THE EMPLOYEE’S HANDBOOK
FOR FEDERAL EMPLOYEE'S
Naval Hospital Charleston
WHAT TO DO WHEN YOU ARE INJURED AT
TABLE OF CONTENTS
Introduction Page 3
What Type of Condition do I have? Page 4
Traumatic Injury Page 4
Occupational Disease Page 4
Notice of Recurrence Page 5
Traumatic Injury vs. Occupational Disease Page 5
How Do I Arrange for Medical Attention Page 6
For care at Naval Hospital Charleston OM Clinic Page 7
For Community physicians or hospitals Page 7
Use of Form CA-20 Page 8
Use of Form CA-17 or SF-78 Page 8
Obtaining Form CA-16 Page 8
Reimbursement for Out of Pocket expenses
How Do I File the Claim Page 9
Issuing Form CA-1 Page 9
Issuing Form CA-2 Page 9
How is My Absence Covered? Page 9
Continuation of Pay for Traumatic Injuries Page 9
Released to Return to Work Page 10
Denial of COP Page 10
Absences After Continuation of Pay Expires Page 11
Absences Due to Occupational Disease Page 11
Points of Contact Page 12
Rules for Issuing COP Page 13
Leave Buy Back Page 14
COMPENSATION FORMS AND PURPOSES Page 15
You have been injured on the job.
What are you supposed to do?
What type of a condition is it?
What paperwork is required?
This handbook will walk you through the basic steps of getting your needed medical care, and then
guide you through the sometimes complicated and confusing steps of reporting and documenting your
While reading through this handbook, remember, you are not alone. Anytime you have questions or
need assistance in dealing with a workers‘ compensation issue, you can call the Injury Compensation
Program Administrator (ICPA) or the Occupational Health Nurse (OHN) for assistance and advice.
Points of contact for the ICPA and the OHN, worksheets, checklists, and samples are included in the
appendices of this booklet to assist you with your responsibilities.
This handbook does not cover all the details of the Federal Employee‘s Compensation Act (FECA) or
all the benefits to which employees may be entitled . Rather it provides quick and simple guidance
that will help you through the majority of the situations you will encounter if you suffer a job related
injury or disease.
What Type of Condition do I have?
Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1), and
(2) occupational disease (Form CA-2). You will need to be familiar with these categories so you can
help you complete the correct paperwork. The easiest way to identify the difference between the
categories is to identify how long it took the medical condition to occur.
TYPES OF OCCUPATIONAL MEDICAL CONDITIONS
General Note: Care is only eligible for reimbursement from OWCP if performed by a licensed physician!
Traumatic Injury (Form CA-1):
1. A traumatic injury is a wound or other condition of the body caused by external force,
including stress or strain.
2. The injury must occur at a specific time and place, and it must affect a specific part(s) or
function(s) of the body
3. Must be caused by a specific event or incident, or a series of events or incidents, within
a single day or work shift.
Examples: cut finger; tripped and fell; hit by forklift, etc. Sometimes the reported condition
may not seem like an injury, such as mental stress or back strain. However, if you
identify the condition as occurring in the course of one work shift, the condition is still
considered to be a traumatic injury.
NOTE: Is it necessary to report all injuries that occur at work, even minor injuries such as a
scratched finger or bumped knee?
All injuries should be reported, since a seemingly minor injury may develop into a
more serious condition. For your protection, you should file a report of the injury with
your immediate supervisor when it occurs. Benefits cannot be paid unless an injury is
Occupational Disease (Form CA-2 and CA-35):
1. An Occupational Disease is a condition produced by the work environment over a
period longer than one work day or shift.
2. The length of exposure, not the cause of the injury or the medical condition which
results, determines whether an injury is traumatic or occupational.
Examples: The condition may result from infection, repeated stress or strain, or repeated
exposure to toxins, poisons, fumes or other continuing conditions of the work environment,
workers and supervisors for the last six months; carpal tunnel from daily use of computer
DAY 1 + DAY 2 + ……… =
TYPES OF OCCUPATIONAL MEDICAL CONDITIONS
Notice of Recurrence (Form CA-2a):
Note: You may be suffering a recurrence of a prior injury or disease and may want to file for benefits
under the prior claim. A recurrence is defined as a return of symptoms related to the original injury or
disease for no explainable reason other than there was a prior medical condition. If a new event or
series of events (e.g., bent over to tie shoes, moved boxes, etc.) causes a return in symptoms, the
condition must be treated as a new injury or disease as described above even if the exact same part
of the body is affected. If symptoms do begin for no explainable reason other than the prior injury or
disease, you can file for a recurrence under the prior claim. Recurrence claims are not detailed in this
guide (contact the ICPA/HRO servicing personnel office for details).
