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Division of Longshore and Harbor Workers' Compensation (DLHWC)

Longshore and Harbor Workers' Compensation Act Frequently Asked Questions

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LONGSHORE FAQ TOPICS

DISCLAIMER: The OWCP Longshore Frequently Asked Questions and responses ("FAQs") were created solely to assist employees and employers in gaining a general understanding of portions of the Longshore and Harbor Workers' Compensation Act ("LHWCA") and its extension acts. These FAQs may not constitute the complete or official opinion of the Department of Labor, the Office of Workers' Compensation Programs, or the Division of Longshore and Harbor Workers' Compensation on any subject. This page does not necessarily contain an exhaustive or current treatment of the LHWCA and its extension acts and should not, under any circumstances, substitute for a party's own research into the statutory, regulatory, and case law authorities on any given subject addressed by the following FAQs. The FAQs are an informational tool, not a final authority, and should not be cited or otherwise considered an authoritative statement of agency policy.

The following online sources provide more detailed information about the LHWCA:

 


OVERVIEW

1. What is the Longshore and Harbor Workers' Compensation Act?

The Longshore and Harbor Workers' Compensation Act ("LHWCA") is a federal law that provides for the payment of compensation, medical care, and vocational rehabilitation services to employees workers disabled from injuries on the job and that occur on the navigable waters of the United States, or in adjoining areas customarily used in the loading, unloading, repairing, or building of a vessel. The LHWCA also provides provides the payment of survivor benefits to dependents if the a work injury cause, or contributes to, the employee's death. These benefits are typically paid by the self-insured employer or by a private insurance company on the employer's behalf. The term "injury" includes occupational diseases, hearing loss and illnesses arising out of employment.  

2. Who is covered by the LHWCA?

The LHWCA covers employees in traditional maritime occupation s such as longshore workers, ship-repairers , shipbuilders or ship-breakers, and harbor construction workers . His/her injuries must occur on the navigable waters of the United States or in the adjoining areas, including piers, docks, terminals, wharves, and those areas used in loading and unloading vessels. Non-maritime employees may also be covered if they perform their work on navigable water and their injuries occur there.  

3. What are the Longshore Act Extensions?

Congress extended the LHWCA to include other types of employment. Employees covered by these extensions are entitled to the same benefits, and their claims are handled in the same way as Longshore Act claims. The following are the extensions of the LHWCA:

  • DEFENSE BASE ACT - applying to employment at overseas military bases of the United States and to employees of U.S. government contractors working outside the United States in public work projects or in national defense and military operations;
  • OUTER CONTINENTAL SHELF LANDS ACT - applying to employees working on the Outer Continental Shelf of the United States in the exploration and development of natural resources, for example, off-shore oil drilling rigs;
  • NONAPPROPRIATED FUND INSTRUMENTALITIES ACT - applying to civilian employees of non-appropriated fund instrumentalities of the Armed Forces (for example, military base exchanges and morale, welfare, and recreational facilities).

 4. Who is excluded from the LHWCA?

The LHWCA specifically excludes the following individuals:

  • Seamen (masters or members of a crew of any vessel);
  • Employees of the United States government or of any state or foreign government;
  • Employees whose injuries were caused solely by their intoxication;
  • Employees whose injuries were due to their own willful intention to harm themselves or others.

The LHWCA also excludes the following individuals if they are covered by a state workers' compensation law:

  • Individuals employed exclusively to perform office clerical, secretarial, security, or data processing work;
  • Individuals employed by a club, camp, recreational operation, restaurant, museum, or retail outlet;
  • Individuals employed by a marina and who are not engaged in construction, replacement, or expansion of such marina (except for routine maintenance);
  • Individuals who (A) are employed by suppliers, transporters, or vendors, (B) are temporarily doing business on the premises of a maritime employer, and (C) are not engaged in work normally performed by employees of that employer covered under the Act;
  • Aquaculture workers;
  • Individuals employed to build any recreational vessel under sixty-five feet in length, or to repair any recreational vessel, or to dismantle any part of a recreational vessel in connection with the repair of such vessel;
  • Small vessel workers if exempt by certification of the Secretary of Labor under certain conditions. 

 5. What is the Office of Workers' Compensation Programs ("OWCP")?

The Office of Workers' Compensation Programs ("OWCP") is charged with oversight of four federal workers' compensation programs, including the LHWCA. Within the OWCP, the Division of Longshore and Harbor Workers' Compensation ("DLHWC") administers the LHWCA.

6. What does the OWCP do for injured Longshore employees?

The OWCP maintains records of injuries and deaths reported under the LHWCA and its extensions. The OWCP reviews each claim to make sure appropriate benefits are paid promptly. The OWCP provides general information about compensation, medical benefits and vocational rehabilitation to employers, insurance carriers, and claimants, and helps injured employees to file claims.

