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Form CA-2a, Notice of Recurrence, page 1
Complex · 65/100Form Complexity Index

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What this form asks for

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Form CA-2a, Notice of Recurrence, is used by federal employees to report a recurrence of a work-related injury or condition. This form is important for claiming benefits under the Federal Employees' Compensation Act (FECA) and ensures that employees receive the necessary medical treatment and compensation for their injuries.
Fillable fields112
Pages3
Sections46
Questions that depend on earlier answers19
Form Complexity IndexComplex, 65/100

The AI checks your answers before you download

20 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Ensures that the employee's full name is entered correctly with Last, First, and Middle Initial in Part A.

The system ensures that the employee's full name is captured accurately by checking the sequence and completeness of the Last, First, and Middle Initial fields in Part A of the Notice of Recurrence (CA-2a) form. It validates the proper capitalization and spacing, and confirms that no special characters or digits are included in the name fields. This check is crucial for maintaining the integrity of the employee's identity throughout the form.

Confirms that the Social Security Number provided in Part A is valid and formatted correctly.

The system confirms the validity of the Social Security Number (SSN) by ensuring it consists of nine digits, formatted as XXX-XX-XXXX. It checks for any non-numeric characters and incorrect sequences that do not comply with the SSN format. This validation is essential to prevent identity errors and ensure that the SSN corresponds to the correct individual on the Notice of Recurrence (CA-2a) form.

Verifies that the OWCP file number for the original injury is present and accurate in Part A.

The system verifies the presence and accuracy of the Office of Workers' Compensation Programs (OWCP) file number associated with the original injury. It checks that the number is entered in the designated field in Part A and that it follows the correct format and length as specified by OWCP guidelines. This verification is critical for linking the recurrence to the original claim.

Checks that the Date of Birth is entered in the correct Month/Day/Year format in Part A.

The system checks that the Date of Birth provided in Part A adheres to the correct Month/Day/Year format. It validates that the month is between 01 and 12, the day is within the appropriate range for the given month, and the year is a plausible value for an employee's age. This check ensures that the age-related information on the form is consistent and accurate.

Validates the selection of Sex (Male/Female) in Part A.

The system validates the selection of the employee's sex in Part A, ensuring that one of the acceptable options, either 'Male' or 'Female,' is chosen. It checks for any entries that fall outside of these specified categories and flags them for review. This validation is important for demographic and statistical purposes in the Notice of Recurrence (CA-2a) form.

Confirms that the Home telephone number is provided and formatted correctly in Part A.

The system confirms that the Home telephone number field in Part A is not left blank and adheres to the standard telephone number format. It checks for the correct number of digits and the inclusion of area code, ensuring that the telephone number is valid for communication purposes. The system also identifies any non-numeric characters that should not be present in a standard telephone number format.

And 14 more checks
  • Ensures that the Home mailing address includes street address, city, state, and ZIP code in Part A.
  • Verifies the indication of Dependents and their details in Part A.
  • Checks for the Name and Address of Employing Agency at the time of the original injury and at the time of recurrence in Part A.
  • Validates the Dates and Hours of the original injury, recurrence, stopping work, pay stopped, and return to work in Part A.
  • Confirms that the employee has indicated if they are claiming Time Loss From Work and/or Medical Treatment in Part A.
  • Ensures that the Date of first medical treatment following recurrence is provided in Part A.
  • Verifies the Name and address of the treating physician in Part A.
  • Checks for a detailed explanation of limitations and duration if the employee was limited after returning to work from the original injury in Part A.
  • Validates the employee's signature and the Date of signing in both Part A and Part C.
  • Completeness of Part B
  • Supervisor or Specialist Signature in Part B
  • Completion of Part C for Non-Federal Employment
  • Employee's Pay and Compensation Claim in Part C
  • Attachment of Relevant Medical Records in Part B

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How to Fill Out CA-2a Online for Free in 2026

What the AI walks you through.

  1. Visit instafill.ai site and select CA-2a.
  2. Enter employee's personal information.
  3. Provide details of the original injury.
  4. Fill in the recurrence information.
  5. Sign and date the form electronically.
  6. Check for accuracy and submit the form.

Common Mistakes in Completing CA-2a

The ones the AI is built to catch.

