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
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
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
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