Get Printable Ca 17 Form

There are two sides to the CA-17: Side A is completed by the employee's supervisor and Side B is completed by the employee's physician. A properly completed CA-17 should give the doctor an accurate picture of a worker's daily work duties so that accurate work restrictions can be noted.

CA-17 - Duty Status Report. This form allows the physician to keep your supervisor updated on your work restrictions and/or duty status.

Employing agency (EA) should submit completed Form CA-7 to the Office of Workers' Compensation Programs (OWCP) within five work days of receipt from IW. OWCP tries to review wage loss claims within five days of receipt, and take action to develop or pay within 14 days of receipt from EA.

It is recommended that you take with you a form CA-17 - Duty Status Report to give to the attending physician. This form provides your supervisor and OWCP with interim medical reports containing information as to your ability to return to any type of work.

The employer is required to maintain the same level of health insurance benefits the worker had while he was employed. If the worker has to be off of work longer than the allotted 12 weeks, the employer may cancel the health insurance benefits.

Instructions for Completing Form CA-7A Time Analysis. General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave.

The types of injuries of duties (IOD) range from minor contusions to amputations of digits. Other injuries include removal of foreign bodies in the eyes and in the skin as a result of, for example, grinding metal. Burns, abrasions and lacerations are all in a days work.

Instructions for Completing Form CA-7A Time Analysis. General: This form is used when claiming FECA compensation, including repurchase of paid leave. It must be used when claiming compensation for more than one consecutive period of leave.