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General Information
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May Human Resources Advisor Volume 2, Issue 5

Adjudicating Your Claim

If you have filed a Form CA-1 for a traumatic injury, and have not lost time from work, limited medical expenses may be paid by OWCP without a formal review of your claim being conducted. In such case, you will not receive a written decision on your claim and may not receive any further correspondence. Your agency representative may be able to advise you in this situation.

A Traumatic Injury is defined as a wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected. It must be caused by a specific event or incident or series of events or incidents during a single day or work shift. 20 CFR 10.5 (ee).

The following are examples of a traumatic injury: dog bite, knee strain after a trip and fall, neck strain after an auto accident, or a broken ankle after a slip on ice.

If OWCP makes a formal review of your case, you are responsible for providing enough factual and medical information for OWCP to decide whether you are entitled to benefits. OWCP will help you to meet this responsibility by asking you for the information they need that is not already included in your file. You should send any additional information in writing.

If you are claiming an occupational disease, make sure that you provide all information outlined in the instructions included with Form CA-2, as soon as possible. If OWCP approves your case after formal review and you have lost time from work due to the injury, they will advise you in writing of the acceptance and send you further information about your benefits.

An Occupational Disease is defined as a condition which is produced by continued or repeated exposure to elements of the work environment such as noxious substances or damaging noise levels over a period longer than one work day or shift.

If OWCP denies your case, they will provide you with an explanation of why your claim is denied and advise you fully of your appeal rights, including the time frames for exercising these rights and the offices you should contact.

If a work-related injury results in an employee's death, a claim for survivor's benefits may be filed on Form CA-5 or 5b. The survivor(s), the employing agency on behalf of the survivor(s), or the estate may file the claim for benefits. These sensitive cases are processed expeditiously by an experienced claims examiner.