PERMISS

Guidelines for Reporting & Documenting Job-Related Injuries/Illnesses

  1. TRAUMATIC INJURY
    This type of injury is defined as a wound or other condition of the body caused by external force, including physical stress or strain. It must be identifiable by time and place of occurrence and a member or function of the body affected. Further, it must be caused by a specific event or incident ora series of events or incidents within a single day or workshift.
    1. Employee - Immediately advise his/her supervisor that an on-the-job injury has been sustained.
    2. Supervisor - If emergency medical treatment is desired, ask employee where he would like to be treated. If he desires private MD or hospital emergency room, immediately furnish CA-16. Immediately notify the Safety Officer of the accident or incident. Normally, a safety incident report must be filed with the installation Safety Office.
    3. Employee - If initial and follow-up treatment is available at the Installation, employee may elect to use their services in order to help reduce Federal Employees' Compensation Act (FECA) costs and cases. He/she has the right, however, to be seen by a private physician, so long as the physician is not on the Office of Workers' Compensation (OWCP) exclusion list. Prior OWCP approval should be obtained before seeing a chiropractor. If the employee elects to see a private physician, he/she may not later change physicians without prior OWCP approval or referral by the attending physician. It is the employee's responsibility to:
      • Obtain timely examination/treatment from a physician.
      • Have the physician complete Forms CA 16, Authorization for Examination and/or Treatment, and CA 17, Duty Status Report, and return them to the supervisor who will then send it to the Injury Compensation Program Administration (ICPA)


      • Advise the physician of the availability of light duty and part-time duty.

  2. Employee - Report injury by completing Form CA 1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, and submit to the supervisor within 2 workdays of the injury. If employee is incapable of completing the CA 1, have someone submit it on their behalf. Give detailed and specific information. In Block 15 of the CA 1, specify whether time lost from work due to the work-related injury should be charged to sick leave ,or annual leave .

    COP is the continuation of an injured employee's regular pay, for up to 45 calendar days, without charge to leave. All periods of COP must be supported by a doctor's certificate. To be eligible for COP, he/she must submit the CA 1 within 30 calendar days of the injury. Statutory time requirements for other FECA benefits will be met if the CA 1 is filed no later than 3 years after the injury. Since the benefits are based on the claim it is important to complete the CA 1 as carefully as possible.


    If the injury is witnessed, obtain the name, telephone number, and written statement from each witness. It is the employee's responsibility to provide prompt and accurate information and submit appropriate medical documentation to support their claim and all absences from work. Additionally, he/she must return to duty, regular or light duty, full-time or part-time, as soon as theyare able.


  3. Supervisor - Ensure receipt of the CA 1 within 2 workdays. Complete and return Receipt of Notice of Injury portion of the CA 1 to the employee. Upon receipt of the CA 1, carefully review the form for completeness, investigate the accident and document completely on the form, interview the witness(es), complete appropriate safety forms, controvert questionable claims, and submit the CA 1 and related documentation to the ICPA within 2 workdays of receipt from the employee.


  4. Employee - If emergency treatment from the Installation Medical Facility was received, there will be advisement in writing as to what the examination revealed about his/her condition, what his/her restrictions are, if any, and when he/she can return to duty, either regular or light duty, full-time or part-time. If the Installation medical Facility refers him/her or they request to see a private physician, he/she may not later change physicians without prior OWCP approval or referral by the attending physician. The supervisor will issue Forms CA 16; CA 17 Duty Status Report, which a private physician must complete aand return to the supervisor to forward to the ICPA. The CA 16 must be issued within 48 hours of the injury. The CA 16 guarantees payment and is only good for 60 days from the date of issuance. If the 48-hour timeframe is not met, a CA 20, Attending Physician's Report, will be issued, however, it does not guarantee payment.


  5. Employee/Supervisor - If no time is lost from work other than on the day of injury and no medical bills are incurred, the CA-1 should be submitted to the ICPA.


  6. Employee - All absences must be supported by a statement signed by a physician, with diagnosis, how injury is related to employment, and number of days before employee can return to light duty. Medical providers may submit bills directly to AQS or original bills may be submitted to the ICPA, who can mail to AQS. (AQS is the contracted bill-paying service for OWCP).


  7. Supervisor - If time is lost from work and the employee elects COP, forward the medical certification to the ICPA. Copies of all OWCP-related information should be retained by the supervisor; however, all original documentation should be forwarded to the ICPA. Additionally, he/she must annotate the Time and Attendance (T&A) Sheet in accordance with Time and Attendance Reporting - Civilian Pay, and provide a copy to the ICPA of the T&A sheet for each pay period that COP is charged.


