Alan J. Shapiro

PHONE: 216-927-2030
FAX: 216-763-2620

IMPORTANT OWCP FORMS FOR INJURED FEDERAL WORKERS

 

Below are links to key OWCP forms that injured federal workers may need to complete in regards to their workers' compensation claim.

When in doubt about your claim, contact OWCP Attorney Alan J. Shapiro for expert advice. There is never a charge for an initial consultation.

These files are in PDF format, readable by the majority of computers. If you don't have Adobe Acrobat Reader installed on your computer, click below to download the program. The program is free and contains no viruses.

The Treasury will no longer issue hard copy checks. Everything has to be direct deposit. This is the form for Direct Deposit Sign-Up. This is the Direct Deposit Sign-Up form 1199A OMB No. 1510-0007

OWCP Form Ca1: Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
This form must be filed within 30 days of the occurrence. Click here to download the fillable PDF version of the form.

OWCP Form Ca2:Notice of Occupational Disease and Claim for Compensation
This form should be filed with OWCP within three years of your awareness of a compensable condition.

OWCP Form Ca2a:Notice of Recurrence
This is a difficult form to complete. Be careful to determine whether the condition is really a recurrence or a new claim.

OWCP Form Ca7:Claim for Compensation
This form begins a claim process for compensation from OWCP, but will not be sufficient by itself. Applicants will need to provide a narrative and appropriate medical records.

Time Analysis Form
This form is used for claiming OWCP compensation, including repurchase of paid leave.

Leave Buy Back (LBB) Worksheet/Certification and Election

OWCP Form Ca20: Attending Physician's Report
The form alone is not sufficient. The employee will need to provide substantive, reliable, and probative evidence from his/her doctor. A PA or NA or nurse may not sign the form or report.

Form OWCP-957: Medical Travel Refund Request

This form is used to obtain reimbursement from OWCP for travel expenses to and from the doctor. Make sure you make a copy because OWCP does not make reimbursements promptly.

Form OWCP-5a: Work Capacity Evaluation Psychiatric/Psychological Conditions This form is used to evaluate a federal employee's work capacity due to various psychiatric or psychological conditions. A qualified physician must complete this form. The federal employer may modify the injured workers duties to meet specific restrictions provided by the doctor.

Form OWCP-5b: Work Capacity Evaluation Cardiovascular/Pulmonary Conditions This form is used to evaluate a federal employee's work capacity due to various cardiovascular and or pulmonary conditions. The physician completing the form can qualify specific activities and restrictions due to the workers illness. The federal employer may modify the injured workers duties to meet specific restrictions provided by the doctor.

Form OWCP-5c: Work Capacity Evaluation Musculoskeletal Conditions This form is used to evaluate a federal employee's work capacity due to musculoskeletal conditions. The physician completing the form can qualify specific activities and restrictions due to the workers illness. The federal employer may modify the injured workers duties to meet specific restrictions provided by the doctor.  

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