Should claim disputes arise, the OWCP assists the parties to resolve the disputes by conducting informal conferences and making written recommendations on benefit entitlement. If the parties cannot resolve their differences and any party requests a formal hearing before the Office of Administrative Law Judges, the OWCP refers the case for a formal hearing.

The OWCP also provides vocational rehabilitation services to permanently disabled employees in appropriate cases.

The OWCP administers the "Special Fund" which pays disability compensation to injured LHWCA employees or their survivors in certain circumstances. See FAQs 40-42 for additional information about the Special Fund.

7. Where are the OWCP offices located?

OWCP Longshore district offices are located in Boston, New York, Baltimore, Norfolk, Jacksonville, New Orleans, Houston, San Francisco, Long Beach, Seattle and Honolulu. Office contact information can be viewed on the internet accessed using this link: http://www.dol.gov/owcp/dlhwc/lscontactmap.htm.


CLAIMS

8. What should I do if I am injured on the job?

  • You should notify your supervisor or employer representative immediately or as soon as possible.
  • If you require medical attention for your injury, you should obtain treatment as soon as possible.
  • You are entitled to select a physician of your choice to treat the effects of your injury. You should ask your employer for the for the Form LS-1, Request for Examination and/or Treatment which authorizes medical treatment.
  • However, in a medical emergency, you may request authorization from your employer or its insurance carrier after obtaining emergency treatment.
  • See FAQ #50 about how to obtain authorization for medical treatment.

9. What is my responsibility to report the injury?

You must give a written notice of injury to the employer within 30 days of the occurrence of the injury or within 30 days of your becoming aware that you have an injury or disability related to the employment. You should also give written notice to the OWCP/DLHWC. You should use the Form LS-201, Notice of Employee's Injury or Death, for this purpose.

10. What if I do not report the injury to my employer within 30 days?

Your entitlement to benefits may be jeopardized if you fail to report the injury within the required timeframe. This failure may be excused if you have a good reason, or if the employer is not prejudiced by not receiving the notice. Failure to report the injury within 30 days will not bar you from receiving medical care necessary for the treatment of your work injury.

11. How do I file a claim?

In addition to the Notice of Injury given to your employer, you should file a written claim with the OWCP within one (1) year after the date of injury; or, if the employer has been voluntarily paying compensation benefits, you should file a written claim within a year of the last payment of compensation. You should use Form LS-203, Employee's Claim for Compensation, to file your written claim. If a written claim is not filed with OWCP within the required timeframe, the employer may object to the claim and deny compensation benefits should you become disabled due to the injury.

12. What if the employee dies as a result of a work injury?

In the event of the employee's death, the eligible survivors, or their legal representatives must file the Form LS-262, Claim for Death Benefits, with the OWCP within one (1) year after the date of death. The OWCP will require additional claim including, but are not limited to: the marriage certificate and birth certificates of eligible survivors, medical records of the deceased employee, and the Form LS-265, Certification of Funeral Expenses.

13. Where should I file the Notice of Injury and Claim for Compensation?

If you do not have an OWCP file number and you are filing a new claim, the claim form should be sent the following address. This is the address of our New York City DLHWC District Office, which is designated as the Central Case Create site for the entire program. This site creates cases for all new injuries, regardless of the location of injury or claimant's home address. After the case is created, it is viewable electronically by the District Office with jurisdiction for the case.

U. S. Department of Labor
Office of Workers' Compensation Programs
Division of Longshore and Harbor Workers' Compensation
201 Varick Street, Room 740
Post Office Box 249
New York, NY 10014-0249

If you already have an OWCP file number , all claim forms and any other documentation pertaining to your case should be sent the following address. This is the address of our Jacksonville DLHWC District Office, which is designated as the Central Mail Receipt site for the entire program. This site processes all mail for all existing cases, regardless of the owning District Office. The mail is then viewable electronically by the District Office with jurisdiction for the case.

U. S. Department of Labor
Office of Workers' Compensation Programs
Division of Longshore and Harbor Workers' Compensation
400 West Bay Street, Suite 63A, Box 28
Jacksonville, FL 32202

Click here for more information about our Central Case Create and Central Mail Receipt sites.

14. Where do I get a Longshore form?

Most Longshore forms can be obtained on-line at: http://www.dol.gov/owcp/dlhwc/lsforms.htm.

Forms are also available at any Longshore district office. To request a form, or for additional information and assistance on how to complete the forms, contact the district office where your claim is administrated. See: http://www.dol.gov/owcp/dlhwc/lscontactmap.htm for contact information.