  8. Employee/Supervisor - Submit CA 17 to the ICPA for every follow-up doctor appointment.


  9. Supervisor - In cases where the medical evidence shows that recovery within the 45-day COP period is unlikely, send Form CA 7/20, Claim for Compensation on Account of Traumatic Injury, to the employee 5 days before the COP period expires. Upon receipt of completed CA 7/20, complete Statement of Official Superior portion and forward the original to the ICPA.


  10. Supervisor - Immediately notify ICAP when: (1) the employee returns to work after being in a COP status,or (2) when the employee stops receiving COP but does not return to work but goes on leave without pay (LWOP), sick leave, or annual leave, or (3) when the employee is released from light duty to full duty. ICPA will notify OWCP.


  11. Employee/Supervisor - If after returning to duty, the employee is again disabled and stops work as a result of the original injury, the recurrence must be reported on Form CA 2a, Notice of Employee's Recurrence of Disability and Claim for Pay/Compensation. If the employee has not used up all 45 days of COP the absence may be charged to COP.


  12. Employee - If COP has been exhausted or 3 months have elapsed, he/she must elect sick leave, annual leave or LWOP. If sick leave or annual leave is elected to avoid possible interruption of income, he/she may later "buy back" the leave when/if compensation is approved by OWCP. He/she must be in a LWOP/nonpay status in order to receive compensation. Compensation is payable after a 3-day waiting period; however, no waiting period is required when there is a permanent injury or where the disability causing wage loss exceeds 14 days.


  13. Supervisor - Submit LWOP SF 52, Request for Personnel Action, when LWOP exceeds 80 consecutive hours. Submit Return to Duty SF 52 and Form CA 3 upon employee's return to duty.


  14. Employee - Submit Form CA 7/20 once COP is exhausted and Forms CA 8, Claim for Continuing Compensation on Account of Disability, bi-weekly until the return to duty.


  • OCCUPATIONAL DISEASE OR ILLNESS


    This is defined as being produced by systematic infection, continued or repeated stress or strain, exposure to toxins, poisons, fumes, noise, etc., in the work environment over a longer period of time than 1 day or workshift.



    1. Employee - Submit CA 2, Federal Employee's Notice of Occupational Disease and Claim for Compensation, within 2 calendar days after you become aware the disease or illness is job-related; however, statutory time requirement will be met if the CA 2 is filed no later than 3 years after the date he/she became aware the disease or illness was job- related. If time is lost from work, he/she may elect sick leave , annual leave , or LWOP . If sick leave or annual leave is elected, he/she may later "buy back" the leave when/if the claim is approved by OWCP. He/she must be in an LWOP status in order to receive compensation.

      Compensation is payable after a 3-day waiting period; however,no waiting period is required when there is a permanent injury or where the disability causing wage loss exceeds 14 days. Persons disabled as a result of occupational disease are not eligible to receive COP. To improve the processing of occupational disease claims, OWCP has developed checklists which tell both the employee and the supervisor what factual information is required before medical questions can be explored. There are 7 special checklists for conditions which are commonly claimed and an 8th checklist for use when the condition does not fall into one of the 7 categories. The checklists are:


        CA 35a - General Checklist,
        CA 35b - Hearing Loss,
        CA 35c - Asbestosis,
        CA 35d - Coronary/Vascular Conditions,
        CA 35e - Skin Diseases,
        CA 35f - Pulmonary/Respiratory (not asbestos-related),
        CA 35g - Psychiatric Illness, and
        CA 35h - Carpel Tunnel Syndrome.


      • Supervisor - Issue employee a CA 20 to determine medical condition and forward completed form to the ICPA. A CA 16 is never authorized for an occupational disease or illness. Provide employee with light duty as required.

      • Employee - If time is lost due to occupational disease or illness, complete and submit CA 7 to supervisor to complete and submit to the ICPA.

      • Employee - Complete and submit CA 8 bi-weekly to supervisor to complete and forward to the ICPA until the return to duty.

      • Supervisor - Submit LWOP SF 52 when LWOP exceeds 80 consecutive hours. Submit Return to Duty SF 52 when employee returns to duty.


    IMPORTANT REMINDER: Supervisors should retain a copy of all completed forms and documentation. All original forms and documentation must be forwarded to the CPAC for case processing. All periods of absence due to a job-related injury or occupational disease/illness must be supported by a physician's statement.

  • Content last reviewed: 6/1/2006-DPC