Attending Physician's Certification of Continuing Worker's Compensation Disability

The claimant will use this form to obtain medical documentation from the attending physician to support continued disability (20 CFR 10.330-10.332). The attending physician completes this form based on their examination of the claimant. OWCP claims examiners will use the information to determine whether the claimant is entitled to continued compensation for disability for work and, if so, to compute the amount of benefits. Rehabilitation specialists and nurses will use the attending physician’s specified work capacity to assist partially disabled employees to return to suitable employment. Without the requested information, entitlements to an eligible beneficiary could be denied or delayed, or benefits could be authorized at an incorrect rate, resulting in an underpayment or overpayment of compensation.