OWCP Form CA-7
Form CA-7 is a claim form used by federal employees to claim compensation for wage loss while in a leave without pay (LWOP) status due to disability or absence to obtain medical treatment (after continuation of pay (COP) period for traumatic injury cases). It can also be used to claim leave buy back, schedule award or lost pay elements (ie, night differential, Sunday premium, holiday pay, etc).
The form must be completed and submitted by the injured worker (IW) every two weeks while disabled and in a LWOP status, unless the IW has been placed on the periodic roll. For traumatic injury cases, Form CA-7 should be completed before the end of the COP period, if disability will continue.
The 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.
Here are the steps on how to complete Form CA-7:
- Read the instructions carefully.
- Fill out the personal information section, including your name, Social Security number, and OWCP file number.
- In the “Period Covered by This Form” section, enter the start and end dates of the period for which you are claiming compensation.
- In the “Dates of Disability” section, enter the dates on which you were disabled and unable to work.
- In the “Hours of Leave Used” section, enter the number of hours of leave that you used during the period.
- In the “Total Wage Loss” section, enter the total amount of wages that you lost due to your disability.
- Sign and date the form.
You can find Form CA-7 on the OWCP website. You can also download the form and fill it out electronically.
Here are some additional things to keep in mind when completing Form CA-7:
- If you are claiming leave buy back, you will need to provide documentation from your employer showing the amount of leave that you have available.
- If you are claiming a schedule award, you will need to provide medical documentation showing your maximum medical improvement.
- If you have any questions about completing Form CA-7, you should contact the OWCP.