Get Editable Compensation Forms

Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.

Form C-1 - Notice Of Injury Or Occupational Disease The C-1 is completed by the injured employee or supervisor for all accidents and injuries. Complete the C-1 form and the Supervisor's Injury/Illness/Incident Report Forward both documents to Risk Management & Safety via UNLV Secure File Transfer or fax (702-895-5227).

Form C-3 Employer's Report Of Industrial Injury or Occupational Disease. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours.

select a physician of his/her choice to provide necessary treatment. The supervisor shall immediately authorize examination and appropriate medical care by use of Form CA-16 issued to either a United States medical office or hospital or any duly qualified physician/ hospital of the employee's choice.

Filing A Workers' Compensation Claim The C-4 form is titled “Employee's Claim for Compensation/Report of Initial Treatment”. The physician fills out their part of the form, and sends a copy to your employer and the insurer. Be sure to get a copy for your records.

CA-5. Subject. Claim for Compensation by Widow, Widower, and/or Children.

Leave Buy Back. Compensation for Leave without Pay. The CA-7 must be filed electronically through the Employees' Compensation Operations & Management Portal (ECOMP). If you do not already have an account, one must be created at http://.ecomp.dol.gov.

The employer shall issue Form CA-16 within 4 hours of the claimed injury. If the employer gives verbal authorization for such care, he or she should issue a Form CA-16 within 48 hours. The employer is NOT required to issue a Form CA-16 more than one week after the occurrence of the claimed injury.

CA-16s can be approved and provided only by a postal supervisor. A properly issued CA-16 must have the name, title and signature of the authorizing official. CA-16s are not available online—for a very good reason. Only the au- thorizing agency has the authority to provide the CA-16.

Federal Workers' Compensation Injured postal workers are required to fill in form CA-17, which is a form which outlines information from a doctor forbidding an injured federal employee from carrying out certain activities due to their inherently physically taxing nature.

Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.

Form C-1 - Notice Of Injury Or Occupational Disease The C-1 is completed by the injured employee or supervisor for all accidents and injuries. Complete the C-1 form and the Supervisor's Injury/Illness/Incident Report Forward both documents to Risk Management & Safety via UNLV Secure File Transfer or fax (702-895-5227).

Form C-3 Employer's Report Of Industrial Injury or Occupational Disease. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours.

select a physician of his/her choice to provide necessary treatment. The supervisor shall immediately authorize examination and appropriate medical care by use of Form CA-16 issued to either a United States medical office or hospital or any duly qualified physician/ hospital of the employee's choice.

Filing A Workers' Compensation Claim The C-4 form is titled “Employee's Claim for Compensation/Report of Initial Treatment”. The physician fills out their part of the form, and sends a copy to your employer and the insurer. Be sure to get a copy for your records.

CA-5. Subject. Claim for Compensation by Widow, Widower, and/or Children.

Leave Buy Back. Compensation for Leave without Pay. The CA-7 must be filed electronically through the Employees' Compensation Operations & Management Portal (ECOMP). If you do not already have an account, one must be created at http://.ecomp.dol.gov.

The employer shall issue Form CA-16 within 4 hours of the claimed injury. If the employer gives verbal authorization for such care, he or she should issue a Form CA-16 within 48 hours. The employer is NOT required to issue a Form CA-16 more than one week after the occurrence of the claimed injury.

CA-16s can be approved and provided only by a postal supervisor. A properly issued CA-16 must have the name, title and signature of the authorizing official. CA-16s are not available online—for a very good reason. Only the au- thorizing agency has the authority to provide the CA-16.

Federal Workers' Compensation Injured postal workers are required to fill in form CA-17, which is a form which outlines information from a doctor forbidding an injured federal employee from carrying out certain activities due to their inherently physically taxing nature.