FORM CA-1: NOTICE OF TRAUMATIC INJURY AND CLAIM FOR CONTINUATION OF PAY / COMPENSATION
About Form CA-1
Form CA-1 Suggestions
More Resources
Traumatic injury means a wound or other condition of the body caused by external force, including stress or strain, which is identifiable as to time and place of occurrence and member or function of the body affected. The injury must be caused by a specific event or incident or series of events or incidents within a single work day or shift.
A specific event or incident must have caused the injury. Picking up a heavy box which caused an injury to your lower back, is a specific event.
You should be able to answer the following questions:
The most misunderstood injury that falls under CA-1: A series of events or incidents, within a single work day or work shift. This injury may occur when you pick up several heavy objects in a single work day.
Example: “I picked up about 25 heavy boxes during the work day, weighing about 40 lbs. each. I don’t know which object caused the injury to my lower back, but by the end of that work shift, the pain to my lower back had significantly increased.”
What happened? Example: Picking up 25 heavy boxes.
When did it happen? Example: During my normal work shift, between 9 AM and 3 PM on March 16, 2018.
What did you injure? Example: Lower back.
Remember if you've missed work, check COP on question 15. A. This means the agency will have to pay your regular pay for the first 45 days after the injury, if loss of work occurs.
Form CA-1 Suggestions
Section 13. Cause of Injury (Describe what happened and why)
Go into detail how the injury occurred and everywhere you felt pain initially or subsequently. If extra space is needed attach a typed explanation.
Section 14. Nature of Injury
LIST ALL BODY PARTS that initially or later were painful. An injured body part that is no longer painful may have a silent injury that will reappear later. If available, it is helpful to submit medical records with your CA-1.
Section 15. Payment If Off Work
Usually select 15 a. COP Continuation of regular pay. If off for more than 45 days you will be put on OWCP workers’ compensation payments at 75% of your pay with dependents or 66.6% without dependents. Payments are income tax free.
Section 16. Witness Statement
It is helpful if you can obtain witness statements. They can be on separate pages.
Receipt of Notice of Injury (Last Page)
Make a copy of your Form CA-1, witness statements and medical records. Give the original Form CA-1 and records to your supervisor. Have your supervisor sign your copy. Your supervisor is required to send your Form CA-1, witness statements and medical records to OWCP within 10 days. If your supervisor delays, then you send your Form CA-1 and records directly to OWCP.
Google Searches
From the Internet (Uncle Sam)
An Employee's Guide on Reporting a Work-Related Injury or Disease
- U.S. Department of Justice
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Workers' Compensation: How to File a Claim
- Department of Commerce
Filing a CA-1 in ECOMP – Instructions for Employees
- NOAA
Employee Rights and Responsibities When Injured at Work
- U.S. Army
- U.S. Department of Labor
The Postal Services's Handling of OWCP Claim Forms
- Office of the Inspector General - U.S Postal Service
Information Handouts
Videos
How to File a Federal Workers' Comp Claim
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