OWCP Blog
What to Do When Your CA-16 Is Denied
Getting denied a CA-16 is stressful, but it does not mean you cannot get treatment. Many federal employees believe the CA-16 is required before they can see a doctor. It is not. Here is what the CA-16 actually does, why agencies deny them, and how to get treated regardless.
What Is the CA-16 Form?
Form CA-16 is an 'Authorization for Examination and/or Treatment.' When your agency issues a CA-16, they are pre-authorizing medical treatment and guaranteeing that OWCP will pay for it. It is essentially your agency saying 'yes, this injury is work-related, go get treated and the bill goes to OWCP.'
Agencies are supposed to issue the CA-16 within 4 hours of being notified of a traumatic injury. In practice, many agencies delay, refuse, or claim they do not have the authority to issue one.
Why Agencies Deny CA-16 Forms
- ✓The supervisor claims the injury did not happen at work
- ✓The agency says they need to investigate first (stalling tactic)
- ✓The supervisor does not know they are required to issue it
- ✓Budget pressure: the agency does not want to authorize treatment costs
- ✓The injury was reported late and the agency disputes the timeline
- ✓Confusion between CA-16 (treatment authorization) and CA-1 (injury report): they are separate forms
You Do NOT Need a CA-16 to See a Doctor
This is the most important thing to understand: you have the right to choose your own doctor and begin treatment without a CA-16. The CA-16 just pre-authorizes payment. Without it, treatment is still covered once your claim is accepted.
Here is what happens without a CA-16: you file your CA-1, you see an OWCP credentialed doctor, the doctor bills OWCP, and once your claim is accepted, OWCP pays the bill retroactively. You pay nothing out of pocket.
Do not let a denied CA-16 stop you from getting treatment. Call us at (516) 400-4861. We treat federal employees with or without a CA-16, and we bill OWCP directly. You owe nothing.
4Steps to Take When CA-16 Is Denied
- 1File your CA-1 immediately through ECOMP if you have not already. The CA-1 is your claim. The CA-16 is just treatment authorization. You need the CA-1 regardless.
- 2Document the denial. Get the denial in writing if possible. Note who denied it, when, and what reason they gave. This matters for appeals.
- 3Contact your union representative. If you are in a union (NALC, APWU, NFFE, etc.), your rep can pressure management to issue the CA-16. Agencies are required to issue them within 4 hours.
- 4See an OWCP credentialed doctor. Call us at (516) 400-4861. We accept federal workers with or without CA-16 authorization. We bill OWCP directly when the claim is accepted.
- 5Follow up with OWCP. If your agency continues to refuse, OWCP can direct them to issue the CA-16 or process your claim without it.
Your Rights Under FECA
The Federal Employees' Compensation Act (FECA) guarantees your right to medical treatment for work-related injuries. Your agency cannot deny you treatment by withholding a CA-16. They can delay payment authorization, but they cannot prevent you from filing a claim and seeing a doctor of your choice.
- ✓You choose your own doctor. Your agency cannot force you to use their preferred provider.
- ✓You can begin treatment before your claim is formally accepted.
- ✓All treatment with an authorized provider is covered retroactively once the claim is accepted.
- ✓If your agency retaliates for filing a claim, that is a separate violation and should be reported.
Frequently Asked Questions
Will I have to pay for treatment if I do not have a CA-16?
+
No. When you see an OWCP credentialed doctor like us, we bill OWCP directly. Once your claim is accepted, OWCP covers all authorized treatment. You pay nothing out of pocket.
How long does it take OWCP to accept a claim without a CA-16?
+
Typical processing time is 30 to 90 days, depending on the complexity of the claim and whether OWCP requests additional documentation. Having complete medical records from an OWCP credentialed doctor speeds this up significantly.
Related Resources
Ready to See an OWCP Doctor?
Free consultation. No out-of-pocket. We file your claim with you.