FORM CA-2:  NOTICE OF OCCUPATIONAL ILLNESS OR DISEASE AND CLAIM FOR CONTINUATION OF PAY / COMPENSATION

About Form CA-2

Form CA-2 Suggestions

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Diseases and illnesses which occur during or after Federal employment are not automatically covered by the Federal Employees' Compensation Act.  You must provide factual and medical evidence to establish that conditions of employment caused or aggravated the disease or illness.

 

Occupational disease or illness is a medical condition produced in the work environment over a period longer than a single workday or shift by such factors as systemic infection, continued or repeated stress or strain, or exposure to hazardous elements such as, but not limited to, toxins, poisons, fumes, noise, particles, radiation, or other continued or repeated conditions or factors of the work environment.  A claim based on an occupational disease or illness is filed with OWCP on Form CA-2.

 

Form CA-2 is for repetitive trauma injuries such as carpal tunnel syndrome, repeated back strains, and prolonged standing causing knee and foot conditions.  Make your CA-2 complete and easy for non medically trained Claims Examiners to understand.  Include a physician’s report with the physician’s medical rationale on how your employment factors caused, aggravated or contributed to your conditions.

 

You will need to furnish the following information:

 1. Give a detailed description of factors of employment believed responsible for condition.  Be specific as to the duration and nature of the factors: for instance weights carried, distances walked, chemicals used, or other relevant job actions.

 

 2. Give the history of the condition from first awareness of the problem.  Include description of all home treatment and professional care as well as symptoms.

 

 3. Describe any prior similar problem, with dates of onset, history, medical care received, and copies of the medical records of your treatment.

 

 4. Attach or forward a medical report from your physician to include the following items:

1. Dates of examination and treatment.

2. History given by you.

3. Detailed description of findings.

4. Results of all diagnostic tests.

5. Diagnosis.

6. The clinical course of treatment followed.

7. Doctor's opinion, with reasons for such opinion, as to the relationship between any condition you may now have and the factors of employment.

Form CA-2 Suggestions

 

Section 9. Employee Occupation: Attach a list of your employment and work activities that contributed to your conditions.

 

Section 11. Date of Awareness: The date you began to hurt or have problems.

 

Section 12. Date You Realized Condition Was Caused or Aggravated by Your Employment:

This date is important because it sets your pay rate if off work and the rate of impairment compensation.  Since OWCP requires a physician’s well reasoned medical rationale as to how and why employment factors caused, aggravated or contributed to an employee’s condition, the Date You Realized can be the date a physician told you that your condition was related to your employment.

 

Section 13. Explain Relationship of Employment and Why You Came to this Realization:

The best method is to attach a physician’s medical report with their well reasoned medical rationale.  Example, write “See attached D. Marcus Welby, 10/1/2013 medical report”.  If the medical records are not attached with your Form CA-2, the Claims Examiner will not have enough information to accept the claim.

 

Section 14. Nature of Disease or Illness: The best method is to attach a physician’s medical report with their well reasoned medical rationale.  Example, write “See attached "D. Marcus Welby, 10/1/2013 medical report”.

 

Section 15. If Notice Was Filed More than 30 Days from Date Realized: Supply your reasons such as, “I was not able to obtain my medical records until the day I filed my Form CA-2.”

 

Section 16. Employee Statement & Medical Report Regarding Employment Factors Causing Your Condition.  See last page for Instructions for Completing Form CA-2 for what is needed in your Employee Statement.  You must submit a physician’s opinion as to whether the disease or illness was caused or aggravated by the employment.

 

Section 17: Medical Records: Form CA-2 requires medical records and must have a physician’s opinion as to whether the disease or illness was caused or aggravated by the employment.

 

Receipt of Notice of Occupational Disease or Illness:

Make a copy of your Form CA-2, witness statements and medical records.  Give your Form CA-2 and records to your supervisor.  Have your supervisor sign your copy.  Your supervisor is required to send your Form CA-2, witness statements and medical records to OWCP within 10 days.  If your supervisor delays, then you should send your Form CA-2 and records directly to OWCP.  If you are no longer working for the employer where you were injured then you send Form CA-2 directly to OWCP.

 

 

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