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Page 1. CA-20. Attending Physician's Report. To obtain this form go to http://www. dol.gov/owcp/regs/compliance/ca-20.pdf.
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How to fill out ca20 form
01
The CA20 form, also known as the Claim for Compensation for Occupational Injury or Occupational Disease, is typically filled out by individuals who have suffered an injury or contracted a disease due to their work-related activities.
02
The first step in filling out the CA20 form is to provide your personal information, such as your name, address, and contact details. It's important to ensure that these details are accurate and up-to-date.
03
Next, you will need to provide information about your employer, including their name, address, and contact details. This information is necessary for the proper processing of your claim and to establish the employer's liability in the case of an occupational injury or disease.
04
The CA20 form also requires you to provide details about the injury or disease you have suffered. This includes the date and time of the incident, a description of how the injury/disease occurred, and any contributing factors. It's important to provide as much detail as possible to support your claim.
05
In addition to the injury/disease details, you will also need to provide information about any medical treatment you have received. This includes the name and address of the medical provider, as well as any diagnosis, treatment received, and medications prescribed.
06
If you have missed any work days as a result of your injury or disease, you will need to indicate this on the CA20 form. This includes providing the dates of the missed work days and any supporting documentation, such as medical certificates or doctor's notes.
07
Finally, the CA20 form requires your signature to certify that the information provided is true and accurate to the best of your knowledge. Make sure to read through the form carefully before signing and submit it to the appropriate authority or organization as instructed.
In summary, filling out the CA20 form involves providing personal information, details about the injury/disease, information about medical treatment, indicating missed work days, and signing the form to certify its accuracy. The CA20 form is typically needed by individuals who have suffered an occupational injury or disease.
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