Form CA-16 is only available from your ICPA (Injury Compensation Program Administrator, HRO, or your Safety Officer).

Before you obtain medical treatment, ask your supervisor to authorize medical treatment by use of form CA-16.  You may initially select the physician to provide necessary treatment.  This may be a private physician or, if available, a local Federal medical officer/hospital.  Emergency medical treatment may be obtained without prior authorization.  Take the form CA-16 and form OWCP-1500/HCFA-1500 to the provider you select.  The form OWCP-1500/HCFA 1500 is the billing form physicians must use to submit bills to OWCP.  Hospitals and pharmacies may use their own billing forms.  On occupational disease claims form CA-16 may not be issued without prior approval from OWCP.

Even if no Form CA-16 is issued, OWCP will pay the charges for initial medical treatment if the case is approved and the treatment was needed for the job-related injury. Preferably, the provider will bill OWCP directly for such charges. If not, however, the employee should claim reimbursement by submitting itemized bills from the provider and a completed HCFA-1500 or OWCP-1500 signed by the provider, explaining the need for emergency care, along with Form OWCP-915, Claimant Medical Reimbursement Form.

Form CA-16 guarantees payment to the original treating physician (or any physician to whom the original treating physician refers the employee) for 60 days from date of issuance, unless OWCP terminates this authority at an earlier date.  Form HCFA-1500, American Medical Association Standard Health Insurance Claim Form, or Form OWCP-1500, the version of the form which includes instructions for submitting bills to OWCP, should accompany Form CA-16.  Even if no Form CA-16 is issued, OWCP will pay the charges for initial medical treatment if the case is approved and the treatment was needed for the job-related injury.  Preferably, the provider will bill OWCP directly for such charges.  If not, however, the employee should claim reimbursement by submitting itemized bills from the provider and a completed HCFA-1500 or OWCP-1500 signed by the provider, explaining the need for emergency care, along with Form OWCP-915, Claimant Medical Reimbursement Form.

How does an employee obtain medical care for a work-related injury?

If the employee requires medical treatment because of a work-related traumatic injury, the supervisor should complete the front of Form CA-16, "Authorization for Examination and/or Treatment," within four hours of the request.  In an emergency, where there is no time to complete the form, the employer may authorize medical treatment by telephone and then forward Form CA-16 to the medical facility within 48 hours.  Retroactive issuance of Form CA-16 is not allowed under any other circumstance.  An employer may refuse to issue a CA-16 if more than a week has passed since the injury.

If the employee requires medical treatment because of a work-related occupational illness, he or she should obtain care directly from a physician, preferably from a specialist in the indicated field. If OWCP accepts the claim, it will pay for medical treatment required by the condition(s) accepted, including treatment received before acceptance.  Form CA-16 may not be used to authorize treatment for occupational disease or illness except in very unusual situations.  An employer may issue a CA-16 for an occupational disease or illness ONLY after obtaining approval from OWCP.  The name and title of the individual granting such approval must be shown on Form CA-16.

When An Injured Worker Presents a Form CA-16 to Physician NO authorization is needed for:

• Office Visits and Consultations
• Labs
• Hospital services (including inpatient)
• X-rays (including MRI and CT scan)
• Physical therapy
• Emergency services (including surgery)

The CA-16 DOES NOT cover:

• Non-Emergency Surgery
• Elective Surgery
• Home Exercise Equipment, Whirlpools, or Mattresses
• Spa/Gym Membership
• Work Hardening Programs
• Authorization requests must be submitted for these.