OWCP uses this report from the attending physician to decide a federal employee's compensation claim, and a medical report is required before it pays wage-loss or permanent disability compensation. It asks for the injury history, objective findings, diagnoses with ICD codes, a reasoned opinion on whether employment caused or aggravated the condition, and the disability status. OWCP also considers other medical records, but the CA-20 is its standard fillable format.
The attending physician completes items 1 to 17. FECA counts MDs, DOs, clinical psychologists, podiatrists, dentists and optometrists as physicians, and chiropractors only for an x-ray-demonstrated spinal subluxation; a nurse practitioner's or physician assistant's report needs a physician's co-signature.
Enter the patient's full name and the OWCP file number if it is not prepopulated; leave it blank if unknown. The patient's acceptance letter shows the case number. Box 3 is the first known date the patient sought treatment for the work injury, and box 4 is the date of the examination on which your findings are based.
Explain how the injury or disease occurred, as specifically as possible. This description anchors the causation question in box 9, which asks whether the conditions were caused or aggravated by the employment activity described here, so name the work activity or incident and the body parts involved.
Detail physical examination findings related to the work injury in box 5 and include the results of any diagnostic testing. Also discuss any pre-existing injury or condition in the affected body parts. Pain can be recorded here as a symptom of a specific diagnosis, since it cannot stand as the diagnosis itself.
Give a specific diagnosis for each medical condition connected to the work injury in box 7 and the corresponding ICD code for each in box 8. The form and instructions both state that pain is not a compensable diagnosis under FECA. Consequential conditions that resulted from the original injury can be addressed in box 9.
State whether the conditions were caused or aggravated by the employment activity in box 5 and explain how the activity or incident was sufficient to cause them; unexplained answers are not accepted. FECA recognizes direct causation, aggravation (say whether temporary or permanent, and when a temporary aggravation ceased or will cease), acceleration and precipitation. There is no apportionment, and a later injury that is the direct and natural result of the accepted injury is compensable.
Circle totally disabled (unable to perform any work), partially disabled (unable to perform the job held when injured but capable of some work) or not disabled (capable of the job held when injured). For total or partial disability give the date disability began and the anticipated return date; for not disabled, list any earlier dates of disability.
If the patient is partially disabled, describe the extent of physical limitations and the type of work that could reasonably be performed with them. You may instead complete Form OWCP-5c for orthopedic conditions, linked from the form, or OWCP-5a for psychiatric and OWCP-5b for cardiac conditions from the DOL forms page.
Add any further remarks about the work injury in box 12 or leave it blank. Sign and date box 13, certifying that the statements are true, complete and correct and acknowledging that knowingly false statements may lead to criminal prosecution. If the treating provider is not a physician, such as a nurse or physician assistant, a physician must co-sign and date below.
Give the name, address and tax identification number of the physician signing the form. Answer whether you specialize, and if you are board-certified in a specialty, name it in box 17. The same tax ID should appear on the OWCP-1500 or HCFA-1500 bill sent with the report.
Download the current version from the source each time; forms change without notice.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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They can sign as the treating provider, but a physician must co-sign and date the form. Under FECA, nurse practitioners and physician assistants are not qualified physicians unless the report is countersigned by a physician. Clinical psychologists count as physicians within their scope of practice, and chiropractors only when a spinal subluxation is diagnosed and demonstrated by x-ray.
Box 9 must be fully explained to be accepted. A yes answer alone is not enough: describe how the work activity or incident in box 5 was sufficient to cause or aggravate each diagnosis, and identify the type of relationship, such as direct causation, aggravation, acceleration or precipitation. For an aggravation, state whether it is temporary or permanent.
Send the completed form and your bill to OWCP's FECA central mailroom at the address printed in the instructions, not to the Department of Labor burden-statement address. To speed processing, you can also upload the CA-20 into the patient's case file through ECOMP, which gives you a tracking number to confirm OWCP received it.
FECA requires written medical documentation to support payment of medical expenses, and the CA-20 is OWCP's standard fillable format for it. Without the form, OWCP will consider medical documentation and records from in-person or telephonic encounters. Separately, a medical report is required before OWCP pays wage-loss or permanent disability compensation to the employee.