DoL CA-16 1997 free printable template

U.S. USDA Form usda-ca-16 Authorization for Examination And/Or Treatment U.S. Department of Labor Employment Standards Administration Office of Workers' Compensation Programs OMB No.: 1215-0103 Expires:

How to fill out DoL CA-16

How to fill out DoL CA-16

1. Obtain the DoL CA-16 form from the official Department of Labor website or your employer.
2. Fill out the employee's personal information at the top of the form, including name, address, and Social Security number.
3. Provide the details of the injury or illness, including date, time, and a brief description of what happened.
4. Complete the employer's information section, including name and address of the employer.
5. Enter the information regarding medical treatment, stating whether medical care has been received.
6. Sign and date the form, confirming that the information is accurate to the best of your knowledge.
7. Submit the completed form to your employer as soon as possible for processing.

Who needs DoL CA-16?

1. The DoL CA-16 form is needed by employees who have suffered a work-related injury or illness and require medical treatment.

Instructions and Help about DoL CA-16

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.

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What is DoL CA-16?

DoL CA-16 is a form used by the U.S. Department of Labor for Federal Employees' Compensation Act claims to authorize medical treatment for federal employees who have sustained work-related injuries.

Who is required to file DoL CA-16?

The DoL CA-16 form must be filed by federal agency officials when an employee sustains a work-related injury or illness and seeks medical treatment.

How to fill out DoL CA-16?

To fill out DoL CA-16, the agency representative must complete sections regarding employee information, nature of the injury, treatment required, and author's information, ensuring accuracy and completeness.

What is the purpose of DoL CA-16?

The purpose of DoL CA-16 is to provide authorization for medical services related to work-related injuries, ensuring that employees receive necessary medical care while documenting the injury for compensation claims.

What information must be reported on DoL CA-16?

DoL CA-16 must report information including the employee's name, job title, details of the injury, the type of medical treatment needed, and any related agency contact information.