TYPES OF CLAIMS
Traumatic Injury (CA-1)
Occupational Disease and Illness (CA-2)
Recurrence (CA-2a)
Traumatic Injury (CA-1)
According to the Federal Employees' Compensation Act (FECA) 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 or series of events must have occurred during one work day. If an injury or illness occurred due to a repetitious event, it should be filed as an occupational injury claim.
If an employee suffers an on-the-job traumatic injury, he/she should immediately notify a supervisor and request a CA-1 and authorization for medical treatment. The injured employee should request a Form CA-16 and identify the physician that has been selected to provide medical treatment for the injury.
If possible, the injured worker should take the CA-16 when first going to the doctor. The Postal Service should also provide a CA-17 (Duty Status Report) and a HCFA-1500 (AMA Uniform Health Insurance Claim Form) for the physician to complete and return to the Postal Service.
As soon as possible after the injury, the injured worker will want to complete a Form CA-1 (Federal Employees’ Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation). This must be done within 30 days of the date of injury in order for the injured worker to be eligible for continuation of pay (COP). On the front of this form, the injured worker will want to mark the box indicating COP. COP is the continuation of regular pay with no charge to sick leave or annual leave for the first 45 calendar days of disability. Please retain the receipt and request a copy of the completed CA-1 from the supervisor.
After OWCP receives the CA-1 from the Postal Service, they will send the injured worker a postcard that identifies the OWCP case file number. The injured worker should receive this number in approximately 2 weeks from the date that OWCP receives the claim. Use this number on all documents submitted to OWCP. Instruct the doctor and other medical providers to include this case file number on all bills or other correspondence sent to OWCP.
If an injured worker is unable to work because of an injury, he or she may be eligible for COP. If the injured worker has requested COP on the CA-1 he or she must ensure that medical evidence is submitted to the Postal Service that shows he or she sustained a traumatic injury and are unable to work as a result of it. Forms CA-16 or CA-17, or a narrative report from the doctor would generally meet this requirement. The Postal Service may stop payment of COP if they do not receive medical evidence within 10 working days after the date the injured worker submitted the CA-1, or the date the injured worker stopped work, whichever is later.
If the injured worker elected to receive sick or annual leave instead of COP, and later elects COP for a period that he or she used leave, the Postal Service shall grant COP, provided the request for COP is submitted within one year of the date that leave was used, the Postal Service has received medical evidence that the injured worker was unable to work, and he or she was otherwise entitled to COP.
If the injured worker is not entitled to COP or the 45 calendar days have elapsed, and he or she is in a LWOP status or expect to lose pay because he or she is unable to work, the injured worker may claim compensation by filing Form CA-7 (Claim for Compensation on Account of Traumatic Injury or Occupational Disease) or may use leave.
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Occupational Disease and Illness (CA-2)
An occupational disease is defined as a condition produced in the work environment over a period longer than one work day or shift. It may involve infection, repeated stress or strain, exposure to toxins, fumes or other continuing conditions of the work environment. Some of the more widely recognized occupational diseases/illnesses include orthopedic injuries due to repeated stress or strain such as carpal tunnel syndrome, rotator cuff strains, or tendonitis and physical or emotional conditions caused by emotional stress. These medical conditions are usually slow in developing and do not generally occur at a specific time and place.
Occupational disease claims are filed on a CA-2 form (Notice of Occupational Disease and Claim for Compensation). To establish a claim for compensation benefits for Occupational Disease or Illness, complete the front of the CA-2 and submit it to the supervisor as soon as possible, but not later than 30 days after being made aware of the connection between the disease or illness and the employment as a rural letter carrier, or 30 days after the injured worker was last exposed to the conditions of employment implicated in the claim, whichever is later. Failure to file written notice may result in loss of compensation rights.
Provide all the evidence outlined in the instructions on the reverse side of the CA-2. Submit all of the additional medical evidence necessary to support your claim. There are checklists available from the Post Office for specific medical conditions in order to serve as an aid (Forms CA-35a through g) (See Appendix C). This additional factual and medical evidence is essential to your Occupational Disease claim.