15. I was injured at work and my doctor told me I should stay home because of my injury. How do I get LHWCA benefits?

You should notify your employer that your doctor took you off work. Give your employer a medical report or a disability slip from the doctor that shows your medical condition and how long you should remain off work due to the injury. You should also notify the insurance claims adjuster handling your claim.

16. When do I get my first compensation check?

The employer or insurance carrier should pay compensation within 14 days of receiving Notice of Injury except in cases where the employer or insurance carrier disputes liability for benefits and files a Notice of Controversion, Form LS-207. See FAQ #18 describing Notice of Controversion.

17. Who pays my disability benefits and my medical bills?

The employer, through its insurance carrier or claims administrator, is responsible for providing the appropriate disability benefits and medical treatment for the work-related injury. In most cases, the OWCP does not pay compensation or medical benefits. If, however, both the responsible employer and its insurance carrier are insolvent or bankrupt, the OWCP may pay benefits from the Special Fund that would otherwise be the employer's responsibility.

18. I received a form called the Notice of Controversion. What does "Controversion" mean?  

If, after receiving notice of your injury and disability, the employer or insurance carrier denies responsibility to provide benefits, it is required by law to file with the OWCP the Form LS-207, Notice of Controversion of Right to Compensation, stating its reasons for the denial. The OWCP will send a copy of that form to the employee with instructions on what to do if the employee disagrees with the denial.

19. I have not been paid any benefits and my claim is denied. What can I do?

Often the insurance claims adjuster denies the claim because he/she does not have documents necessary to pay benefits. You may contact the claims adjuster to ask what additional information the adjuster needs to accept and pay your claim. If you disagree with the reasons for the denial, you may also write to the OWCP giving the reasons why you disagree. You should also provide the OWCP with documents to support your claim, including your statement of how you were injured, your earnings records or wage statements, and medical reports from your doctor. You should send copies of all your documents and correspondence to both the OWCP and the insurance claims adjustor. Keep copies of all documents, forms, reports, and correspondence. If you do not know what documents are required, you may contact your local Longshore district office for guidance.

20. I participated in an informal conference and the OWCP recommended payment of benefits, but the carrier still refuses to pay me. What can I do?

While the district office may issue a written recommendation based upon the evidence submitted, that recommendation is not binding on the parties. If either party disagrees with the recommendation, the next step is a formal hearing before a Department of Labor Administrative Law Judge who has the authority to award benefits or to deny claims.

21. How do I get a hearing before an Administrative Law Judge?

Either party may request a hearing before an Administrative Law Judge bysubmitting to the district office the Form LS-18, Pre Hearing Statement, with a copy to all other parties. The district office will review the LS-18 before referring the case to the Office of Administrative Law Judges ("OALJ") for hearing.

22. My claim has been referred to the Office of Administrative Law Judges for formal hearing. When will I get a hearing date?

You should contact the Office of Administrative Law Judges in Washington, D.C, or the assigned judge, if you have any questions regarding a hearing date or procedures before that office. Contact information may be obtained at: http://www.oalj.dol.gov/DISTRICT_OFFICES_INDEX.HTM.

23. Can my employer retaliate against me for filing a claim?

Under the LHWCA, it is unlawful to discriminate against or fire an employee solely because he or she has filed a claim for compensation or has testified, or is about to testify, in an LWHCA hearing. However, it is not a violation of this law if an employer fires or refuses to hire an employee who has knowingly and willfully filed a false claim.

24. What happens to my OWCP case file if I move?

If you move to a State that is under the jurisdiction of a different district office, your OWCP case file can be transferred to the office closer to your home. You should submit your new address and contact information to our Central Mail Receipt site, and you may request that your case file be transferred. Please make sure to provide a day-time telephone number in the event we need to contact you.

25. How do I get a copy of my OWCP case file?

OWCP case files are protected by The Privacy Act of 1974, 5 U.S.C. §552a ("the Privacy Act"). You may request a copy of your case file (or any information in your case file) by submitting a written request to our Central Mail Receipt site. The OWCP will provide one copy of your case file free of charge, but you must pay a copying charge for any additional copies.

26. Who has the right to review my OWCP case file?

Your employer, the employer's workers' compensation insurance carrier, and DOL officials all have access to your OWCP case file for purposes of administering your claim.

27. How do I get a copy of someone else's OWCP case file?

The Privacy Act prohibits disclosure of the contents of OWCP case files to anyone who is not a party to the claim without (1) specific written consent from the injured employee who filed the claim; or (2) a court order. All properly authorized requests for copies of case files should be sent to the local district office handling the claim.

