According to the Federal Employees’ Compensation Act, a traumatic injury is defined as “a wound or other condition of the body caused by external force, including stress or strain, which is identifiable as to the time and place of occurrence and member or function of the body affected. The injury must be caused by a specific event or incident or series of events or incidents within a single work day or work shift.”
The key to this definition is that an event must have occurred during one work day. If you suffer an on-the-job traumatic injury, you should immediately notify your supervisor and request authorization for medical treatment. You should request a Form CA-16 and identify the physician that you have selected to provide medical treatment for the injury. You should also be advised that, in non-emergency situations, you may be required to be examined by a Postal Medical Office or contract equivalent prior to obtaining initial medical treatment. However, this examination must in no way interfere with your right to seek prompt examination/treatment from a physician of your choice.
If possible, you should take the CA-16 with you when you first go to your physician.
The Postal Service should also provide you with a CA-17 (Duty Status Report) and a HCFA-1500 (Health Insurance Claim Form) for the physician to complete and return to the Postal Service. Now that you have obtained proper medical attention, how and when is a notice of traumatic injury filed? To claim benefits under the FECA, an employee who sustains a work-related traumatic injury must give notice of the injury in writing on Form CA-1, which may be obtained from the employer or at dol.gov/dol/esa/ owcp.htm. The important thing to remember is that, regardless of where you obtain the Form CA-1, you must be diligent to ensure that your portion of the form is accurate and complete before you sign it. You must then timely submit the CA-1 to your supervisor. A timely CA-1 must be filed within three years of the date of injury. However, the completion of the CA-1 must be done within 30 days of the date of injury in order for you to be eligible for continuation of pay. Be sure to retain your receipt and request a copy of the completed CA-1 from your supervisor.
Another person, including the employer, may give notice of injury on the employee’s behalf. The person submitting a notice shall include the Social Security number of the injured employee. After OWCP receives the CA-1 from the Postal Service, it will send you a postcard within about two weeks that identifies your OWCP case file number. Use this case file number on all documents submitted to OWCP and ask your doctor and other medical providers to do the same.
To establish the essential elements of a claim, you must provide evidence that shows that the injury occurred as reported and in the performance of duty, and that your condition or disability is related to the injury. Your physician must provide a clear diagnosis of your medical condition and his or her rationalized medical opinion about the causal relationship between your condition and the reported work-related factors on the date of injury. If your CA-1 claim is accepted, in most cases you will receive an approval letter from OWCP.
This letter will spell out what condition has been accepted as being work related and will provide you with a list of your benefits and entitlements. This letter will also explain filing for lost wage compensation, submitting medical bills for payment, and how to be reimbursed for medical expenses. Some CA-1 claims are accepted by OWCP under the “Short-Form Closure” provision.
This means OWCP will unconditionally approve a claim until lost wages and/or medical expenses exceed $1,500. Once that monetary threshold is met, OWCP will evaluate the claim and place it into development for a review of the evidence. “Short form closure” claims generally do not receive an acceptance letter.
