The page is designed for Self-Insured Employers, Insurance Carriers, and Third Party Claims Administrators ("Carriers") to assist them in all matters of compliance with the LHWCA and its extensions. Carriers will find information about our program and services, about their rights and responsibilities under the law, and how to contact us if assistance is required.



Carrier Responsibilities


As an authorized insurance company or an Authorized Self-insured employer, what are my responsibilities under the Act?

1. Advise your insureds to post an up-to-date Form LS-241, or post Form LS-242 (if you are permissibly self-insured) at each place where you conduct your business. These forms are provided by the Insurance Carrier when the policy is issued. Employers should request them from their carrier. Carriers and self-insureds should request them from their corporate compliance department.

2. If not previously authorized, you should authorize medical care upon request from the injured worked using Form LS-1.

3. Make sure your insured has timely filed form LS-202 with the Jacksonville DLHWC Central Mail Receipt Office, which is designated as the Central Case Create site for the entire program. See Document Submission and Communication with OWCP FAQ #15.

4. Pay compensation benefits to the injured workers' at the correct rate and within the timeframes as outlined in the Longshore and Harbor Workers' Compensation Act at 33 U.S.C. 906 and 914 (a). See FAQ #29-46.

5. You must submit the Form LS- 207, Notice of Controversion to Right to Compensation if you object to the payment of compensation benefits. The Form may be used by the employer/insurer to controvert the right to compensation; 33 U.S.C 914(a) requires the employer to pay compensation promptly and without an award unless the right to such compensation is controverted [see 33 U.S.C. 914(d)]. If you have an OWCP number the LS-207 may be filed using Longshore's Secure Electronic Access Portal (SEAPortal). See Document Submission and Communication with OWCP FAQ #5.

6. File all necessary forms using the SEAPortal or the Jacksonville address (See Document Submission and Communication with OWCP FAQ #5), serve a copy of the medical reports and other information developed during the administration of the claims. Respond promptly to DLHWC requests for information.


Frequently Asked Questions (FAQ's)



Insurance and Industry Information


Forms - below is a listing of Longshore forms that may be of interest to Carriers/Self-Insured Employers

Form Number

OWCP's Form Title/Description


Request for Examination and/or Treatment


Report of Earnings


Employer's First Report of Injury or Occupational Illness


Payment of Compensation Without Award


Notice of Controversion of Right to Compensation


Notice of Final Payment or Suspension of Compensation Payments

LS-241 / LS-242

Notice to Employees (This form is provided by the Insurance Carrier when the policy is issued. Employers should request from their carrier. Carriers and self-insurers should request from their corporate compliance department.)


Application for Self-Insurance instructions


Application to write Longshore Insurance (Carriers)


Report of Injury Experience of Insurance Carrier or Self-Insured Employer


Agreement and Undertaking (Insurance Carrier)


Agreement and Undertaking (Self-Insured Employer)


Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart


Report of Payments


Carrier's Report of Issuance of Policy (formerly Card Report of Insurance)


Pre-Hearing Statement


Approval of Compromise of Third Person Cause of Action

  • For law and other reference material and procedure guides, visit the DLHWC Home Page.