- 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). 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.