Entering incorrect or incomplete name
The Name field on the Notice of Recurrence (CA-2a) form requires the full legal name of the claimant as it appears on their Social Security card. Incomplete names, such as missing middle initials or last names, can lead to processing delays or potential denial of the claim. To avoid this mistake, ensure that all required name fields are accurately and completely filled out.
Failing to provide Social Security Number
The Social Security Number field is mandatory on the Notice of Recurrence (CA-2a) form. Failing to provide this information can result in processing delays or potential denial of the claim. It is essential to ensure that the Social Security Number is entered correctly and complete, including the hyphens. To avoid this mistake, carefully review the Social Security card and enter the number exactly as it appears.
Entering an incorrect OWCP file number for the original injury
The OWCP file number is a critical piece of information required on the Notice of Recurrence (CA-2a) form. Entering an incorrect or incomplete file number can lead to processing delays or potential denial of the claim. To avoid this mistake, ensure that the OWCP file number for the original injury is accurately and completely filled out. If unsure, contact the original employer or the Division of Workers' Compensation for assistance.
Providing an incorrect or incomplete home address
The home address field on the Notice of Recurrence (CA-2a) form requires the claimant's current mailing address. Incomplete or incorrect addresses can lead to processing delays or potential denial of the claim. To avoid this mistake, ensure that all required address fields are accurately and completely filled out. Use clear and legible handwriting or type the address if possible.
Failing to indicate dependents or providing incorrect information
The Notice of Recurrence (CA-2a) form requires claimants to indicate whether they have any dependents and provide their information. Failing to provide this information or providing incorrect information can lead to processing delays or potential denial of dependent benefits. To avoid this mistake, ensure that all required dependent fields are accurately and completely filled out. Use clear and legible handwriting or type the information if possible.
Incorrect or Incomplete Telephone Number
When completing the Notice of Recurrence (CA-2a) form, it is essential to provide an accurate and complete telephone number. Failing to do so may result in communication issues between the parties involved. To avoid this mistake, double-check the telephone number provided and ensure it includes the area code and is easily reachable. If the telephone number has changed since the original injury, update it accordingly.
Failure to Provide the Name and Address of the Employing Agency at the Time of the Original Injury
Another critical detail to include on the Notice of Recurrence form is the name and address of the employing agency at the time of the original injury. This information is necessary for processing the claim accurately. To prevent this mistake, carefully review the form instructions and ensure you have the correct information before submitting the form.
Failure to Provide the Date and Hour of the Original Injury and Recurrence
Providing the accurate date and hour of the original injury and recurrence is crucial when completing the Notice of Recurrence form. Incorrect or missing information may delay the processing of the claim. To avoid this mistake, double-check the dates and hours provided and ensure they are consistent with your records.
Failure to Indicate if Time Loss from Work and/or Medical Treatment is Claimed
It is essential to indicate on the Notice of Recurrence form whether time loss from work and/or medical treatment is being claimed. Failing to do so may result in delays or denials of benefits. To prevent this mistake, carefully review the form instructions and check the appropriate box to indicate if time loss or medical treatment is being claimed.
Failure to Provide the Name and Address of the Treating Physician
Lastly, it is crucial to provide the name and address of the treating physician on the Notice of Recurrence form. This information is necessary for processing the claim and ensuring proper communication between the parties. To avoid this mistake, double-check the physician's name and address before submitting the form and ensure it is complete and accurate.
Failing to provide all relevant medical records
One of the most critical errors in completing the Notice of Recurrence (CA-2a) form is neglecting to attach all necessary medical records. These records may include doctor's reports, medical bills, and other documentation related to the recurrence of the injury or illness. To avoid this mistake, ensure that you have gathered all relevant medical records before beginning the form-filling process. It is also essential to keep a copy of the submitted documents for your records.
Signing the form before all information is complete
Another common mistake is signing the Notice of Recurrence (CA-2a) form before all required information is complete. This error can lead to delays in processing the form and may result in additional paperwork. To prevent this mistake, ensure that all sections of the form are filled out completely before signing it.
Failing to provide the name and address of the reporting office for Part B
A crucial piece of information often overlooked on the Notice of Recurrence (CA-2a) form is the name and address of the reporting office for Part B. This information is necessary for the processing of the form. To avoid this mistake, carefully read the instructions on the form and provide the correct information.
Failing to indicate the date of first return to full-time regular duty following the original injury
