Peace Corps Volunteer Authorization for Examination and/or Treatment

Justification for No material/Non-substantive Change

Peace Corps Volunteer Authorization for Examination and/or Treatment (CA-15)

The Office of Workers' Compensation Programs (OWCP) administers the Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101 et seq. The statute provides for the payment of benefits for wage loss and/or for permanent impairment to a scheduled member, arising out of a work related injury or disease. The other forms in this clearance collect medical information necessary to determine entitlement to benefits under the FECA. Before compensation may be paid, the case file must contain medical evidence showing that the claimant's disability is causally related to the claimant's federal employment.

CA-15, Peace Corps Volunteer Authorization for Examination and/or Treatment, is generated by the Peace Corps, and authorizes the injured employee to seek immediate medical treatment upon sustaining a workplace injury. Form CA-15 is initiated solely by the Peace Corps and is not available online for download or electronic submission as it is not a public use form.

As part of its opioid control policy, OWCP Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC) instituted a policy when it issued FECA Bulletin 17-07 on June 6, 2017, to monitor and manage the prescription of opioid medications for newly prescribed opioid users (i.e., where an opioid has not been prescribed within the past 180 days, if ever). Per FECA Bulletin 22-02, in accordance with 5 U.S.C. 8103 and 20 C.F.R. 10.809, OWCP has contracted with a Pharmacy Benefit Manager (PBM) to serve as FECA's PBM for claimants covered under the FECA.  Prior authorization requests for opioids now must be submitted through the PBM. OWCP is requesting change to the instructions of the CA-15 in order to align with current policy and prevent unauthorized prescribing of opioid medications.

With regards to the form itself, there are 2 minor changes. On the top of the form there is a current reference for more information at the following site: https://www.dol/owcp/dfec. This website no longer exists and online access to this form does not apply. Our supporting statement specified that this form would not be available for public download or for transmission by electronic means to protect against potential fraud and abuse. This form will be solely initiated by a Peace Corps official who has been approved to authorize emergency care for recently terminated volunteers.

Lastly, OWCP requests an address be revised in item 11 of the form which requires that the completed form be sent to OWCP. The address currently notes the U.S. Department of Labor, OWCP/DFEC, P.O. Box 34090, San Antonio, Texas 78265. Due to the consolidation of the Division of Federal Compensation (DFEC) and the Longshore and Harbor Worker’s Compensation Programs (LHWC), which took effect in 2020, the new Division is now noted as OWCP Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC). The address in item 11 should now be noted as Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, Federal Employees' Compensation Act, (OWCP/DFELHWC-FECA), PO Box 8311, London, KY 4072-8311.