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

For Case Create Forms

The Jacksonville DLHWC District Office will assign OWCP case numbers to all new cases, regardless of the location of the injury or the claimant's home address. The Jacksonville office is thus designated as the "Central Case Create" site. Unless a case number has already been assigned, you should submit the following forms to the Central Case Create site at the address listed below for creation of a new case:

  • LS-201 (Notice of Employee's Injury or Death)
  • LS-202 (Employer's First Report of Injury or Occupational Illness)
  • LS-203 (Employee's Claim for Compensation)
  • LS-262 (Claim for Death Benefits)

Submission of forms for NEW reports of injury should be:

  • Faxed to the Case Create Fax: (202) 513-6814 - this is the preferred method for receiving "case create" forms
  • OR (if unable to fax):

  • Mail case create forms to the Jacksonville DLHWC District Office. The Jacksonville District Office is the Central Case Create site and will create cases for all injuries/deaths under the Longshore and Harbor Workers' Compensation Act (LHWCA), and its extensions, for all district offices regardless of where the injury occurred or where the injured worker resides.

U. S. Department of Labor
Office of Workers' Compensation Programs
Division of Longshore and Harbor Workers' Compensation
Charles E. Bennett Federal Building
400 West Bay Street, Room 63A, Box 28
Jacksonville, FL 32202
Case Create Fax: (202) 513-6814
For submission of all non-case create mail please use the SEAPortal

Click HERE to view an Industry Notice that provides details about this centralization. Click HERE to view Frequently Asked Questions