28. Why won't the OWCP staff talk to my spouse or my family about my claim?

The Privacy Act prevents the OWCP from releasing any information regarding a claim without the signed written authorization of the injured employee, even if the person requesting information is a spouse or other relative.

29. Why can't I communicate with the OWCP by email?

As a matter of policy, the OWCP does not discuss or handle claims by e-mail. This is to protect your privacy. You should contact the district office by telephone with specific claim-related questions, since that office has access to the OWCP case file and is most familiar with the claim. Alternatively you can submit written correspondence to our Central Mail Receipt site, and the Claims Examiner handling your case will receive the documentation for review.


COMPENSATION

30. What are the different types of disability benefits?

"Disability" means the inability to earn the same wages that the employee was receiving at the time of injury. The LHWCA provides for the payment of compensation for the following four types of disability: temporary partial, temporary total, permanent partial, and permanent total. Under the LHWCA, the type of disability depends on the answers to two main questions: (1) is the disability temporary or permanent, and (2) is the disability partial or total?

 31. What is the difference between "temporary disability" and "permanent disability"?

  • A disability is "temporary" if the injured employee is unable to return to work for medical reasons and is still recuperating from the work injury. A medical doctor must certify that the employee is not able to work.
  • A disability is "permanent" if the injured employee's medical condition has become stable and is not expected to improve. A stable condition is often described as having reached the point of "maximum medical improvement," or "MMI."

32. What is the difference between "total disability" and "partial disability"?

A disability is "total" when the injured employee cannot do any work due to the work-related injury. A disability is "partial" if the injured employee cannot do the same job he or she was doing at the time of the injury but is able to work in a lighter or modified job, either with the same or with a different employer.

33. What is the "Average Weekly Wage"?  

All compensation benefits are paid based on the employee's Average Weekly Wage ("AWW") at the time of injury. In general, the AWW is the average weekly wages the employee was earning when injured. There are several methods to determine the AWW. Each method takes the employee's average annual earnings and divides that figure by fifty-two (52) to obtain an Average Weekly Wage.

34. I think the insurance carrier is paying compensation benefits at a lower rate than I am entitled to. What can I do?

The law provides different methods for determining the AWW. If your wages in the 52 weeks prior to injury do not reflect your true earning capacity, for example, due to promotion, reduction in force (RIF), illness, or lack of work, or if the employment has not been permanent and continuous, there are other methods to calculate the AWW. You should contact OWCP/DLHWC for more information. Be sure to provide the district office with documentation of earnings in the form of pay stubs, W-2 tax forms, earnings statements, or tax returns.

35. What are the "Maximum" and "Minimum" rates?

Compensation payable under the Act is subject to the Maximum ("Max") and Minimum ("Min") rates. The Max and Min are determined each year on October 1 based on the National Average Weekly Wage ("NAWW") determined by the DOL. The NAWW is calculated using national wage data published by the Bureau of Labor Statistics. The Max equals 200% of the NAWW; the Min equals 50% of the NAWW. For current and historical rates, see the NAWW Table at: http://www.dol.gov/owcp/dlhwc/NAWWinfo.htm.

In general, the aggregate weekly compensation payable cannot be higher than the Max in effect at the time of injury. If two-thirds (2/3) of the AWW falls below the Min, compensation is paid at the Min. If the AWW is below the Min, compensation is paid at the AWW. The Min does not apply to compensation paid under the Defense Base Act.

36. How much compensation do I get when I am temporarily disabled?  

  • Temporary Total Disability ("TTD") is compensated at two-thirds (2/3) of the employee's Average Weekly Wage (AWW), subject to certain minimum and maximum amounts set by the OWCP annually. For example: if the AWW is $600 per week, the TTD benefit rate is $400.00 per week ($600 x 2/3 = $400.00).
  • Temporary Partial Disability ("TPD") is compensated at two-thirds (2/3) of the employee's loss of earning capacity, calculated based on the difference between the AWW (what the employee earned at the time of injury) and what he/she is able to earn after the injury. For example: if the AWW is $600 per week, and now the employee can only earn $300 per week, the TPD benefit rate is $200.00 per week (($600 - $300) x 2/3 = $200.00).

If you have any questions about how your compensation benefits are calculated, contact the local Longshore district office for guidance.  