Another common mistake is failing to indicate the date of first return to full-time regular duty following the original injury. This information is essential for determining the length of disability and calculating benefits. To avoid this mistake, ensure that you have accurate records of your return to work date.
Failing to specify regular work hours and days
Lastly, failing to specify regular work hours and days on the Notice of Recurrence (CA-2a) form can lead to processing delays and inaccurate calculations of disability benefits. To avoid this mistake, ensure that you provide the correct information regarding your regular work schedule.
Omitting the dates of Cost of Procedure (COP) payments for recurrence
The Notice of Recurrence (CA-2a) form requires the employer to provide the dates when COP payments were made for the recurrence of the injury or illness. Failure to include this information may result in delays or inaccuracies in processing the form. To avoid this mistake, employers should ensure they have access to accurate records of COP payments and include the dates in the designated fields on the form.
Neglecting to indicate if accommodations or adjustments were made in the employee's regular duties due to injury-related limitations
The Notice of Recurrence form asks if any accommodations or adjustments have been made in the employee's regular duties due to injury-related limitations. Failing to provide this information may result in an incomplete or inaccurate record of the employee's injury or illness. To prevent this mistake, employers should carefully review the form instructions and provide a clear and complete response in the designated fields.
Failing to provide full details of any other injury or illness affecting performance of duties
The Notice of Recurrence form requires employers to provide details of any other injury or illness that may be affecting the employee's performance of duties. Omitting this information may result in an incomplete or inaccurate record of the employee's injury or illness history. To avoid this mistake, employers should carefully review the form instructions and provide a clear and complete response in the designated fields.
Failing to sign the form or providing an illegible signature
The Notice of Recurrence form must be signed by the employer or their authorized representative. Failing to sign the form or providing an illegible signature may result in delays or rejection of the form. To prevent this mistake, employers should ensure that the person signing the form is authorized to do so and that their signature is clear and legible.
Failing to provide the title and work phone number of the signing authority for Part B
The Notice of Recurrence form requires the employer to provide the title and work phone number of the signing authority for Part B. Failing to provide this information may result in delays or rejection of the form. To prevent this mistake, employers should ensure that they have the correct information for the signing authority and include it on the form.
Omitting jobs held since leaving the job held when the initial injury occurred for Part C
The Notice of Recurrence (CA-2a) form requires employees to list all jobs held since leaving the job where the initial injury occurred in Part C. Neglecting to include this information can lead to incomplete or inaccurate records. To avoid this mistake, carefully review the instructions and ensure all relevant jobs are included. It is important to remember that failure to disclose all jobs may result in delays or denial of benefits.
Failing to provide job title, nature of duties, hours worked per week, and rate of pay for each job listed in Part C
Part C of the Notice of Recurrence form requires employees to provide specific information about each job listed, including job title, nature of duties, hours worked per week, and rate of pay. Neglecting to provide this information can result in incomplete or inaccurate records. To avoid this mistake, ensure all required information is provided for each job. This will help ensure that your claim for benefits is processed efficiently and accurately.
Failing to describe any educational and/or vocational training received since the original injury
The Notice of Recurrence form asks employees to describe any educational and/or vocational training received since the original injury. Failing to provide this information can result in incomplete records and may impact your eligibility for benefits. To avoid this mistake, ensure all relevant training is described in detail. This includes any formal training programs, as well as informal training or on-the-job experience.
Failing to indicate the rate of pay if the employee stopped work due to the recurrence
If an employee stopped work due to the recurrence of an injury, the Notice of Recurrence form requires them to indicate their rate of pay at the time of injury or the rate of pay they would have been earning if they had not stopped work. Failing to provide this information can result in delays or denial of benefits. To avoid this mistake, ensure the correct rate of pay is indicated.
Failing to mark 'Yes' or 'No' if claiming compensation for lost wages
The Notice of Recurrence form asks employees to indicate whether they are claiming compensation for lost wages due to the recurrence of an injury. Failing to mark 'Yes' or 'No' can result in delays or denial of benefits. To avoid this mistake, carefully review the instructions and ensure the correct answer is marked.
Omitting the specification of amount and source of pay received during the period claimed
The Notice of Recurrence (CA-2a) form requires taxpayers to report any pay received during the period claimed. Neglecting to specify the exact amount and the source of the pay can lead to inaccurate reporting and potential discrepancies. To avoid this mistake, taxpayers should ensure they provide the correct amount received from each source, as reported on their W-2 or 1099 forms, to prevent any confusion or potential audits. It is essential to double-check all entries for accuracy and completeness before submitting the form.