As with all Workers’ Compensation claims, details are extremely important. This is more so for Occupational Disease claims. The injured worker must explain in detail the work that is done, as well as the type of injury he or she is claiming. The injured worker must urge the doctor to be as specific as possible in diagnosing the injury and showing how specific job functions have caused, aggravated or accelerated the condition1. The injured worker will want to provide a very detailed description of what is done at work on a daily basis for the doctor. Keep in mind that the doctor might not get a clear picture of what is meant if the injured worker simply says "I case mail". Try to avoid postal related language and concentrate on the actual physical functions of the job. When describing the duties of a rural carrier, make sure that you elaborate as much as possible. The injured worker must remember that he or she is communicating to the doctor and the claims examiner. They may have no idea what the detailed job description is of a rural letter carrier.
An appropriate narrative should include information such as:
Upon reporting for work, retrieve mail from designated location and place on mail case ledge, cutting strings, straps, bands, etc.… as appropriate for returning equipment to its proper location. Pick up fold/crease newspaper sized articles to fit into one or two inch separations on a mail case. The mail case has approximately four hundred separations in a "U" shaped configuration. The bottom shelf is approximately three feet from the floor and extends upward to approximately six feet, with six shelves. This movement/action is repeated until all flats (newspaper type items) are inserted into the mail case. On my route I repeat this motion approximately .. (number of flats that you fold on your route).
Pick up handful of letters and hold in one hand with the other hand taking individual letter pieces to insert into the one or two inch separation of the mail case. This action is repeated .. (number of letter sized items on your route). Any other items which can be cased into the mail case of odd size or shape will be sorted.
Parcel post hamper is then retrieved from its designated location and brought to the mail case where parcels are then arranged in delivery sequence. Once all mail is inserted into the mail case, it is extracted from the case by pulling down the individual customer’s mail from the one to two inch separations. This mail is held, tied, bundled, banded, or compressed by straps or containers until all mail that has been previously inserted into the mail case has been extracted into delivery sequence.
1See section addressing Medical Management for details.
The mail (now in bundles, trays, etc.…) is now taken to the vehicle and loaded (provide method of loading and approximate weight of trays). The carrier drives to the first delivery point (describe right or left hand drive vehicle that is used on your route). Then the carrier arrives at the first delivery point and pulls up to the mailbox. If the signal flag is raised, which indicates that there is mail to be picked up, the flag is lowered with the right hand, the mailbox lid is opened, and the mail is extracted from the box and placed in the designated location within the vehicle. Frequently, loose change is in the box (customers can purchase stamps, etc.…) which requires picking up money/coins. The mail for that delivery is gathered and combined into one bundle to be inserted into the mailbox. At that point, the mailbox lid is closed and the carrier drives to the next stop. This is a typical action that is repeated .. (insert number of deliveries/boxes on your route).
Upon return to the office, the mail collected from the patrons on the route and other items that need to be brought to the post office are again loaded onto a conveyance and transported into the work location. Here, collected mail is placed into a designated location.
For Occupational Disease claims, the injured worker will also need to describe other office functions which indicate repetitive motion, stress, exposure or other issues that relate to the claimed injury or disease. The above written narrative is only to serve as a guideline. The injured worker will want to tailor it to the specific injury and what he or she believes has been the cause of the condition.
Once the injured worker has submitted the CA-2 and has provided supporting medical documentation, OWCP will receive the claim from the Postal Service. Approximately two weeks later the injured worker will receive a postcard in the mail that contains an OWCP case file number. Use this number on all documents, correspondence and billing information submitted to OWCP.
If the injured worker needs medical care for an Occupational Disease claim, he or she should arrange for such treatment. If OWCP approves the claim, they will pay for medical treatment related to the accepted condition(s). The Postal Service may not authorize medical treatment for Occupational Disease claims unless approved by OWCP. Keep in mind that the injured employee has the initial choice of physician.
