This will serve as a guide for supervisors when they have an employee get injured on-the-job.
- When an employee sustains a traumatic on-the-job injury the supervisor should give the employee a CA-16 “Authorization for Treatment” form so that the employee can receive immediate treatment. The supervisor must also give the employee a CA-1 “Traumatic Injury Claim” form to fill out the employee’s portion in its entirety. CA-16 should not be used for occupational disease/illness claims that use a CA-2 form. Employees will be seen at the Occupational Health Clinic in the Bradley Building, William Beaumont Army Medical Center, or the ER, as appropriate.
- Employee must fill out the employee’s entire portion of the CA-1 and give it to the supervisor who will fill out the Supervisor’s portion on the back. Please note that date of notice, item 23, should not be filled out on either portion until all paperwork is complete and ready to be submitted to WB Safety Office. The employee should sign and date the form when all items are completed. Federal law requires that the claim arrive at the Office of Workers Compensation Programs, Department of Labor (DOL), Dallas, Texas, no later than 14 calendar days from date of notice, item # 23 on supervisors portion.
- The supervisor must submit originals of both forms to the WBAMC Safety Officer, as soon as all the paperwork is completed. The CA-16 and/or any other medical documentation relating to the injury must be submitted with the claim. A FECA claim will not be accepted or approved without the medical documentation. If the Safety Officer is not available, originals must be submitted to the Fort Bliss FECA office at Building 504-B, Room 108. A copy must be given to the Safety Officer.
- The safety officer will be responsible to check the forms and ensure that the forms are received by the Fort Bliss FECA office in a timely manner. The FECA office will send the forms no later than the next day’s mail to comply with DOL’s 14 day requirement.
- It is the responsibility of the supervisor to inform the FECA office, at 568-5628, when an injured employee returns to work. The FECA office will do the DOL “Return to Duty” form CA-3.
Note: Claims that have lost time and/or medical expenses will be done electronically by the supervisor through the EDI system.
Forms can be found at http://www.dol.gov/esa/regs/compliance/owcp/forms.htm.
Although the employee may choose between using their sick or annual leave and COP, it is strongly suggested that COP be used in traumatic injury cases. COP does NOT apply to Occupational diseases/illnesses. COP is continuation of pay where the employee’s pay continues as if the employee was at work. Medical documentation is required.
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DoD contract employees must obtain the necessary paper work from their employer. If you are seen at WBAMC you will be billed unless the appropriate documentation is provided by your employer.
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