DoL CA-16 1988 free printable template
Show details
Authorization for Examination And/Or Treatment U.S. Department of Labor Employment Standards Administration Office of Workers' Compensation Programs OMB No.: 1215-0103 Expires: 09-30-91 The following
pdfFiller is not affiliated with any government organization
Get, Create, Make and Sign DoL CA-16
Edit your DoL CA-16 form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your DoL CA-16 form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit DoL CA-16 online
To use the services of a skilled PDF editor, follow these steps:
1
Log in to account. Click Start Free Trial and register a profile if you don't have one.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit DoL CA-16. Text may be added and replaced, new objects can be included, pages can be rearranged, watermarks and page numbers can be added, and so on. When you're done editing, click Done and then go to the Documents tab to combine, divide, lock, or unlock the file.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
With pdfFiller, it's always easy to deal with documents.
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
DoL CA-16 Form Versions
Version
Form Popularity
Fillable & printabley
How to fill out DoL CA-16
How to fill out DoL CA-16
01
Begin by downloading the DoL CA-16 form from the official Department of Labor website.
02
Fill out the employee's name and identification details at the top of the form.
03
Provide the employee's contact information, including phone number and address.
04
Indicate the type of injury or illness that has occurred.
05
Complete the section detailing the circumstances surrounding the injury or illness.
06
Include the date and time when the injury or illness occurred.
07
Ensure the employer's information is accurately filled out, including name and address.
08
Sign and date the form to certify the information is correct.
09
Submit the completed DoL CA-16 form to the appropriate office within the Department of Labor.
Who needs DoL CA-16?
01
The DoL CA-16 form is needed by federal employees who are filing a claim for compensation related to job-related injuries or illnesses.
Instructions and Help about DoL CA-16
Fill
form
: Try Risk Free
People Also Ask about
How long do I have to fill out a ca1?
To be eligible for COP, you must submit a CA-1 within 30 days of the injury. If disabled and claiming COP, you must submit medical evidence supporting your disability to your employing agency within 10 workdays.
What is the purpose of CA-16 form?
Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.
What is the difference between CA-1 and CA-2?
Form CA-1 is used for a traumatic injury (a medical condition resulting from an incident or activity occurring during one work shift). Form CA-2 is for an occupational disease (a medical condition resulting from an incident or activity occurring over more than one work shift).
Do I need a CA-16?
If you suffer a traumatic on-the- In traumatic injury cases, the Post- al Service is required by federal law and postal regulations to provide a CA-16, Authorization for Examination and/or Treatment, within four hours of a worker reporting a traumatic injury and seeking medi- cal treatment.
How do I get a CA-16?
CA-16s can be approved and provided only by a postal supervisor. A properly issued CA-16 must have the name, title and signature of the authorizing official. CA-16s are not available online—for a very good reason. Only the au- thorizing agency has the authority to provide the CA-16.
When can CA-16 be issued?
A CA-16 can be issued up to 48 hours after the employee has been treated. If the employee provides a medical report within 48 hours or treatment indicating the condition is work-related, a CA-16 can be issued with supervisory approval.
Our user reviews speak for themselves
Read more or give pdfFiller a try to experience the benefits for yourself
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
How can I manage my DoL CA-16 directly from Gmail?
You can use pdfFiller’s add-on for Gmail in order to modify, fill out, and eSign your DoL CA-16 along with other documents right in your inbox. Find pdfFiller for Gmail in Google Workspace Marketplace. Use time you spend on handling your documents and eSignatures for more important things.
How do I execute DoL CA-16 online?
pdfFiller has made it easy to fill out and sign DoL CA-16. You can use the solution to change and move PDF content, add fields that can be filled in, and sign the document electronically. Start a free trial of pdfFiller, the best tool for editing and filling in documents.
Can I sign the DoL CA-16 electronically in Chrome?
You can. With pdfFiller, you get a strong e-signature solution built right into your Chrome browser. Using our addon, you may produce a legally enforceable eSignature by typing, sketching, or photographing it. Choose your preferred method and eSign in minutes.
What is DoL CA-16?
DoL CA-16 is a form issued by the Department of Labor that is used to report claims for compensation by federal employees who are injured or become ill as a result of their job.
Who is required to file DoL CA-16?
Federal employees who sustain injuries or illnesses in the course of their employment are required to file DoL CA-16 to report their claims for compensation.
How to fill out DoL CA-16?
To fill out DoL CA-16, the employee needs to provide personal information, details of the injury or illness, the circumstances surrounding the event, and any medical information relevant to the claim.
What is the purpose of DoL CA-16?
The purpose of DoL CA-16 is to document the claim for federal worker's compensation and ensure that injured employees receive the appropriate benefits and medical care related to their work-related injuries or illnesses.
What information must be reported on DoL CA-16?
DoL CA-16 must report the employee's identification information, work details, nature of the injury or illness, date and place of the incident, and any supporting medical documentation or evidence related to the claim.
Fill out your DoL CA-16 online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
DoL CA-16 is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