37. How much compensation do I get when I am permanently disabled?  

  • Permanent Total Disability ("PTD") - Compensation is paid at two-thirds (2/3) of the AWW. For example: if the AWW is $600 per week, the PTD benefit rate is $400.00 per week ($600 x 2/3 = $400.00). PTD benefits are paid as long as the disability continues. Benefits may be adjusted annually based on increases in the National Average Weekly Wage.
  • Permanent Partial Disability ("Scheduled PPD") - Compensation for permanent impairment or loss of use of the arm, hand, fingers, leg, foot, toes, ears (hearing) or eyes (vision) is paid for a specified number of weeks. This is commonly called "Scheduled PPD" and is payable even if the employee is able to return to work. The "Schedule" and the number of weeks of compensation payable for each body part may be found in Section 8(c) of the LHWCA at the following website: http://www.dol.gov/owcp/dlhwc/lhwca.htm#908.
  • Permanent Partial Disability ("Unscheduled PPD") -Compensation for permanent loss of wage earning capacity is payable when the injury causes permanent impairment to other parts of the body not listed in the "Schedule" of § 8(c) of the LHWCA. The impairment must limit the employee's ability to earn wages. Unscheduled PPD benefit is paid at two-thirds (2/3) of the employee's loss of earning capacity, calculated based on the difference between the AWW (what the employee earned at the time of injury) and what he/she is able to earn after the injury. For example: if the AWW is $600 per week, and now the employee can only earn $300 per week, the PPD benefit rate is $200.00 per week (($600 - $300) x 2/3 = $200.00). Unscheduled PPD benefits are payable as long as the disability continues. These benefits are not adjusted to reflect increases in the NAWW.
  • Permanent Partial Disability for Retirees - In cases of permanent disability due to an occupational disease diagnosed after retirement (e.g. asbestosis), PPD benefits are payable based upon a percentage of impairment determined under the American Medical Association Guides to the Evaluation of Permanent Impairment ("AMA Guides"). Contact the local Longshore district office for more information.

38. Do I have to report earnings to the OWCP while I am receiving compensation benefits?  

Your employer, insurance carrier, or the OWCP may require you to report any earnings you receive because your compensation benefits may be based upon your ability to earn. You should report any earnings from employment or self-employment in order to avoid overpayment of benefits. By law, your employer or insurance company can deduct any overpayment from future payments of compensation due.

39.  Is there a limit on how long I can receive compensation for a work-related injury?

Generally, disability compensation is payable for as long as the disability continues. The two exceptions are temporary partial disability benefits, which cannot exceed 5 years, and the "Scheduled" permanent partial disability benefits, which are limited to a fixed number of weeks. The employer or insurance carrier may require medical documentation of your continuing disability. To ensure that you receive benefits without interruption, you should provide the documentation when requested.

40. What benefits are available for survivors?

If the work injury causes, contributes to, or hastens the employee's death, death benefits are paid to certain specified survivors up to an aggregate of two-thirds (2/3) of the deceased employee's Average Weekly Wage. Funeral expenses up to $3,000 are also payable.

A widow or widower receives one-half (1/2) of the decedent's AWW for life or until remarriage. Additional compensation at one-sixth (1/6) of the AWW is payable for one or more children. If there is no widow or widower, 1/2 of the AWW is paid for one child, or two-thirds (2/3) of the AWW if there are two or more children. Benefit payments to children terminate when they reach age 18 but may be extended to age 23 if the beneficiary is a full-time student. Death benefits may be paid to an adult "child" who is totally disabled and incapable of self-support.

If there is no surviving spouse or child, death benefits may be payable to other dependents at various rates fixed by law. The death benefit is adjusted annually for cost-of-living as calculated by the DOL.

41. What is the Special Fund and why is it paying me instead of the insurance company?

The "Special Fund," also known as the "Second Injury Fund", pays certain types of claims and expenses authorized by the LHWCA. The OWCP's Longshore National Office processes payments from the Special Fund, and the U.S. Treasury issues the compensation benefit checks. In certain circumstances, an employer or insurance company may be responsible to pay your compensation benefits for only the first 104 weeks of permanent disability. The Special Fund then pays disability compensation for the duration of your entitlement. However, the employer or insurance company remains liable for paying for your medical treatment related to your injury, and the employer retains the right to challenge the employee's continuing disability even if the Special Fund is paying the claim.

42. What other types of payments are made by the Special Fund?

The Special Fund also may pay compensation and medical benefits when both the responsible employer and its insurance carrier are insolvent or are out of business. Additionally, the Special Fund pays the cost of vocational rehabilitation services authorized by the OWCP in appropriate cases.

43. Where do I file a change of address if I am paid by the Special Fund?

If you currently receive benefits from the Special Fund and need to report a change of address, you should you should submit a written request to our Central Mail Receipt site. When contacting the district office, you must supply your full name, address, your OWCP claim number or social security number (the deceased employee's social security number if you are receiving death benefits), and a day-time telephone number. Additional information for Special Fund recipients is available at the following link: http://www.dol.gov/owcp/dlhwc/lssfpage.htm.

