CA-1 Form – Fill Out and Use This PDF

CA-1 Form: What Federal Employees Need to Know

The CA-1 form, titled "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation," is the official document federal employees use to report a traumatic work-related injury to the U.S. Department of Labor's Office of Workers' Compensation Programs (OWCP). It serves as the starting point for receiving medical treatment, wage-loss compensation, and continuation of pay under the Federal Employees' Compensation Act (FECA).

Who Must File a CA-1 Form

Federal civilian employees who sustain a traumatic injury during the performance of their duties must file Form CA-1. The form applies to injuries that occur at a specific time and place, such as a slip and fall, a machinery accident, or an acute lifting injury. It is not used for occupational diseases that develop gradually over time. Federal employees with occupational diseases file Form CA-2 instead. Both full-time and part-time federal workers are eligible to file.

Key Sections of the CA-1 Form

The form is divided into four main sections. The employee section captures personal information, the date and location of the incident, a description of the injury, and the employee's choice between Continuation of Pay (COP) or use of sick and annual leave. A witness section records statements from anyone who observed the injury. The supervisor section verifies the incident and provides agency details. The medical section documents the treating physician's information and authorizes the Department of Labor to access relevant medical records.

Filing Deadlines and Continuation of Pay

To receive Continuation of Pay (COP), employees must file Form CA-1 within 30 days of the date of injury. COP covers up to 45 calendar days of work absence. The general statute of limitations for filing a FECA compensation claim is three years from the date of injury. Filing promptly protects your rights and ensures uninterrupted pay during your recovery.

Accuracy and Legal Obligations

Accuracy is required from all parties completing the CA-1 form. Employees, witnesses, and supervisors are each responsible for truthful and complete reporting. Providing false information or misrepresenting the facts of an injury is a federal offense. Penalties can include fines and imprisonment. The OWCP reviews all submissions and may request additional documentation to support the claim.