- An employee is eligible for benefits when covered while working or performing work tasks; when the injury or illness arises out of and in the course of his or her employment, including when traveling in a government vehicle or of mode transportation while performing District of Columbia business.
How to File a Claim
1. Submit Notice of Injury within thirty (30) days of the injury to the Immediate Supervisor and the Public Sector Workers' Compensation Program (PSWCP). The email address is [email protected] Please note that the Program will not authorize or pay any medical expenses until a claim for Compensation has been filed and accepted by the PSWCP. You must provide Form 2 to your supervisor to complete.
2. Once the PSWCP recives the employee's Form 1 and Employing Agency's Form 2, the PSWC will provide the Claimant with a Compensation Claim Packet (CCP).
3. Complete and submit the Compensation Claim Packet to the PSWCP. The Compensation Claim Packet will include the following required documents:
- Form CA-7, Part A - Claim for Compensation (Employee Statement) - To be completed by Employee
- Form 3 - Physician's Report of Employee's Injury - To be completed by Physician
- Form 3A - Employee's Statement of Medical History - To be completed by Employee
- Form 4 - Employee Authorization for Releaase of Medical Records - To be completed by Emplyee
- Form 5 - Employee Authorization for Release of Earnings - To be completed by Employee
- Form CA7, Part B - Claim for Compensation (Employing Agency Statement) - To be completed by Employing Agency
Please note that a claim will not be deemed filed until the Program receives all of the required documents.
4. Once a claim is filed, you will receive an acknowledgement form. the PSWCP will review the claim and issue a decision within 30 days, absent extraordinary circumstances.