Traumatic Injury Vs. Occupational Illness
When you are exposed to toxic fumes for one day, the incident is considered a traumatic
If you are exposed to toxic fumes for two or more days-more than one shift, the incident is
HOW DO I GET MEDICAL ATTENTION?
Regardless of the category of the medical condition, your first concern will be to determine if
you need immediate medical care.
*If emergency care is required, CALL 911 or MEDICAL EMERGENCY.
ALL FORMS WILL BE HANDLED ACCORDINGLY
If immediate care is required, make arrangements to go to the nearest health care facility or to your
private health care provider. Remember:
**BY LAW YOU HAVE THE RIGHT TO CHOOSE YOUR TREATING PHYSICIAN**
You are entitled to select the physician who is to provide treatment. If you are treated by the
Hospital‘s facilities, no authorization is required. If you choose to be treated by your personal
physician, you should contact the ICPA to arrange authorization for medical treatment (CA-16). While
you have the right to initially choose your physician, you must obtain Office of Workers’ Compensation
Programs (OWCP) approval to change physicians, except where your physician has referred you to
You can ask your supervisor for assistance in making your transportation arrangements, or in calling
for an ambulance. Your supervisor can assist you to contact the ICPA to authorize the medical
treatment by telephone to the private provider or hospital, and follow-up with the Authorization for
Examination and/or Treatment (CA-16) to the medical facility within 48 hours. Remember that your
supervisor cannot authorize medical treatment in occupational disease claims without prior Office of
Workers‘ Compensation (OWCP) approval.
If the situation is not an emergency, you will want to take time to discuss the situation with your
supervisor. The Occupational Health Clinic can provide medical attention for first aid cases
and more advanced care (as available). If you choose not to obtain care or service are not
available from the Naval Hospital Charleston clinics, make arrangements with your supervisor
to go to the nearest local community health care facility.
You may not want to report for medical care; however, it will be important to your claim to have early
medical reports. If you refuse to seek medical care, your supervisor is obligated to document your
refusal with the claim. Your employing agency may require fitness-for-duty examinations in
accordance with Office of Personnel Management regulations or equivalent agency authority. The
FECA does not provide any additional authority for agency-conducted examination
The forms that are required to receive private medical attention and forms to report the work-related
condition can be obtained on the Occupational Health Intranet page or directly from the Occupational
Medicine Clinic. Direction for completion and additional required forms can be given by Occupational
Medicine as well.
TO AVOID DELAY IN YOUR MEDICAL TREATMENT
Please contact (or have your supervisor do it for you) the Occupational Health Nurse (743-
7525) PRIOR to sending you directly to the OM clinic at the Naval Hospital or to the NWS
Branch clinic. This is to ensure that the proper care will be AVAILABLE for you. Our provider
resources are limited and it may be necessary to refer you to a local community physician or
For care at Naval Hospital Charleston OM Clinic:
After completing the call to the OHN and treatment is available:
1. Your supervisor will give you a Medical Referral Form (OPNAV 5100/9) with the top portion
completed [appendix E]
2. Your supervisor will give you a CA-1 for traumatic Injury or CA-2 (with accompanying CA-35
page) for Occupational Disease to complete and return to your supervisor ASAP.
3. Take these forms to the OM or NWS clinic as directed by the OHN.
4. You will be seen as follows:
A) First Aid for minor or superficial injuries will be evaluated and care provided by the
OHN (via Standing Orders). Care is only eligible for reimbursement from OWCP if
performed by a licensed physician! You will need to return to clinic on the following Tuesday
with an appointment with the provider. You will be returned to work with any instructions or
limitations notated on the Medical Referral Form.
B) Care by a physician must be provided for any other injury or illness not considered
―first aid only‖. The Occupational Medicine physician is here on Tuesdays only.
However, the OHN will work with the Family Practice and Internal Medicine providers
to have you seen the other days of the week. Please note that due to staffing constraints
that this may not be possible. That is why it is essential that you or your supervisor
call to OHN prior to arrival to avoid delay in your treatment or care. In that event see
instructions below for Care from Community Physicians or Hospitals.
