Workers Comp Form For Employers
Description
How to fill out Checklists - Worker's Compensation Claims?
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FAQ
The CA-17 was designed to provide the doctor with an accurate description of the physical work requirements of the injured letter carrier. The CA-17 is a legal document that determines both an injured worker's medical restrictions and entitlement to wage-loss compensation benefits.
Under the FECA, medical evidence must be submitted by a qualified physician. Nurse practitioners and physician assistants are not considered qualified physicians under the FECA unless the medical report is countersigned by a physician.
If, after retiring, you have consequential injuries or conditions. If your accepted condition causes consequential injury use Form CA- 2a. Examples: Bad knees and limp causing back injuries.
When describing the nature of the disease or illness, use the diagnosis on your medical report. If your claim is not filed within 30 days of the date you became aware of a relationship between your illness and your employment, you may explain the delay in filing.
Form CA-17 is designed to be filled out by the injured worker's supervisor and his/her treating physician to complete.
