WebNov 19, 2024 · The following compensation forms information is provided for only those forms you are likely to use. CA-1 - Federal Employee's Notice of Traumatic Injury and … WebFederal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation Employee: Please complete all boxes 1 -15 below. Do not complete shaded areas. Witness: Complete bottom section 16. Employing Agency (Supervisor or Compensation Specialist): Complete shaded boxes a, b, and c. Employee Data 1.
Notice of Reported Work Injury - Tennessee State Government
WebIf your injury results from a specific event or a series of events during one day or shift, complete a Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for … WebThe regulations at 20 CFR § 10.15 address waiver of compensation rights as follows: No employer or other person may require an employee or other claimant to enter into any agreement, either before or after an injury or death, to waive his or her right to claim compensation under the FECA. No waiver of compensation rights shall be valid. B. tiffany francisco
eCFR :: 20 CFR 10.100 -- How and when is a notice of traumatic injury ...
WebFederal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. (2) CA–2: Notice of Occupational Disease and Claim for Compensation. (3) CA–2a: ... Any such statement shall be submitted to OWCP with the notice of traumatic injury or death, or within 30 calendar days from the date notice of occupational disease ... WebJun 29, 2012 · The injured employee must file the CA-1, the Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation form, within 30 days … Weba separate letter enclosed with this notice. The adjuster has fifteen (15) calendar days (from the date you provided notice of your injury to your employer) to conduct an investigation … tiffany frances filmmaker