1) You will first be assessed and triaged by the OHN.
2) The treating physician will evaluate and treat you as needed.
3) You will be released to return to work with the following forms in hand:
CA-20-- Attending Physician's Report or narrative SF 600
CA-17-- Duty Status Report
Medical Referral Form
Prescription to be seen for Specialized Care/Treatment (prn)
For Care from Community Physicians or Hospitals:
You can elect to be seen by the provider of your choice. Be sure to remember and understand that
care is only eligible for reimbursement from OWCP if performed by a licensed physician that will
accept Federal Workers Compensation. Remember that medical treatment for occupational disease
claims cannot be authorized without prior Office of Workers‘ Compensation (OWCP) approval.
Other reasons for obtaining care outside Naval Hospital Charleston Clinics:
A) Urgent or more advanced care is needed.
B) Lack of NHC provider availability.
Please notify the OM clinic that you are injured or ill (this is required for tracking and statistics) and to
obtain the proper forms and instructions to receive care outside the NHC clinics. The forms listed
below inform the doctor of the type of physical requirements you regularly perform; inform the
physician that you can be accommodated with light and/or part-time duty; and provide the doctor a
means to communicate to your supervisor what you can safely do; when you can return to light duty
work; and when you can resume regular duty. These forms will be provided by the OHN and you will
need return to return them to your supervisor after being seen:
1) CA 20--Attending Physician's Report (Note that the physician‘s notes may be
2) CA-17-- Duty Status Report
a) This may also be accompanied with a copy of your most recent SF 78-Certificate of
Medical Examination as needed (this is your minimal functional job requirements)
3) Light Duty Availability Letter
4) You will be instructed to obtain a CA-16-- Authorization for Examination and/or
Treatment from the ICPA located at the Pass & ID building Naval Weapons Station. This
form guarantees payment to the care provider.
To Obtain a CA-16-- Authorization for Examination and/or Treatment:
This form is controlled as it authorizes PAYMENT for an injured employee to obtain examination
and/or treatment for up to 60 days and provides OWCP with initial medical report. Treatment may
be obtained from a local hospital or physician (who may be a surgeon, osteopath, podiatrist,
dentist, clinical psychologist, optometrist, or, under certain circumstances, a chiropractor), or from
a U. S. medical facility, if available. The selected provider must also accept Federal Workers
Compensation as payment. Obtain authorization (Form CA-16) BEFORE, you go for medical
treatment. Except for emergency care, the agency may not issue the authorization retroactively
These forms are issued by the local ICPA, (764-4300 ext 10) located at the Naval Weapons Station
Pass & ID building in the HROSE corridor. If you do not obtain this form, you will need to utilize your
personal finances or insurance to cover you care and file for OWCP reimbursement upon your case
WHAT IF I PAID FOR MY CARE OUT OF POCKET?
To obtain payment for medical expense
Your physicians and other medical providers may claim payment by sending their bills and medical
reports to OWCP. Physicians MUST submit their bills on Form OWCP-1500 (also called HCFA-
1500). Other medical providers, such as hospitals, may use the UB-82 or UB-92. Bills for direct
payment to pharmacies must be submitted on a Universal Billing Form. Claims for reimbursement of
pharmacy bills must be submitted on Form CA-915 and accompanied by a Universal Billing Form with
a 9-digit employer tax identification code completed by the pharmacy. Pharmacies may submit bills
electronically via the National Data Corporation (NDC) network. .NOTE: Services of chiropractors
may be reimbursed only for treatment consisting of manual manipulation of the spine to correct a
subluxation as demonstrated by X-ray to exist.
If you paid the medical providers you may request reimbursement by submitting a CA-915 or written
request with the billing form(s) described above and proof that you paid the Provider; e.g., a receipt or
cancelled check. You may also claim reimbursement for travel expenses to obtain medical treatment
on Form SF-1012, Travel Voucher, or other travel voucher forms used by Federal agencies.
To be considered for payment, bills must be submitted to OWCP within a year after the end of the
calendar year in which the expense was incurred or the service was provided, or within a year after
the end of the calendar year in which the treated condition was first accepted as compensable by
OWCP. For example, if you were treated in 1993 and OWCP accepted your claim in 1993, OWCP
will process bills for that treatment if they are submitted by December 31, 1994. If, however, OWCP
accepted your claim in 1994, you would have until December 31, 1995 to submit bills, even though
treatment was received in 1994.