44. Can I receive state workers' compensation benefits and Longshore benefits at the same time?

The LHWCA allows you to receive compensation for the same injury under both a state workers' compensation system and the LHWCA. However, any amounts you receive under the state system reduce what your employer must pay under the LHWCA. Furthermore, some states prohibit receiving compensation under the state workers' compensation system if LHWCA benefits are payable. You cannot receive any more than the weekly compensation rate under whichever statute would pay you the larger weekly benefit.

45. Can I receive Social Security Administration ("SSA") benefits and Longshore benefits at the same time?

The Longshore Act does not prohibit the receipt of both SSA and Longshore benefits. However, SSA may reduce the benefits it pays to you based on the amount of workers' compensation payments you receive. You should notify SSA if you receive both SSA and Longshore benefits to ensure that you have not been overpaid.

46. Do I have to pay income tax on my compensation benefits?

A person who receives workers' compensation benefits must declare the funds received as compensation for an occupational sickness or injury. The IRS exempts these payments from taxation if they are paid under a federal or state workers' compensation law. The tax exemption also applies to survivors' benefits. For additional information, please refer to IRS Publication 525 or contact your local Internal Revenue Service Office.


MEDICAL

47. What medical benefits are available under the LHWCA?

An injured employee is entitled to reasonable and necessary medical, surgical, and hospital treatment and other medical supplies and services required by the work-related injury or illness, such as prescription medications, diagnostic tests, physical therapy, prostheses, hearing aids, attendant care, and the cost of travel for such treatment. An injured employee is entitled to select a physician of his/her choice to provide medical treatment for the work injury.

48. Is there a time limit to claim medical benefits?

There is no time limit to request medical treatment for a work injury; however, you should request treatment as soon as it is necessary. Even if the employee does not file a claim for compensation within the time required by the LHWCA to receive compensation benefits, he/she still has the right to medical care related to the LHWCA injury.

49. Is there a time limit to how long medical benefits are paid?

There is no time limit for receiving medical treatment necessary for the work-related injury. The injured employee is entitled to medical care related to the injury for as long as the nature and extent of injury or the process of recovery may require. This includes conditions which may arise from the injury, or from treatment related to the injury, after the initial period of treatment.

50. How do I obtain medical treatment for my injury?

Before receiving medical treatment other than emergency treatment, you must request authorization from the employer or from the insurance claim adjuster. Once authorized by the employer or insurance company, your treating physician may refer you for diagnostic testing and non-surgical treatment as necessary.

51. Do I have to select a doctor from an approved list of medical providers?

There is no enrollment program or network of approved medical providers under the LHWCA.

52. What kinds of doctors are allowed to treat my injuries?

The LHWCA defines the term "physician" to include doctors of medicine ("M.D.s"), surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. It is important to select a physician whose specialty is appropriate to your injury.

53. Is there any type of doctor that is not authorized to be my treating physician?

Naturopaths, faith healers, and other health care providers not listed in FAQ #52 are not "physicians" defined under the Act, even if they are licensed under state law. They may provide treatment under a prescription from an authorized treating physician. Chiropractors may only provide treatment consisting of manual manipulation of the spine to correct subluxation shown by x-ray, but they may not provide treatment for any other body part except the spine. You may choose any physician you wish to treat you, but your employer or insurance company may not be responsible for the physician's medical bills if you choose a physician who is currently debarred by the DOL. If you have questions regarding medical treatment authorization, contact your local Longshore district office.

54. Why can't I have a chiropractor as my treating physician?

Chiropractors are recognized as physicians under the LHWCA only under limited circumstances. A chiropractor may be a treating physician only if the injury caused a spinal subluxation, verified by x-ray, which can be treated by manual manipulation of the spine. Thus, if the work injury is to other body parts besides the spine, a chiropractor may not be your treating physician.

55. How do I change doctors?

Once you have selected a treating physician for your injury, you may not change doctors without the permission of the employer or insurance company or the OWCP. In general, if specialty care is required for your injury, your treating physician will refer you to the appropriate specialist. If the employer or insurance company objects to the referral or to your request for a change of physician, the Longshore District Director may order a change of treating physician if good cause exists for the change. The employer or insurance company may also request that your treating physician be changed for good cause. Again, such change will be made by the District Director after considering the reasons from both sides.

56. Is there a limit on what my doctor may charge for medical treatment under the LHWCA?

Medical fees are paid at the customary rate for the area in which you live. If a dispute arises between the employer or insurance company and the medical provider over the rate charged for a medical service, the OWCP will use the State's fee schedule or the OWCP Medical Fee Schedule as a guide to resolve the disputed fee. The OWCP Medical Fee Schedule may be found at: http://www.dol.gov/owcp/regs/feeschedule/fee.htm.

