Form CA-16, the Authorization for Examination and/or Treatment, is the document a federal employer issues to guarantee payment for medical care after a work-related traumatic injury. Your employer should issue it within four hours of the injury when possible, and it covers treatment for up to 60 days from the date of injury.1eCFR. 20 CFR 10.300 – What Are the Basic Rules for Authorizing Emergency Medical Care
What CA-16 Actually Does
The form is a payment guarantee to the doctor or facility that treats you. During the 60-day window, the treating physician (and anyone that physician refers you to) is assured of payment through OWCP for covered services connected to the injury, whether or not your underlying claim has been formally accepted yet.2U.S. Department of Labor. Initial Authorization of Medical Care The 60 days run from the date of injury, not from the date the form is signed.1eCFR. 20 CFR 10.300 – What Are the Basic Rules for Authorizing Emergency Medical Care
CA-16 is only for traumatic injuries. Federal regulations define a traumatic injury as a bodily condition caused by a specific event or series of events within a single workday or shift, brought on by external force including stress or strain, and identifiable by when it happened, where it happened, and the part of the body affected.3eCFR. 20 CFR 10.5 – What Definitions Apply to the Regulations in This Subchapter A slip on a wet floor, a back injury from lifting equipment, or a fall from a ladder fits. Conditions that build up over multiple shifts — carpal tunnel, chronic lung disease — are occupational diseases and use Form CA-2 instead, on a different track.4U.S. Department of Labor. Federal Employees’ Compensation Act – Frequently Asked Questions
When Your Employer Has to Issue It
The rule is four hours from the reported injury whenever possible. If you need emergency care right away, your employer can authorize verbally and then complete the actual form within 48 hours. After a week from the injury date, the employer is no longer required to issue a CA-16 at all, because urgent care needs typically show themselves within that window.1eCFR. 20 CFR 10.300 – What Are the Basic Rules for Authorizing Emergency Medical Care
A supervisor who doubts whether the injury is really work-related should still issue the form. The proper step is to check box 6b to flag the doubt for OWCP, not to withhold authorization.2U.S. Department of Labor. Initial Authorization of Medical Care
How You Get One
You cannot download Form CA-16 or fill it out yourself. It’s only available to authorized agency personnel through the Agency Query System, the Employees’ Compensation Operations and Management Portal (ECOMP), or the agency’s workers’ compensation office.5U.S. Department of Labor. Forms In practice: you report the injury to your supervisor, describe clearly what happened and when, and the supervisor (or a designated agency official) prepares the authorization.
Before your supervisor writes a provider’s name into the form, they should advise you of your right to pick your own doctor.1eCFR. 20 CFR 10.300 – What Are the Basic Rules for Authorizing Emergency Medical Care Check that the physician printed on the form is the one you actually intend to see; a mismatch causes billing problems later.
Choosing Your Doctor
Federal law lets you make the initial choice of physician for treatment of a work-related injury.6Office of the Law Revision Counsel. 5 USC 8103 – Medical Services and Initial Medical and Other Benefits The doctor can be in private practice, part of an HMO, or work for a federal agency such as the Department of Veterans Affairs or a military hospital. In a genuine emergency, any qualified physician can provide initial treatment regardless of the name on the form.1eCFR. 20 CFR 10.300 – What Are the Basic Rules for Authorizing Emergency Medical Care
Providers treating you under a CA-16 get paid according to the OWCP fee schedule and cannot bill you for the difference between their normal charges and what OWCP pays.7eCFR. 20 CFR Part 10 Subpart I – What Services Are Covered by the OWCP Fee Schedule If a provider tries to balance-bill you for injury-related care during the 60 days, that’s not permitted.
What the 60 Days Cover
Covered services within the window include your initial examination, diagnostic studies such as X-rays and lab work, and necessary conservative treatment. Physical therapy for the injury does not need separate authorization while a CA-16 is in effect.8U.S. Department of Labor. Information for Medical Providers
Some things fall outside the authorization:
- Non-emergency surgery requires separate OWCP approval. The provider must wait until a claim number is on file, then request authorization through the OWCP Web Bill Processing Portal or by fax at 800-215-4901.8U.S. Department of Labor. Information for Medical Providers
- Home exercise equipment, whirlpools, mattresses, gym memberships, and work-hardening programs are excluded.
- Preventive testing after simple exposure to a workplace hazard, such as a single contact with an infectious agent, is not covered unless you actually develop an identifiable condition from the exposure.9eCFR. 20 CFR 10.303 – Should the Employer Use a Form CA-16 to Authorize Medical Testing When an Employee Is Exposed to a Workplace Hazard Just Once
Treatment After the 60 Days
The CA-16 covers the acute phase, not long-term care. Treatment beyond 60 days is possible, but it depends on OWCP accepting your claim. If your claim is approved, OWCP pays for medical services, appliances, and supplies that are likely to cure the condition, provide relief, shorten the period of disability, or reduce compensation owed.6Office of the Law Revision Counsel. 5 USC 8103 – Medical Services and Initial Medical and Other Benefits
File your Form CA-1 promptly and get medical evidence to OWCP quickly. If adjudication is still pending when day 60 arrives, you can end up in a coverage gap while OWCP finishes its review.2U.S. Department of Labor. Initial Authorization of Medical Care
If Your Claim Is Denied
The CA-16 guarantees payment during its 60-day window regardless of whether OWCP eventually accepts the claim. But once a denial issues, the authorization becomes invalid as of the denial date.10U.S. Department of Labor. Basic Information on New Claims Treatment before the denial should still be paid; treatment after the denial date becomes your responsibility unless you successfully appeal.
Injuries Caused by a Third Party
If someone outside the federal government caused your injury, say a driver in a crash while you were on duty, the CA-16 process itself doesn’t change. But you must identify the third party on Form CA-1 and check “yes” in box 30. You may be required to pursue a damage claim against the responsible party, and any recovery you obtain has to be used to reimburse the government for FECA benefits paid on your behalf. OWCP cannot waive that reimbursement, and benefits can be suspended if you don’t pursue the claim or don’t report a settlement.11U.S. Department of Labor. Third Party Liability
When a Supervisor Refuses to Issue the Form
Some supervisors delay, especially on injuries they view as minor or questionable. The regulation says the form should be issued within four hours, and doubt about the claim is not a valid reason to withhold it.1eCFR. 20 CFR 10.300 – What Are the Basic Rules for Authorizing Emergency Medical Care If your supervisor still refuses, go directly to your agency’s workers’ compensation office or human resources.
You do not need a CA-16 to get treatment or start a claim. File Form CA-1 to report the injury and seek care on your own. If OWCP ultimately accepts the claim, it will pay medical bills retroactively even though no CA-16 was issued. Keep every receipt and every medical record; you will need them to document expenses for reimbursement.