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Fax: 215-545-4617
 

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Philadelphia, PA 19102​
 

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Forms and

Information

The Department of Labor (DOL) provides a complete list of OWCP forms on their website. Generally, forms should be printed, filled out, and then submitted through your agency to DOL. Always keep a copy of what you submit, and make sure you have proof that you submitted the form. Here are links to some commonly requested forms:

CA-1: Federal Notice of Traumatic Injury and Claim for Continuance of Compensation

Use this form to report a traumatic injury. Complete the employee portion of the form and turn it in to your supervisor no later than 30 days following an injury. Make sure you get a "receipt of notice" from your supervisor.

CA-2: Notice of Occupational Disease and Claim for Compensation

Use this form to report an occupational disease. Complete the employee portion of this form and turn it in to your supervisor. Make sure you get a "receipt of notice" from your supervisor.

CA-2a: Notice of Recurrence

Use this form to report a recurrence of a former injury (when no new injury has occurred). Be aware that workers are sometimes told to file recurrence claims when they should be filing new injury claims.  

 

Information for Medical Providers

If your doctor's office is unsure of how to bill for your work injury, print out and give them this form. You should also give your doctor's office the list of accepted conditions, including injury codes, for your case. You can log in to OWCP's website and get this information at 

https://www.dol.gov/owcp/dfec/regs/compliance/infomedprov.htm

CA-7: Claim for Compensation

If you are unable to return to work within the 45-day continuation of pay period, use this form to request disability compensation. File this form as soon as it is apparent you will not be able to return to work.

OWCP-915: Claim for Medical Reimbursement

If you've paid your doctor for treatment that should be covered by OWCP, use this form to request reimbursement. Make sure to carefully read and follow all of the instructions on the form.