ELLIS CLINICOCCUPATIONAL & LEGAL MEDICINEOklahoma City, Oklahoma
OWCP · NOTICE OF TRAUMATIC INJURY

CA-1 CA-1

Form CA-1 is used for a federal traumatic injury caused by a specific work event, incident, or series of events during a single workday or work shift.

OFFICIAL DOL FORMSELLIS CLINIC OWCP
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ELLIS CLINIC FORM GUIDE

Understand the Form Before You File

This is an educational guide to the medical and practical issues surrounding the form. The official Department of Labor form, ECOMP, and current OWCP instructions control the actual filing process.

CA-1 or CA-2?

Use CA-1 when the injury can be identified to a specific event or events within one workday or shift. Conditions produced over more than one workday or shift generally fit CA-2.

The Date Matters

The employee identifies the specific injury date and the date notice was given. DOL states CA-1 must be submitted to the employing agency within 30 days for COP eligibility.

Medical Evidence

The claim still needs medical evidence that identifies the diagnosed condition and explains how the work event caused or aggravated it.

MEDICAL EVALUATION →
A CLEANER WAY TO THINK ABOUT IT

Event → Injury → Diagnosis → Medical Causation

The form starts the claim, but the medical evidence must make the connection between the identified work event and the diagnosed condition understandable.

01EVENTDescribe what happened at work and when.
02INJURYIdentify the body part or function affected.
03MEDICAL FINDINGSDocument diagnosis, examination, tests, and treatment.
04CAUSATIONExplain medically how the event produced or aggravated the condition.
Important: DOL currently directs federal employees to file CA-1 through ECOMP for traumatic injuries. A CA-1 is not simply a medical report; it is the claim form, while supporting medical evidence addresses diagnosis, disability, and causation.
OTHER COMMON FECA FORMS

Know Which Form Fits the Situation