Get Esa2a 2a Create 2024

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

Fillable Forms Form NumberOWCP's Form Title / DescriptionCA-5*Claim for Compensation by Surviving Spouse and/or ChildrenCA-5b*Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildrenCA-6Official Supervisor's Report of Employee's DeathCA-7*Claim for Compensation37 more rows

This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease.

CA-2 - Notice of Occupational Disease and Claim for Compensation. Use for occupational disease or illness claims - medical condition developed over more than one workday (i.e. carpal tunnel, skin disease). CA-2a - Federal Employee's Notice of Recurrence of Disability and Claim for Pay/Compensation.

A CA-2a form is a claim for recurrence. If for instance an employee has an injured back and they go out of work for awhile and they're returned back to work, and then they have a worsening of that back injury condition, they would claim a recurrence. To do that they would file a form CA-2a.

Form CA-17 is designed to be filled out by the injured worker's supervisor and his/her treating physician to complete. It is split into two sections: A and B. Side A is to be completed by the employee's supervisor.

CA-7a* Time Analysis Form, used for claiming compensation, including repurchase of paid leave.

Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation), and (2) occupational disease (Form CA-2, Notice of Occupational Disease and Claim for Compensation).