12th Annual Federal Workers' Compensation Conference S i #39 ...

Agency Responsibilities
• The supervisor should immediately notify the district office
by telephone or facsimile message, and should file a Form
CA-6, Official Superior’s Report of Employee’s Death, with
OWCP.
• The supervisor should also contact any survivors, provide
them with claim forms (forms CA-5 and CA-5b), and help
them prepare the claim using those forms, which may be
submitted by either the survivors or the supervisor.
• The submittal should include a copy of the death certificate.
It should also include a copy of the marriage certificate if a
spouse is making claim, and a copy of any divorce or
annulment decree if the decedent or spouse was formerly
married. The submittal should include copies of birth
certificates of any children for whom claim is made.
• These forms should be submitted to OWCP even if a
disability claim was previously filed and benefits were paid.
Continuation of benefits is not automatic, as it must be
shown that the death resulted from the same condition for
which the disability claim was accepted.
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