Effective June 26, 2014, the Postal Service⢠is revising the Employee and Labor Relations Manual (ELM) subchapÂter 5, due to the following:
- In January 2013, the Department of Labor/Office of Workersâ Compensation Programs (DOL/OWCP) updated its website that included injury compensaÂtion basic forms which are required to record and report a work-related injury.
- ELM section 541.3, Forms needs to be revised to reduce the risk of inaccurate information or employee actions that could potentially result in negative legal, contractual, or other business consequences to the Postal Service.
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Employee and Labor Relations Manual (ELM)
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5 Employee Benefits
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540 Injury Compensation Program
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541 Overview
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541.3 Forms
[Revise the text and table of 541.3 to read as follows:]
Each installation head/Health & Resource Management office must maintain an adequate supply of the following basic forms, which are needed for recording and reporting injuries.
|
Form
|
Title
|
|
CA-1
|
Federal Employeeâs Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
|
|
CA-2
|
Notice of Occupational Disease and Claim for Compensation
|
|
CA-2a
|
Notice of Recurrence
|
|
CA-5
|
Claim for Compensation by Widow, Widower, and/or Children
|
|
CA-5b
|
Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
|
|
CA-6
|
Official Superiorâs Report of Employeeâs Death
|
|
CA-7
|
Claim for Compensation
|
|
CA-7a
|
Time Analysis Form
|
|
CA-7b
|
Leave Buy-Back (LBB) Worksheet/Certification and Election
|
|
CA-10
|
What a Federal Employee Should Do When Injured at Work
|
|
CA-16
|
Authorization for Examination and/or Treatment
|
|
CA-17
|
Duty Status Report
|
|
CA-20
|
Attending Physicianâs Report
|
|
CA-35A
|
Evidence Required in Support of a Claim for Occupational Disease
|
|
CA-35B
|
Evidence Required in Support of a Claim for Work-Related Hearing Loss
|
|
CA-35C
|
Evidence Required in Support of a Claim for Asbestos-Related Illness
|
|
CA-35D
|
Evidence Required in Support of a Claim for Work-Related Coronary/Vascular Condition
|
|
CA-35E
|
Evidence Required in Support of a Claim for Work-Related Skin Disease
|
|
CA-35F
|
Evidence Required in Support of a Claim for Work-Related Pulmonary Illness (not asbestosis)
|
|
CA-35G
|
Evidence Required in Support of a Claim for Work-Related Psychiatric Illness
|
|
CA-35H
|
Evidence Required in Support of a Claim for Carpal Tunnel Syndrome
|
|
HCFA-1500
|
Health Insurance Claim Form
|
|
OWCP-915
|
Claim For Medical Reimbursement
|
|
PUB WHD 1420
|
Employee Rights and Responsibilities Under the Family and Medical Leave Act
|
|
PS Form 2488
|
Authorization for Medical Report
|
|
PS Form 2573
|
Request â OWCP Claim Status
|
â Injury Compensation and Medical Services, Employee Resource Management, 6-26-14
via ELM Revision: Injury Compensation Program.