57. I want specialized medical care available only at a location hundreds of miles from my home, and the insurance carrier will not authorize my request. What can I do?

The employer and insurance carrier are required to provide reasonable and necessary medical treatment for the injury by a physician selected by you. Medical care must also be reasonable in terms of distance, so if the necessary care or treatment is available locally, the carrier may decline to pay for the treatment located outside your area. If you have questions about authorization of medical care, contact the local district office for guidance.

58. What happens when there is a dispute about medical treatment?

If a dispute arises concerning the necessity of treatment, the frequency of treatment, the type of treatment provided, or the amount of fees billed, the OWCP District Director will attempt to resolve the dispute informally. If the parties cannot agree on an acceptable result, then, at the request of any party, the District Director will refer the dispute for a formal hearing by an Administrative Law Judge.

59. How do I get reimbursed for prescription medications that I paid for out of my pocket?

Normally, the insurance carrier prefers that the pharmacy bill them directly. This is something you should discuss with your claim adjuster in advance. However, if the treating physician or other authorized provider prescribed medication for your work injury and you paid for it yourself, you may submit the itemized receipts to the insurance carrier with a written request for reimbursement. Keep copies of such requests and copies of your itemized receipts for your records.

60. Can I get reimbursed for the cost of transportation to medical appointments and, if so, how much?

Reasonable transportation expenses necessary for treatment of the work injury, including mileage, parking, and toll, are reimbursed at cost. Mileage is reimbursed at the rate in effect at the time travel costs were incurred according to the mileage rates for privately owned vehicles set by the Federal General Services Administration ("GSA"). The past and current rates are listed on the GSA website at: GSA Mileage Reimbursement Rates

61. What form do I use to request mileage reimbursement?

There is no special form required to request mileage reimbursement under the LHWCA. Some insurance companies have their own form which they may ask you to use. To claim mileage reimbursement, you must provide accurate documentation including the date of the travel, the destination (doctor's office, physical therapy facility, pharmacy, etc.), and the mileage to and from that destination. While the LHWCA does not impose a time limit for filing mileage reimbursement requests, it is recommended that you submit your requests to the insurance carrier on a regular basis and keep copies for your records.

62. My employer's insurance company has scheduled a medical appointment for me with a doctor I don't know. Do I have to go?

The insurance carrier may schedule a medical evaluation with a doctor of its choice at a reasonable distance from your residence. If you refuse to attend a medical examination scheduled by your employer or its insurance carrier, your compensation may be suspended until the medical examination is completed. The OWCP also has the authority to schedule a medical examination, and the employee must attend or risk suspension of his/her compensation.


VOCATIONAL REHABILITATION

63. What is vocational rehabilitation?

Vocational rehabilitation is the process that helps a permanently disabled employee to return to gainful employment as quickly as possible in a job with pay at or near the wages at the time of injury. Vocational services may include vocational assessment and skills testing, counseling, job development, modification of the previous job, limited training when required, and job placement assistance.

64. Who is eligible to receive vocational rehabilitation services?

If a work injury prevents an employee from returning to his/her pre-injury employment, he/she may be eligible for vocational rehabilitation services. The OWCP must determine whether the employee is permanently disabled and whether vocational rehabilitation is appropriate. The OWCP may begin considering whether vocational rehabilitation is appropriate when the medical record shows that the employee is likely to have some degree of permanent disability.

65. Who pays for vocational rehabilitation services?

Services are provided by the OWCP out of the Special Fund at no cost to employees. The employer or insurance carrier may also pay for vocational rehabilitation services in individual cases, although they are not required to do so under the law.

66. How do I obtain vocational rehabilitation services?

You, your attorney, the employer, or insurance company may request that the OWCP district office evaluate you for vocational rehabilitation services as soon as your doctor determines that you will be unable to return to your previous job and that you are medically able to participate in vocational rehabilitation activities. You may ask for services by contacting the district office where your claim is administrated. A complete list of the contact information for the district offices can be found at: http://www.dol.gov/owcp/dlhwc/lscontactmap.htm.

67. Is vocational rehabilitation mandatory?

No, participation in vocational rehabilitation services is entirely voluntary. However, if you decide not to take advantage of these free services, the employer or insurance company may ask that you be evaluated by a vocational rehabilitation counselor to determine if there are jobs in the open labor market that you can perform. Your compensation may be reduced on the basis of this evaluation.

68. How do I support myself and my family if I pursue vocational rehabilitation?

If you are accepted into an OWCP-sponsored vocational rehabilitation program, you may be entitled to receive total disability compensation for the duration of the rehabilitation program if your full participation in the program prevents you from working full-time or part-time.