Frequently Asked Questions About CA-2a

 

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What is a recurrence as defined by OWCP in the CA-2a form?
A recurrence, as defined by the Office of Workers' Compensation Programs (OWCP) in the CA-2a form, refers to the aggravation or re-aggravation of a pre-existing work-related injury or illness. It is important to note that for a recurrence to be considered work-related, the aggravation or re-aggravation must arise out of and in the course of employment.
How should an employee complete Part A of the CA-2a form if they have experienced a recurrence?
An employee who has experienced a recurrence should complete Part A of the CA-2a form by providing the following information: the date of the original injury or illness, the date of the recurrence, a description of the recurrence, and the name and address of the treating physician. It is important for the employee to be as specific and detailed as possible when describing the recurrence.
What information should an employee provide in Part A of the CA-2a form regarding their original injury?
In Part A of the CA-2a form, an employee should provide the following information regarding their original injury: the date of injury or illness, the body part(s) affected, the nature of the injury or illness, and the name and address of the treating physician. This information is necessary for the OWCP to determine if the recurrence is work-related and to process the claim accordingly.
What is the purpose of Part B of the CA-2a form and who should complete it?
Part B of the CA-2a form is to be completed by the Federal Employing Agency (FEA) or their designee. The FEA should provide a description of the work the employee was performing at the time of the recurrence, the conditions under which the work was performed, and any actions taken by the FEA to prevent or reduce the risk of recurrence. This information is important for the OWCP to determine if the recurrence was work-related and if any modifications or accommodations are necessary to prevent future recurrences.
What is the role of the Federal Employing Agency in the CA-2a form process?
The Federal Employing Agency (FEA) plays a crucial role in the CA-2a form process. The FEA is responsible for reporting any work-related injuries or illnesses to the OWCP and for completing Part B of the CA-2a form. The FEA should provide accurate and complete information regarding the employee's work duties and conditions at the time of the recurrence. This information is necessary for the OWCP to determine if the recurrence is work-related and to process the claim accordingly.
What should an employee do if they are no longer employed with the Federal Government at the time of the claimed recurrence?
If an employee is no longer employed with the Federal Government at the time of the claimed recurrence, they should not file a CA-2a form. Instead, they should contact the Office of Personnel Management (OPM) to discuss their options for continuing their disability retirement application process. OPM can provide guidance on whether the employee is eligible for disability retirement under other provisions, such as the Disability Retirement List or the Voluntary Early Retirement Authority.
What should an employee do if they are claiming a recurrence of disability for an occupational illness?
If an employee is claiming a recurrence of disability for an occupational illness, they should provide detailed information about the recurrence in Part II of the CA-2a form. They should also submit any new medical evidence that supports their claim for disability. This may include reports from treating physicians, test results, or other documentation that demonstrates the connection between their employment and their current disability.
What medical reports should an employee provide with their CA-2a form?
An employee should provide all relevant medical reports and documentation with their CA-2a form. This may include reports from treating physicians, test results, prescription records, and any other documentation that supports their claim for disability. The reports should cover the period since the last CA-2a form was filed or since the last disability retirement decision was made. Employees should ensure that their medical reports are complete and include all necessary information about their diagnosis, treatment, and prognosis.
What is the Privacy Act statement regarding the collection of information in the CA-2a form?
The Privacy Act statement for the CA-2a form explains that the information collected on the form is used for personnel and security purposes. The information may be disclosed to other Federal agencies, as required by law, for the purpose of making a disability retirement decision. Employees have the right to access and correct their personal information, and they may file a complaint with the Office of Personnel Management if they believe their privacy rights have been violated.
What is the estimated public reporting burden for the CA-2a form?
The estimated public reporting burden for the CA-2a form is approximately 1 hour per response. This includes the time it takes to gather and provide the necessary medical documentation and complete the form. Employees should note that this is an estimate, and the actual time may vary depending on the complexity of their case and the availability of their medical records.
What accommodations or auxiliary aids and services are available to individuals with disabilities in the CA-2a form process?
The Department of Industrial Relations (DIR) and the Division of Workers' Compensation (DWC) are committed to ensuring equal access to the CA-2a form process for individuals with disabilities. Reasonable accommodations and auxiliary aids and services may include, but are not limited to, providing the form in an alternative format (such as large print or audio), allowing additional time to complete the form, or providing a sign language interpreter. If you require accommodations, please contact the DIR or DWC as soon as possible to discuss your specific needs.
What should an employee do if they have a disability and need communication assistance when completing the CA-2a form?
