WORKERS COMPENSATION INFORMATION

WORKERS COMPENSATION INFORMATION page updated 13 Mar 07

Attention-ALL Technicians & Technician Supervisors

In order to meet Federal Employment Compensation Guidelines, it is mandatory that Supervisors and Employees use the following electronic process for submission of OWCP forms any time there is a workplace injury.

Department of Labor requires that forms CA-1’s and CA-2’s be at OWCP within 10 calendar days from the date of notice of injury.

The following Guidelines MUST be utilized to submit Workers Compensation Electronic Forms CA-1’s and CA-2’s to HRO-ERS:

Note: If an employee needs immediate medical care, at the supervisor’s discretion, issue a CA-16 prior to completing CA-1. Supervisor completes page 1 of Ca-16. Doctor completes page 2 of CA-16. Ensure employee gets page 2 of the CA-16 back from the doctor. See CA-16 Cover Letter (Attached Below) for more information on the CA-16. A CA-16 is not needed for military medical clinics for first aid treatment. We encourage the use of military medical clinics, but it is not mandatory. If you need a copy of the CA-16 please call COMM 678-569-6431/6428/6441/6422/6419 or DSN 338-6431/6428.

The Supervisor & Employee should go to the below web site to complete electronic CA-1’s and CA-2’s.

Notes: CA-1 is used for injuries that incurred in one work shift. (Traumatic Injury)
CA-2 is used for injuries that occurred over a period of time. (Occupational Disease or illness)

2. http://www.cpms.osd.mil/ICUC/ICUC_index.aspx

Then click on Filing Claims Electronically with EDI. (On the left) It will take a few minutes for the form to populate.

Note3: In order for link to work, you must have JAVA Plus Systems loaded to your computer (contact your HelpDesk for this program). In order for the Electronic CA-1/CA-2 to come up, you may have to temporarily all pop ups. See Tool Bar below Web Address.

It may be easier to complete the form via hard copy, then input electronically in EDI. (Hard copy forms can be found at http://www.dol.gov/esa/regs/compliance/owcp/forms.htm

Enter SSN and DOB. Click Enter Claim. Name will auto populate. Complete all tabs on the form. You must have JAVA Plus & a recent ADOBE version for this to work. Call your computer help desk if you need help getting these loaded.

Note 1: White fields are mandatory, yellow fields are optional. No dashes in phone numbers.

Note 2: Periodically click in the zip code fields to prevent the claim from timing out.

Note 3: Recommended to input claims before noon for faster processing times, as the west coast is also using EDI in the evening.

3. Once the form is completed, click print and submit to ICPA. Once the form is submitted it will be electronically sent to Kelly Casey/HRO-ERS to review and send to OWCP. Please call HRO at COMM 678-569-6431/6428 DSN 338-6431/6428 to verify that the claim was received. HRO-ERS will e-mail a copy of the CA-1 to the supervisor and HRO Reps if applicable.

4. Supervisor and Employee should sign printed forms (CA-1, CA-16) and mail signed originals to

Georgia National Guard

HRO-ERS-SSgt Kelly Casey

PO Box 17965

Atlanta, GA 30316

5. Once a CA-1 is entered, if the employee needs medical care, supervisor at his/her discretion should issue a CA-16 to accompany technician to the doctor. (A CA-20 should be sent with employee to the doctor if the claim is questionable by supervisor or medical attention is needed later than 4 days after injury)

6. A CA-17 is recommended to send with employee to determine work restrictions. Supervisor completes left part of CA-17. Doctor completes right side of CA-17. Please see attached Policy Memo stating that supervisors are required to provide light duty. Please call SSgt Kelly Casey at COMM 678-569-6431 DSN 338-6431 if questions regarding Light Duty or Continuation of Pay (COP).

The doctor should complete their portion of the CA-16, CA-17, or CA-20 and return forms to the employee and supervisor so the forms can be mailed to HRO-ERS-KELLY CASEY, PO BOX 17965, ATLANTA, GA 30316 as soon as possible. Bills and claim may be denied if CA-16 is not received in HRO-ERS ASAP.

Make sure to tell the medical providers that the claim is a Federal Workers Compensation claim. The bills should be mailed to ACS, on Forms HCFA 1500’s or UB 92’s to US DEPT OF LABOR, PO BOX 8300, LONDON, KY 40742-8300. Providers can call ACS at 1-866-335-8319 for billing questions.

6. Please report injury to your local Safety Offices for reporting and prevention. Georgia Army National Guard can contact LTC Shannon at 678-675-5165. 116^th ACW can contact SMSgt Britt at 478-201-5934 DSN 241-5934. 165^th AW can contact Reginald.Mcpherson@GASAVA.ANG.AF.MIL

7. If you need additional information on Electronic Data Interchange (EDI) or other Workers Compensation matters, please call SSgt Kelly Casey at COMM 678-569-6431/6428 DSN 338-6431/6428 or by e-mail at kelly.casey@us.army.mil Alternate POC: SSG Merlyn Gore at COMM 678-569-6428 DSN 338-6428. Other contact numbers 678-569-6441/6419/6422 for general workers compensation information.

You can also get other forms at OWCP-FORMS (CA-16 not on web)

http://www.dol.gov/esa/regs/compliance/owcp/forms.htm

TSgt Kelly Casey

Workers Compensation Program Manager

Phone 678-569-6431 DSN 338-6431

Fax 678-569-6446 DSN 338-6446

Address:

Human Resources Office

Attn: SSgt Kelly Casey

PO Box 17965

935 E. Confederate Ave. Bldg 21

Atlanta, GA 30316