FORM CA-7: CLAIM FOR COMPENSATION
About Form CA-7
Form CA-7 Suggestions
More Resources
This form is used by a federal employee to claim compensation for employment-related disability. The form must be filed with one's employing agency.
The purpose of Form CA-7 is to request compensation for:
A. Leave Without Pay
You can request leave without pay so you do not lose your job while healing. It is better to be on Federal Workers’ Compensation payments: 75% with dependents • 67% without dependents.
B. Leave Buy Back
You can buy back leave you used while off work due to your injury.
C. Other Wage Loss
Difference in wages because your injury required a downgrade. Losing overtime pay, etc.
D. Scheduled Award
Payment for a permanent impairment from a work related injury.
You must attach a physician’s medical opinion report based upon the American Medical Association’s, Guides to the Evaluation of Permanent Impairment, 6th Edition and all the Office of Workers’ Compensation Program's requirements.
Form CA-7 Suggestions
How to submit your Form CA-7:
1. If you are still employed at the agency where you were injured:
• Complete your portion of Form CA-7.
• Electronically file with PDF’s of medical reports and/or documents.
• Paper: Give the CA-7 and documents, medical reports to your supervisor.
2. If you are not employed at the agency where you were injured:
• Electronically & Paper send directly to the U.S. Department of Labor.
3. Schedule Awards - Request payment for permanent impairment.
• Electronically & Paper send directly to the U.S. Department of Labor with medical report rating your injuries.
Form CA-7, Page 2
Employee:
For first CA-7 claim sent, complete sections 8 through 15.
Supervisor:
For subsequent claims, your supervisor is to complete sections 12 through 15 only.
Form CA-7, Page 3: Instructions for Completing Form CA-7
This is the instructions page for filling out Form CA-7.
Form CA-7 Page 4 - Privacy Notice
This page outlines the Government's Privacy Act.
Google Searches
From the Internet (Uncle Sam)
An Employee's Guide on Reporting a Work-Related Injury or Disease
- U.S. Department of Justice
- U.S. General Services Administration
Workers' Compensation: How to File a Claim
- Department of Commerce
Filing Form CA-7, Claim for Compensation
- ECOMP - U.S. Dept. of Labor
Employee Rights and Responsibities When Injured at Work
- U.S. Army
- U.S. Geological Survey
- Wisconsin - Dept of Military Affairs
Information Handouts
- Checklist Federal Workers' Compensation
- Right to Select Your Physician
- Medical Travel Payments
- Supervisors Delaying Claims
- OWCP Nurse Case Managers
- Video Surveillance - Activities of Daily Living
- Video Surveillance - Physician's Protocol
- Employee Protected Health Information
- Getting Fair VA Disability Decisions
Videos
How to File a Federal Workers' Comp Claim
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