If an injured worker is unable to work because of an Occupational Disease, he or she may use sick or annual leave, leave without pay, and/or claim compensation for wage loss. Occupational Disease claims are different from Traumatic Injury claims (CA-1) in that there is no provision for Continuation of Pay (COP). Occupational claims generally take longer to adjudicate and approve (generally in the area of 3 to 6 months, depending upon the medical support) and force the injured employee to think more carefully about how long they expect to be out of work and what their economic situation is like.
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Recurrence (CA-2a)
Under the Federal Employees' Compensation Act (FECA), a recurrence is defined as follows:
A work stoppage that occurs after an employee has returned to work following a preceding period of disability and is the result of:
- a spontaneous return of symptoms (disability) of a previously accepted work-related condition without intervening cause; or
- a return or increase of disability due to a consequential injury.
In most cases, the key to differentiating a recurrence from a new injury is that, in a recurrence situation, the only evident cause of disability or increased symptoms is the original accepted injury. No new identifiable event or events are responsible for the increased symptoms or disability. The exception to this rule is a "consequential injury".
The following is an example of a Recurrence. This is an easily identifiable recurrence that would require the submission of a form CA-2a for claiming compensation.
Tom is a rural letter carrier who has a previously accepted left knee condition. Following initial disability, Tom returned to work in a limited duty position that met all of his medical restrictions, in which he is seated at a table answering the phone. There is no unusual use of the legs involved in this limited duty position.
Several weeks later, Tom's knee symptoms increased to the point that he was unable to continue in his limited duty position answering the phone. There was no identifiable cause for the increase in symptoms other than the original accepted injury. By definition, this would be classified as a recurrence. Tom should file a CA-2a for claiming workers' compensation benefits.
This is a relatively simple recurrence that is easily identified because there is no apparent, identifiable cause for the worsening of the condition other than the original condition itself.
Included in the definition of recurrence is the special case of "consequential injury". A consequential injury is a new injury which occurs as the result of a previously accepted work-related injury; for example, it occurs because of weakness or impairment caused by a work-related injury. Included in this definition are injuries sustained while obtaining medical care for a work-related injury.
Consequential injuries (recurrences) may resemble traumatic injuries in certain cases. Like a traumatic injury, a consequential injury may be the result of a specific, identifiable traumatic event. This event, however, must be related in some way to a previously accepted, work-related condition.
Unlike a traumatic injury, a consequential injury may be accepted even if it occurs when an employee is in a non-pay, non-working status (that is "off the clock").
It is important to differentiate between new traumatic injuries and consequential injuries. The procedures for claiming a consequential injury are different from the procedures for claiming a new traumatic injury.
As stated above, a consequential injury may result from medical treatment of a previously accepted injury. A consequential injury may affect the same body part as the previously accepted injury, as in the following example:
Tom has a previously accepted claim for a strain of the left knee, which was sustained when he slipped on a wet floor at work. While at his doctor's office for treatment of the strained left knee, Tom's left knee gave out and he fell to the floor, bruising the same knee. The new injury would be considered a consequential injury and a claim would be submitted on a form CA-2a.
A consequential injury to a new body part may result from medical treatment, as in the following example:
Tom has a previously accepted claim for a strain of the left knee. While attending physical therapy for his knee, Tom was involved in weight training. Tom developed a back injury due to the strengthening exercises. Tom must file a form CA-2a to claim this as a workers' compensation injury.
The following example shows a consequential injury sustained by a claimant in his own home:
Tom has an accepted claim for a strained left knee. Following initial disability, Tom was on crutches due to the accepted injury, working in a limited duty assignment. One day, while walking to his car, Tom's crutch slipped on a patch of ice in his driveway. He fell to the ground, worsening the condition in his left knee and making him unable to continue in his limited duty assignment. This would be considered a consequential injury (recurrence) and a form CA-2a would be filed by Tom to claim this injury.
Please note that, in all of the examples above, the consequential injuries were all caused by a previously accepted injury. This is the most important factor in identifying a consequential injury.
It is helpful to note that while a consequential injury may occur outside of work, a consequential injury infrequently occurs at work since a new condition or disability that develops as a result of an incident in the work place is almost always considered a new injury, not a recurrence.
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