Federal Employee's Compensation Act Forms (FECA)

 

Used by a Federal employee to report an injury and process their pay and/or compensation.

Used to allow a Federal employee injured by accident while in the performance of duty the initial right to select a physician of his/her choice to provide necessary treatment.

Used for evaluating the duty status of an injured employee.

To be submitted by the attending physician to support medical evidence of disability of an injured employee for compensation of lost wages for the period claimed.

Used by an employee to report a recurrence of a medical condition or a recurrence of a disability.

Used for submitting a claim for compensation by a widow or widower for self and surviving children.

To be completed and filed by the deceased employee's parents, grandparents, or representative (custodian or guardian) of minor brothers, sisters or grandchildren. A separate form is required for each person claiming benefits.

Used to claim continuing compensation, when a previous CA-7 claim has been made.

Used to furnish information about patient, insurance, and physician or supplier for the purpose of billing medical procedures, services, or supplies.

Used to request reimbursement of medical expenses payable under the Federal Employees' Compensation Act (FECA) (20 CFR 10.602).

Used to explain the sequence of actions that a Federal employee should follow when injured at work.

Used to report and document a disease contracted through an employee's occupation and to submit a claim for compensation.

To be submitted by the attending physician to support continued medical evidence of an injured employee for compensation of lost wages for subsequent pay periods.

Used when disability ceases and/or employee returns to work. This form should be submitted for each injury resulting in time lost from work whether or not claim for compensation is made.

Used to report the death of a Federal employee as a result of injury in performance of duty or because of an employment related disease.

Used to explain the sequence of actions that a Federal employee should follow when injured at work.

Used to report and document a disease contracted through an employee's occupation and to submit a claim for compensation.

To be submitted by the attending physician to support continued medical evidence of an injured employee for compensation of lost wages for subsequent pay periods.

Used when disability ceases and/or employee returns to work. This form should be submitted for each injury resulting in time lost from work whether or not claim for compensation is made.

Used to report the death of a Federal employee as a result of injury in performance of duty or because of an employment related disease.