CA-2 · U.S. Department of Labor (OWCP)
Notice of Occupational Disease and Claim for Compensation. For conditions developing over time such as repetitive stress injuries, chemical exposure, or occupational illness.
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ECOMP (recommended)
https://www.ecomp.dol.gov/File your Notice of Occupational Disease electronically through ECOMP.
Mail to OWCP
U.S. Department of Labor OWCP/DFEC PO Box 8300 London, KY 40742-8300
Filing Deadline
Within 3 years of when you became aware (or should have been aware) that the condition was related to your employment.
30-90 days for initial adjudication. Occupational disease claims often require more evidence than traumatic injury claims.
OWCP will review the claim and may request additional medical or factual evidence. Unlike CA-1, there is no Continuation of Pay for occupational disease claims — use leave or apply for LWOP.
FROI · State Workers' Compensation Agencies
Report of workplace injury or occupational disease filed with the state agency and insurer. Required within 3-10 days of injury depending on state. Establishes the claim in the system.
DWC-1 · California Division of Workers' Compensation
Employee claim form for workers' compensation benefits in California. Employer must provide within one working day of learning of a workplace injury or illness.
C-3 · New York Workers' Compensation Board
Employee's claim for compensation filed with the NY Workers' Compensation Board. Must be filed within 2 years of the accident or within 2 years of when the claimant knew or should have known the condition was work-related.
DWC-041 · Texas Department of Insurance, Division of Workers' Compensation
Employee's claim for compensation for a work-related injury or illness in Texas. Must be filed within one year of injury or within one year of when the employee knew or should have known the condition was work-related.
DFS-F2 · Florida Division of Workers' Compensation
Florida's first report of injury or illness form. Employer must file within 7 days of knowledge of an injury or within 24 hours if the injury results in death.
Form 18 · North Carolina Industrial Commission
Notice of Accident to Employer and Claim of Employee. Must be filed when injured on the job in North Carolina. Written notice to employer required within 30 days; claim filed within 2 years.
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