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					       Reports                  Forward to:                   CPACs               ICPA phone #
Step 1:                   Supervisor
Notify supervisor of      Not later than 30 days      BENELUX                 DSN: 361-5063
injury; request Form      after date of injury.                               Fax: 361-5386                   Army in Europe
CA-16; begin prepar-      CPAC ICPA has details.
ing Form CA-1 online.                                 Grafenwöhr              DSN: 475-7264
Step 2:                   NOTE: Form CA-16                                    Fax: 475-7920
Take Form CA-16 to        must be signed by
physician.                supervisor at the time of
                          initial treatment or        Hanau                   DSN: 323-3185
                          within 48 hours after the                           Fax: 323-2407
                          time of injury.
Step 3:                   CPAC ICPA                   Heidelberg              DSN: 370-1430
Supervisor completes      Files Form CA-1 and                                 Fax: 370-7501
and submits Form          Form CA-16 with the
CA-1.                     DOL within 10 days
                          after notification of
                          injury.
                                                      Kaiserslautern          DSN: 489-7220
                                                                              Fax: 489-6102                Injuries
Step 4:                   CPAC ICPA
Take Form CA-20,
Form CA-17, and
                          Submits forms to DOL
                          when your physician has
                                                      Stuttgart               DSN: 421-2150
                                                                              Fax: 421-2077
                                                                                                          On the Job
position description to   completed them.
your physician on
follow-up visits.         NOTE: Form CA-17            Vicenza                 DSN: 634-7356            Appropriated Fund:
                          requires supervisor to                              Fax: 634-8344
                          complete Part A.                                                            A Guide for Employees
Step 5:                   CPAC ICPA                   Würzburg                DSN: 351-4612
Take medical              If necessary, submit                                Fax: 351-4630
paperwork and bills to    Form CA-915 for
the CPAC ICPA as          reimbursement.
soon as possible.                                      Contact your local CPAC ICPA for assistance.
 Forms are available on the CHRA-E Web site at
         http://www.chra.eur.army.mil.




                                                                                                         AE Misc Pub 690-2A ● 15 Dec 04
You Are Protected                                       CHRA-E Web site. Click on Master Index;            For more information on filing your claim, contact
                                                        I; Injuries On-the-Job.                            your CPAC ICPA or visit the CHRA-E Web site.
As a U.S. appropriated fund (APF) employee, you
are protected under the Federal Employees’              You have the right to select the physician         Benefits Under FECA
Compensation Act (FECA) for injuries and                you want for treatment. Once you choose a
illnesses that are work related.                        physician, you cannot change to another            ● Attendant’s allowance
                                                        physician without consent from the work-           ● Death benefits
This guide will walk you through the basic steps of     ers’ compensation claims administrator.            ● Hospital costs
addressing an on-the-job injury. When you have                                                             ● Partial disability
questions or need more assistance with workers’         You are encouraged to seek treatment at a          ● Permanent disability
compensation issues, talk to your supervisor and        U.S. military medical facility so you will         ● Pharmacy costs (medication)
your local civilian personnel advisory center           not be billed for the initial treatment or for     ● Physician costs
(CPAC) injury compensation program adminis-             follow-up treatments within 60 days. Tell          ● Schedule award
trator (ICPA). For more information, visit the          the treasurer at the facility that your visit is   ● Temporary disability for traumatic injury
Civilian Human Resources Agency, European               for an on-the-job injury so your paperwork         ● Vocational rehabilitation
Region (CHRA-E), Web site at http://www.chra            will be coded accordingly. At a host-nation
.eur.army.mil.                                          facility you may need to pay for services          Information and Assistance
                                                        up front and request reimbursement later.
Reporting Injuries                                      To avoid reimbursement delays, you                 Contact the CPAC ICPA as soon as possible after
                                                        should have all documents translated into          your injury or illness. Discuss your reports,
If you are injured at work, notify your supervisor as   English before filing them with the CPAC           claims, and benefits with your supervisor and the
soon as possible after the injury occurs. By            ICPA.                                              CPAC ICPA.
reporting your on-the-job injury, you protect your
ability to make a compensation claim. All injuries      Filing Your Claim for Compensation                 If you are temporarily unable to work because of
should be reported, even when treatment is not                                                             your injury, you must provide medical documen-
required and there is no worktime lost.                 ● You and your supervisor must complete            tation certifying the continuation of your medical
                                                        the online Form CA-1, available on the             condition. Light-duty assignments may be
Seeking Medical Attention                               CHRA-E Web site. This form must be filed           available if you are not able to perform your
                                                        with your supervisor within 30 days after          regular job and if approved by your physician.
If your injury is an emergency, seek treatment          the date of injury.
immediately. Before you obtain medical treatment                                                           The CPAC ICPA will file all of the required forms
for a medical problem that is not an emergency, ask     ● If you have an occupational disease, you         that you and your supervisor complete. For more
your employer for U.S. Department of Labor              should file Form CA-2.                             information about your rights under FECA, go to
(DOL) Form CA-16, which authorizes treatment by                                                            http://www.dol.gov/esa/regs/compliance/owcp/ca-
a physician of your choice. This form is available at   ● Every 30 days, your physician must               11.htm.
your local CPAC. Other forms you need in order to       provide a status report on Form CA-17.
file an on-the-job injury claim can be found on the

				
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