Get Disabilty Form Ca2a

Filling out the Disability Form CA-2a is an essential step for individuals experiencing a recurrence of disability due to a prior work-related injury. This guide will provide you with a clear and supportive walkthrough to complete the form effectively and ensure your claim is processed efficiently.

Follow the steps to complete the Disability Form CA-2a online

1. Use the ‘Get Form’ button to access the Disability Form CA-2a and open it in your preferred editing tool.
2. Begin with Item 1 by entering your complete name, including last name, first name, and middle name, if applicable.
3. For Item 2, provide your Social Security Number (SSN), ensuring it consists of nine digits.
4. In Item 3, input the OWCP file number you received from your original CA-1 or CA-2 claim.
5. Enter your date of birth in Item 4.
6. Item 5 is self-explanatory; provide the necessary information as indicated.
7. In Item 6, provide your home telephone number with the area code. If you do not have a phone, enter 'None.'
8. For Item 7, supply your complete home address, including ZIP+4.
9. In Item 8, check the appropriate box(es) regarding dependents and include any required information in an attachment.
10. Complete Item 9 by entering the address of your employing establishment at the time of your original injury.
11. In Item 10, provide the address of your employing establishment at the time of the recurrence, if it differs from Item 9.
12. For Item 11, report the date and time of your original injury as documented in your prior claim.
13. In Item 12, indicate the date and time when you first realized that you had sustained a recurrence.
14. Item 13 requires you to specify the date and time you stopped working due to the recurrence. If you did not stop, enter 'Did Not Stop.'
15. Provide the date you entered a non-pay LWOP status in Item 14, or enter 'NA' if not applicable.
16. Item 15 should complement your response in Item 13 by indicating any changes in your work status.
17. If you received medical care for the recurrence prior to completing the form, list all treatment dates in Item 16.
18. In Item 17, provide the details of the sources of medical care obtained following the recurrence.
19. Describe your condition since returning to work after the original injury in Item 19.
20. Ensure the information in Item 20 supports a recurrence of your condition.
21. Detail any other injuries or illnesses suffered after returning to work in Item 21.
22. Item 22 is self-explanatory; provide the requested information.
23. Finally, complete Item 23 by entering the date you submitted the CA-2a.
24. Once you have filled out all necessary items, review your entries for accuracy.
25. Save your changes, and consider downloading, printing, or sharing the completed form as needed.

Complete your Disability Form CA-2a online to ensure your claim is processed promptly.