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Office of Workers' Compensation Programs
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Division of Longshore and Harbor Workers' Compensation (DLHWC)

Insurance Carrier Page

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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 directly with the DLHWC District Office upon knowledge of a workplace injury, illness, or death.

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 # 18 & 19.

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)] . The LS-207 must be filed with the Longshore District Office with jurisdiction over the place of injury; the jurisdiction and contact information for each District Office can be found at Contact Us.

6. File all necessary forms with the DLHWC District Office(s) having jurisdiction for the claim(s), and provide them with a copy of the medical reports and other information developed during the administration of the claims. Respond promptly to DLHWC requests for information.

7. Adhere to the seven conditions listed in the Annual Renewal Compliance Agreement for Insurance Carriers.


Frequently Asked Questions (FAQ's)


Insurance and Industry Information


Forms - below is a listing of Longshore forms for use by Carriers/Self-Insureds

Form Number

OWCP's Form Title/Description

LS-1

Request for Examination and/or Treatment

LS-200

Report of Earnings

LS-202

Employer's First Report of Injury or Occupational Illness

LS-206

Payment of Compensation Without Award

LS-207

Notice of Controversion of Right to Compensation

LS-208

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.)

LS-271

Application for Self-Insurance instructions

LS-272

Application to write Longshore Insurance (Carriers)

LS-274

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

LS-275ic 

Agreement and Undertaking (Insurance Carrier)

LS-275si

Agreement and Undertaking (Self-Insured Employer)

LS-276

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

LS-513

Report of Payments

LS-570

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

LS-18

Pre-Hearing Statement

LS-33

Approval of Compromise of Third Person Cause of Action

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