I’VE GOTTEN MEDICAL CARE,
NOW HOW DO I FILE THE CLAIM?
You should report all work-related conditions to your supervisor and to file them as official claims even
if there is no lost time or medical expense. Department of Labor considers claims to be ‗timely‘ if they
are submitted within three years; however, it will be easier for you to prove your case if paperwork is
submitted as soon as possible after the injury or disease occurs.
Traumatic Injuries: Use form CA-1.
The front side of the form must be completely filled out and signed by you. If the injury is so severe
that you cannot fill out the report, a supervisor, family member, or friend can fill it out and sign it. The
reverse side of the form must be completely filled out and signed by the immediate supervisor.
Occupational Disease: Use form CA-2.
The front side of the form must be completely filled out and signed by you. The reverse side of the
form must be completely filled out and signed by your supervisor. Checklists and/or Factual and
Medical Development Sheets (CA-35) usually accompany CA-2 claims and may also require
completion by you and your supervisor.
NOTE: In many instances, some of the blocks on Forms CA-1and CA-2 will not apply to your
situation. Rather than leave them blank (which will result in them being returned to you and delaying
the claim), indicate ―N/A‖. It is your responsibility and to your benefit to complete these forms.
Compensation paperwork must be processed through your immediate supervisor, the servicing
personnel office, and to the DOL within 10 workdays from the day that you submit the paperwork to
your supervisor. Upon giving the documents to your supervisor, ask that he/she fill out and return the
receipt portion to you. It is then your supervisor's responsibility to promptly forward the original claim
form(s) to your servicing personnel office within the allotted time frame. Your servicing personnel
office will complete agency coding, process the case file, and forward claims to the DOL. Submit any
additional paperwork (CA-16, CA-17, CA-20, witness statements, etc.) to your supervisor with the
claim or as soon as they become available.
You may submit medical updates, bills, etc., to your supervisor after the original claim has been sent
off. All these original documents must be submitted by your supervisor to your servicing personnel
office to be included in the agency case files and to be processed through the DOL.
HOW IS MY ABSENCE COVERED?
Benefits to cover absences differ based on whether you suffered a traumatic injury or an occupational
disease. We‘ll cover each separately.
Continuation Of Pay (COP): You may be eligible for uninterrupted pay beyond the date of injury
without charge to leave. This benefit is called continuation of pay and is granted if all the following
conditions are met:
1. You suffered a traumatic injury and filed form CA-1 within 30 days from the date of the injury.
2. You have provided your supervisor with valid medical documentation to show that the
inability to work in any capacity is due to the injury.
3. The absences due to the injury began within 90 days from the date of injury.
4. Your absences do not exceed a total of 45 calendar days of COP. COP counts in whole day
increments. If you work partial days, but are entitled to COP for the remainder of the work
day, the few hours of COP count as a whole day of the 45 day entitlement.
5. If you return to work, but have a recurrence of disability within the 90 days, you may receive
COP for any of the remaining 45 day period that you have not yet expended, even if the
disability extends beyond the 90 day period.
WHAT IF I DO NOT FEEL LIKE GOING TO WORK, BUT THE
DOCTOR SAID I COULD?
If you were released back to work after having been evaluated and treated by a provider and you
choose to not return to work…you will be required to use your personal sick or annual leave to cover
your absence. It is the policy of Naval Hospital Charleston to provide light and/limited duty to all
employees. You are obligated to return to work as soon as your doctor allows you to do so!
You must advise your physician that your employer has light duty available and is willing to provide
work that is compatible with the work restrictions caused by the injury. Whenever necessary, the
Human Resources Division will contact your physician to determine work restrictions and/or return to
If your agency gives a description of duties and physical demands of a light duty job, you must furnish
a copy of it to your physician and ask whether and when you will be able to perform such duties. If
your agency advises that it will provide light duty that is compatible with the limitations caused by the
injury, you must ask your doctor to specify the work limitations. You must then advise your employing
agency immediately of these restrictions, and arrange for your agency to receive written verification of
the work limitation from your doctor. Form CA-17, Duty Status Report, may be used for this purpose.
If you are able to work at least 4 hours a day, your agency offers you a job within the work restrictions
set by your doctor, and the job is otherwise suitable, you are obligated to return to work. If you do not,
your agency may stop paying COP, or OWCP may terminate compensation employees as much a
possible. If you are not sure, check with the OHN or the ICPA for help.
