. If your spouse or parent has died due to work-related injuries, you should fill this form to claim compensation. Forward any all the evidences that indicate the diseases used to support you before they died. Indicate if you now have a job. Provide your occupation, wages, employer's name, and Social Security account number

CA-5*Form link: https://www.dol.gov/owcp/regs/compliance/ca-5.pdf

5. CA-7* Claim for Compensation

This is the form you should use to claim compensation for occupational or traumatic injury. You can also use CA-7* to claim the ongoing compensation when a previous claim for compensation has been made. You can file this form for those cases that are filed through ECOMP. You can also use it to file for cases using any other method of submission. You can use this workers' compensation form to claim compensation for the following:

  • Leave Buy Back
  • Leave Without Pay
  • Schedule Award
  • Wage Loss

Federal employees use complete and file this form to claim compensation for work-related disability. Your employing agency has the obligation to file this form.

CA-7*Form link: https://www.dol.gov/owcp/regs/compliance/ca-7.pdf

6. CA-10: What A Federal Employee Should Do When Injured At Work

When you get work-related injury, you should report it to the supervisor. Your supervisor should use a form CA-16 to approve medical treatment. If you prefer choosing your own physician, then you should take forms OWCP-1500/HCFA-1500 and CA-16 to them. Your health provider will use the form OWCP-1500/HCFA-1500 as the billing form. It is the form your physician will use when submitting medical bills to the OWCP. Pharmacies and hospitals are free to use billing forms of their own. In case of traumatic injuries, you should complete the worker's part of the form CA-1. Your employing agency will provide you with this form. After completing this form, take it to your supervisor. Do this within the 30 days of the injury. The form you are supposed to use in case of work-related disease is the form CA-2.

CA-10 Form link: https://www.dol.gov/owcp/regs/compliance/ca-10.pdf

7. CA-17*: Duty Status Report

This is another common workers' compensation form. It allows the doctor to keep your employer or supervisor informed about your work restrictions or duty status. You should forward the original documents or forms to the office of the Human Resources. You should do this in within 30 days. If you fail to submit the claim forms within the required period, your benefits might delay.

CA-17*Form link: https://www.dol.gov/owcp/regs/compliance/ca-17.pdf

8. CA-26: Authorization Request Form and Certification/Letter of Medical Necessity for Compounded Drugs

CA-26 is another common workers' compensation form. It is available only to registered and licensed medical providers. To get this form, you must log in to the OWCP Web Bill Portal. For you to submit this form, hit the button of the ‘Provider' Link. Login by entering your used name or ID and then enter your password. Find the ‘LMN Documents' link and then click on it, and then register for the web access.

CA-26 Form link: https://www.dol.gov/owcp/regs/compliance/ca-26.pdf

9. CA-27: Authorization Request Form and Certification/Letter of Medical Necessity for Opioid Medications

CA-27 is a workers' compensation form that is available only to medical providers who are registered. Medical providers can only access this form from the OWCP Web Bill Portal. To submit this form, hit on the ‘Private' Link button. Enter your user ID and password to log in. After logging in, find the ‘LMN Documents' and then click the link. You will find this link on the menu bar on the left. If you are not register, then you can do so by yourself. Just hit on the ‘Provider' link and then move to the ‘Web Registration' link. This link is located in the menu bar at the left of the page. Follow the procedure and register so that you can access the web.

CA-27 Form link: https://www.dol.gov/owcp/regs/compliance/ca-27.pdf

10. CA-1074: Letter to Parents in Death Claim Development

CA-1074 form comes from U.S Department of Labor. It is actually a letter intended to seek for more clarification. It seeks to gather more information regarding the claim case for dependency compensation. It comprises of questionnaires, which the employee is required to fill. The claimant is typically required to complete an affidavit.

CA-1074 Form link: https://www.dol.gov/owcp/regs/compliance/ca-1074.pdf

Conclusion

We do hope that you find this information helpful. You can complete all the above named forms electronically through electronic fill option. You can also complete them manually through the print form option. The forms are all available in PDF. You must have the Adobe Acrobat Reader for you to print any of the above files.

ClaimFight.com - Sherlin Lindsay - author / writer

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