Form CA-5B Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren

What Is Form CA-5B?

This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on April 1, 2013 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: Who can file Form CA-5B?
A: Parents, brothers, sisters, grandparents, or grandchildren of an employee who died due to a work-related injury or illness.

Q: What is the purpose of Form CA-5B?
A: Form CA-5B is used to claim compensation for the death of an employee who was not survived by a spouse or child.

Q: How do I file Form CA-5B?
A: You can file Form CA-5B by completing the form and submitting it to the Office of Workers' Compensation Programs (OWCP), along with any required supporting documentation.

Q: What information do I need to provide on Form CA-5B?
A: You will need to provide information about the deceased employee, your relationship to the employee, and details about the death and any financial dependency.

Q: Is there a deadline for filing Form CA-5B?
A: Yes, there is a time limit for filing Form CA-5B. Generally, you must file the claim within three years of the employee's death.

Q: What benefits can be obtained through Form CA-5B?
A: If approved, Form CA-5B can provide survivors' benefits, including compensation for funeral expenses and ongoing monetary benefits.