Denial Of COP: COP can only be denied based on the following reasons (if COP already began, it
will be terminated) :
1. The disability is caused from an occupational disease rather than a traumatic injury.
2. You are not a U.S. citizen or a resident of the U.S. or Canada.
3. The injury occurred off government premises and you were not involved in official ―off premise‖
4. The injury was caused by your willful misconduct.
5. The injury was not reported on CA-1 within 30 days following the injury.
6. Work stoppage first occurred 45 days or more after the injury.
7. You initially reported the injury after your employment was terminated.
8. You are enrolled in the Civil Air Patrol, Peace Corps, Job Corps, Youth Conservation Corps,
Work Study Program, or other similar groups covered by special legislation.
9. You are a volunteer working without pay or for nominal pay or you are a person appointed to
the staff of a former President.
Note: If you are eligible for COP, but the claim is later denied, DOL will direct the Department of
Justice to recoup the COP and change the COP absences to leave or leave without pay. Also, COP
can be terminated if you refuse a job within your restrictions and limitations, or if you fail to respond to
a job offer.
After COP Expires: If you were eligible for COP, but are absent beyond the 45 day limit or do not
become disabled within the 90 day window, you have two options:
1. You can use sick or annual leave to continue uninterrupted pay, or:
2. You can elect to go on Leave Without Pay and submit form CA-7 - Claim for Compensation
on Account of Traumatic Injury or Occupational Disease to request wage loss payments
from the DOL. Form CA-7 alerts the DOL that you are not receiving any income and initiates
wage loss pay. Form CA-7 is also used to claim absences at 2-week intervals if the absences
continue beyond the period claimed on the initial form CA-7. You have the responsibility to
submit medical documentation to support that the ongoing absences are related to the work-
injury and should anticipate at least a 3-4 week delay before you receive pay from DOL. The
delay can be longer if a claim is incomplete or controversial. Employees who elect to use their
own leave can later repurchase the leave with their compensation benefits.
Occupational Disease: COP is not a benefit for occupational disease. If you cannot work due to
the claimed condition, two options are available:
1. Use sick or annual leave to continue uninterrupted pay or:
2. Elect to go on Leave Without Pay and submit forms CA-7 to request wage loss benefits from
the DOL. Form CA-7 initiates wage loss pay, and continues wage loss at bi-weekly intervals if
the absences continue beyond the initial period claimed on the form CA-7. You have the
responsibility to submit medical documentation (Form CA-20 and CA-20a) to demonstrate that
the absences are related to the claimed work condition. Because occupational disease claims
take longer to adjudicate, it can take several weeks or even several months before you can
expect to receive pay from the DOL. As a result, most employees elect to use their own leave
and then later repurchase the leave with their compensation benefits.
Note: If disability continues beyond the date shown on the initial CA-7, subsequent Form CA-7s
should be submitted 5 to 7 days before the end of the period claimed on the last claim form
submitted. Form CA-20a (Attending Physician‘s Supplemental Report) should be filed with the
POINTS OF CONTACT FOR WORKERS’ COMPENSATION
Ms. Theresa Smalls
Phone: (843) 764-4300 extension 10
Naval Hospital Charleston Human Resources
Ms Elvira Steed
Phone: (843) 743-7384 DSN 563
Naval Hospital Charleston Occupational Medicine
Mrs. Denise Mullins, RN, COHN
Phone: (843) 743-7525 DSN 563
RULES FOR ISSUING AND TRACKING CONTINUATION OF PAY (COP)
1. Use only for traumatic injuries (injury happened during the course of a single workday).
2. COP cannot exceed 45 calendar days.
3. COP counts in whole day increments. Example: Employee works seven hours then misses
two hours for an appointment related to the injury. Time and Attendance report will reflect 7
hours of work and 2 hours of COP, but a whole day of the 45 day entitlement will be used.
4. If medical documentation indicates a period of absence which includes work and nonwork
days, all the days count against the 45 day entitlement.
5. COP must be used within 45 days from the date of injury or within 45 days from the first day
the employee returns to work if any of the 45 days has not been used and additional
Exception: The COP absences can go beyond the 45 day window only if it involves a
continuous period of absence that started within the 45 day window, however, the total
days used still cannot exceed 45.