If you have a disability and need communication assistance to complete the CA-2a form, please contact the DIR or DWC as soon as possible to request accommodations. Reasonable accommodations may include, but are not limited to, providing the form in an alternative format, allowing additional time to complete the form, or providing a sign language interpreter. The DIR and DWC are committed to ensuring equal access to the CA-2a form process for individuals with disabilities.
What is the definition of a consequential injury as it relates to the CA-2a form?
A consequential injury is an injury that results from or is caused by another injury. For example, if an employee sustains a back injury in a work-related accident and later develops carpal tunnel syndrome as a result of the back injury, the carpal tunnel syndrome would be considered a consequential injury. Consequential injuries may be covered under workers' compensation if they are a natural and probable result of the original injury.
What should an employee do if they have received medical care at an agency facility due to the recurrence?
If you have received medical care at an agency facility due to a recurrence of a work-related injury or illness, you should report the recurrence to your employer and the workers' compensation insurance carrier as soon as possible. You should also complete and submit the CA-2a form to the DIR or DWC. If you need assistance completing the form, please contact the DIR or DWC for accommodations.
What should an employee do if they are still receiving continuation of pay (COP) at the time of the claimed recurrence?
If you are still receiving continuation of pay (COP) at the time of the claimed recurrence, you should report the recurrence to your employer and the workers' compensation insurance carrier as soon as possible. You should also complete and submit the CA-2a form to the DIR or DWC. If you need assistance completing the form, please contact the DIR or DWC for accommodations. The DIR and DWC will work with your employer and the insurance carrier to determine if the recurrence is work-related and if you are entitled to additional workers' compensation benefits.
What should an employee do if the recurrence is for medical care only and the claim is still open?
If an employee experiences a recurrence of a work-related injury or illness that requires medical care only and the claim is still open, they should report the recurrence to their employer as soon as possible. The employer will then complete the Notice of Recurrence (CA-2a) form and submit it to the Workers' Compensation Insurance Carrier. The employee may continue to receive medical treatment for the recurrence under the existing claim.
What should an employee do if they are currently requesting neither wage-loss compensation nor payment of medical expenses for the recurrence?
If an employee is not requesting wage-loss compensation or payment of medical expenses for a recurrence of a work-related injury or illness, they do not need to complete the Notice of Recurrence (CA-2a) form. However, they should still report the recurrence to their employer as soon as possible. The employer may still need to complete the form if they believe that the recurrence may affect the employee's future workers' compensation benefits.
What is the difference between a recurrence and a new injury or condition due to occupational exposure?
A recurrence is a worsening or aggravation of a pre-existing work-related injury or illness. A new injury or condition due to occupational exposure is a separate injury or illness that arises out of and occurs in the course of employment. The Notice of Recurrence (CA-2a) form is used to report recurrences of work-related injuries or illnesses, while a new injury or condition should be reported on a new Workers' Compensation claim form.
What should an employee do if they have made any accommodations or adjustments in their regular duties due to injury-related limitations after the original injury?
If an employee has made any accommodations or adjustments in their regular duties due to injury-related limitations after the original injury, they should report the recurrence and any necessary accommodations to their employer as soon as possible. The employer may need to complete the Notice of Recurrence (CA-2a) form and provide the employee with reasonable accommodations under the Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA).
What should an employer do if they knowingly certify to any false statement, misrepresentation, concealment of fact, etc., in respect to this claim?
An employer who knowingly certifies to any false statement, misrepresentation, concealment of fact, or other misrepresentation in respect to a workers' compensation claim, including the Notice of Recurrence (CA-2a) form, may be subject to penalties and legal action. Employers are required to provide accurate and complete information to the Workers' Compensation Insurance Carrier and to cooperate fully with the claims process. False statements or misrepresentations may result in fines, denial of benefits, or even criminal charges.
What is the role of the Office of Workers' Compensation Programs (OWCP) in the CA-2a form process?
The Office of Workers' Compensation Programs (OWCP) plays a significant role in the CA-2a form process. This form is used to report recurrent periods of disability or death due to a work-related injury or illness. The employer is required to file a CA-2a form with the California Division of Workers' Compensation (DWC) when an employee experiences a recurrence of a previous work-related injury or illness that results in missed work or medical treatment. The OWCP is responsible for administering and overseeing the workers' compensation program under the Federal Employees' Compensation Act (FECA). Although the CA-2a form is specific to the California State Disability Insurance (SDI) program, the OWCP's involvement is crucial because the form also reports any concurrent FECA benefits. Employers must provide the OWCP with a copy of the CA-2a form when they file it with the DWC. The OWCP uses the information from the CA-2a form to determine if the employee is eligible for continued FECA benefits. In summary, the CA-2a form process involves reporting a recurrence of a work-related injury or illness to the California Division of Workers' Compensation and the Office of Workers' Compensation Programs, as the form also pertains to Federal Employees' Compensation Act benefits.
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