About OWCP Form CA-5

The OWCP Form CA-5, titled “Claim for Compensation by Widow, Widower, and/or Children,” is used to file for benefits under the Federal Employees’ Compensation Act (FECA) when a federal worker dies due to a work-related injury or illness. Here’s what I can tell you about it:

Who can file:

  • Spouses (widow or widower) of deceased federal employees who were married at the time of death.
  • Biological children of the deceased employee who are unmarried and under the age of 18 or are disabled.
  • Legally adopted children of the deceased employee under the same conditions as biological children.
  • Stepchildren who were living with the deceased employee and dependent upon them for support at the time of death, under certain conditions.

What the form covers:

  • Compensation payments to eligible survivors based on the deceased employee’s earnings at the time of death.
  • Funeral expenses up to a specific limit.
  • Dependency and indemnity compensation (DIC) for certain surviving spouses and children who meet the eligibility requirements.

Where to get the form:

  • You can download the form from the U.S. Department of Labor website: https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms
  • You can also request a copy by calling the OWCP at 1-800-840-1566.

How to file the claim:

  • Complete the form and gather all required supporting documentation, such as the death certificate, marriage certificate, birth certificates for children, and proof of dependency.
  • Mail the completed form and supporting documentation to the OWCP office that serves your area. You can find the address on the OWCP website or by calling the OWCP.
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Additional things to know:

  • There are deadlines for filing a claim for benefits under the FECA. You can find more information about deadlines on the OWCP website.
  • An attorney is not required to file a claim, but you may want to consult with one if you have questions or need assistance.
  • The OWCP website has a wealth of information about benefits for survivors of federal employees, including the claims process, eligibility requirements, and benefit amounts. You can find more information here: https://www.dol.gov/agencies/owcp
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