6. Use the following worksheet to track COP for each injured employee. Send a copy of the
worksheet and supporting medical documentation to HRO at the end of each pay period for
inclusion in the agency injury file.
7. To be eligible for COP, the employee must:
a. File form CA-1 within 30 days from the date of injury.
b. Provide medical documentation to support they are totally disabled for work due to
the job injury.
LEAVE BUY BACK
Employees who elected to use sick or annual leave during their period of disability to avoid
interruption of income, may claim compensation for the period of disability and ―buy back‖ (subject to
approval of the employing agency) the leave used. Once the injury or disease claim is approved by
the Department of Labor Office of Workers‘ Compensation Programs (OWCP), the employee may
submit a request to ―buy back‖ leave used due to disability from the job-related injury/disease. The
request is made on Form CA-7.
The following information is provided to assist employees in their decision:
a. An employee without dependents is entitled to compensation at the rate of 2/3 their regular
salary. With dependents, the employee is entitled to 3/4 of their regular salary. Because
leave is paid at 100 percent of salary and compensation is paid at a percentage, the
employee will owe the agency money for the leave repurchase.
b. The gross amount paid for sick or annual leave during the disability is the amount the
payroll office will have to recover from the employee. The employee will be required to have
the compensation check forwarded to payroll and to make arrangements with payroll to pay
the difference between the compensation check and the money they received while on
leave. The employee will recoup most, if not all, of their repayment at year end tax time
because the leave pay was taxed and the compensation pay is tax-free.
c. The higher of the pay rate on date of injury, date of recurrence, or date disability began is
used by OWCP in computing compensation.
d. Any sick or annual leave used during the 45-day COP period cannot be used for buy back
purposes unless the employee was not entitled to COP.
e. If annual leave is to be recredited and it exceeds the maximum permissible carry over
balance, the excess is subject to forfeiture.
f. Since all the leave previously used must be converted to Leave Without Pay (LWOP), all
leave earned during the period of disability used for leave buy back is nullified.
g. Holiday pay is included in the leave buy back if the employee was in a LWOP status on the
last hour of the day before a holiday and at the beginning of the business day after a
h. Medical evidence supporting the period of disability must be submitted with the Form CA-7 if
the disability has not already been documented. If the employee has an irregular work
schedule, or if leave being repurchased was not used continuously, the employee should
use the following worksheet to document the dates and hours of absence, the type of leave
used and to total the time claimed. The worksheet must be reviewed by the supervisor.
COMPENSATION FORMS AND PURPOSES
THE FOLLOWING COMPENSATION FORMS INFORMATION HAS BEEN PROVIDED ON ONLY
THOSE FORMS YOU ARE LIKELY TO USE.
CA-1 - Federal Employee‘s Notice of Traumatic Injury and Claim for Continuation of
Pay/Compensation. Use for traumatic injury – employee was hurt because of a single event or
within one workday.
CA-2 - Notice of Occupational Disease and Claim for Compensation. Use for occupational disease or
illness claims - medical condition developed over more than one workday (i.e. carpal tunnel,
skin disease). A checklist (CA-35) and or Factual and Medical Development Sheet should
accompany each CA-2. Contact HRO for checklist and/or sheet.
CA-2a- Federal Employee‘s Notice of Recurrence of Disability and Claim for Continuation of
Pay/Compensation. Use for recurrence of injury or occupational disease - medical condition
has flared up for no other explainable reason other than a previous work-related condition.
CA-7 - Claim for Compensation on Account of Traumatic Injury or Occupational Disease. Used for
1. To claim lost wages when continuation of pay expires on a traumatic injury, and to claim
wage loss on occupational disease claims.
2. Use to initiate leave buy backs.
3. Use to claim a scheduled award (employee has reached maximum medical improvement
but has suffered a permanent loss or impairment to a part of their body).
CA-17 - Duty Status Report. This form allows the physician to keep you updated on your employees
work restrictions and/or duty status.
OWCP will only work with original forms. Send originals to HRO.
Failure to submit claim forms in a timely manner by employee (30 days) jeopardizes the employee‘s
benefits. The employer (including the supervisor and HRO) has 10 working days to submit a claim to
DOL from the time it is submitted from the employee (20 CFR, part 110). Submit information to
challenge claims rather than avoid or delay the process.
Incomplete forms cause unnecessary delays and causes complications at HRO and OWCP. Look at
and address every block. Indicate N/A if information is not pertinent. Call HRO if you need assistance.