ATTORNEYS

69. Why can't the OWCP staff give me legal advice about my claim?

The OWCP cannot provide legal assistance or advice to the public regarding individual claims. OWCP staff members are not attorneys and are not qualified to give legal advice or to answer questions which involve interpretation of the law or the regulations. District office staff will explain benefits and claims procedures under the LHWCA, provide general information about medical and vocational rehabilitation services, and assist claimants to file claims.

70. How do I find an attorney to handle my claim? Will you appoint an attorney for me?

The OWCP cannot appoint an attorney to represent you or refer you to one. You may obtain a lawyer referral from a Lawyer Referral Service ("LRS") program or your local State Bar Association office which maintains a list of local attorneys who handle Longshore claims. The American Bar Association maintains a list of LRS contacts.

71. Who is responsible for my attorney's fees?

If the employer or insurance company has denied any portion of your claim and you subsequently obtain greater benefits with the assistance of an attorney, the employer or insurance company may be responsible for paying your attorney's fees and costs. In some circumstances, you may be responsible to pay the attorney fees and costs yourself. If the attorney is not successful in winning greater benefits, no fees or costs will be assessed against the employer or insurance company. An attorney may not collect a fee unless that fee is approved by the OWCP, the Office of Administrative Law Judges, or the courts.

72. The attorney I selected wants an advance payment and a percentage of any settlement - is this proper?

Under the LHWCA, an attorney may not collect a retainer fee or receive a contingent fee (a percentage of your award) for representing you in your claim. All requests for attorney fees must be submitted to the OWCP or to the courts for approval. Fees must be reasonable in relation to the prevailing rates in the attorney's local area, the time spent on your case, the experience of the attorney, the quality and complexity of the work performed, and the amount of benefits awarded.

73. I want to settle my case. Do I have to get an attorney?

While consulting with an attorney may be advisable, you are not required to do so. You may negotiate a settlement directly with the insurance carrier's claims adjuster. The OWCP cannot advise or assist you in settling your claim. Rather, the District Director or the Administrative Law Judge is required by law to evaluate all settlement applications for adequacy, i.e., whether the amount of the settlement is adequate to compensate you for your disability and future medical needs.

74. Once I settle my case, how long does it take to receive my settlement?

When you settle your claim, the signed settlement agreement must be submitted to the DOL for approval. The District Director or the Administrative Law Judge will approve or deny the settlement within 30 days of receipt of the settlement agreement. The employer or insurance company must pay the lump sum settlement within ten (10) days of the Order Approving Settlement.


INSURANCE

75. Does the Department of Labor regulate insurance premium rates?

The DOL has no authority to regulate insurance premium rates. All authorized carriers are regulated by the insurance commissioners in the states in which they operate.

76. How does my company become an authorized Longshore Insurance Carrier or Self-Insured Employer?

The OWCP is responsible for the authorization of insurance carriers and self-insured employers. Each employer or insurance carrier must be separately authorized for each Act administered by this office. The Code of Federal Regulations, Title 20, Part 703, contains detailed information on how to apply for authorization, and can be found at Title 20 Part 703.

77. What is an employer or insurance carrier required to do in order to remain authorized?

Authorized self-insured employers and insurance carriers are required to maintain security deposits and submit various financial reports as specified by the OWCP. The Code of Federal Regulations, Title 20, Part 703 contains detailed information on the requirements for continuing authorization and can be found at: Title 20 Part 703.

78. How do I contact the OWCP regarding insurance authorization and compliance with insurance regulations?

All insurance-related matters are handled by the DLHWC National Office, Branch of Financial Management, Insurance and Assessment, located in Washington, DC. Address inquiries to the address shown at: http://www.dol.gov/owcp/dlhwc/lscontac.htm.


EMPLOYERS

79. How can I find out whether my business should be covered under the Longshore Act or its extensions?

Longshore insurance coverage can be a complex legal question that depends on the nature and location of the work to be performed. The Longshore district office staff may provide general information and guidance regarding the types of work covered by the LHWCA, but their recommendation does not constitute legal advice or a formal adjudication of this issue.

80. I am a self-employed maritime worker. Do I have to buy Longshore insurance coverage for myself?

The OWCP recommends that all coverage questions be discussed with an experienced maritime insurance broker or attorney in order to evaluate any potential liability under the Longshore Act. The LHWCA requires that maritime employers, including sole proprietors who are employees of their own company, obtain insurance for all employees; officers of a corporation are not exempt from LHWCA coverage.

81. As a covered employer, what are my responsibilities under the LHWCA?

You must secure payment of compensation through the purchase of insurance or by obtaining authorization from the OWCP to be self-insured.

  1. You must post an up-to-date Form LS-241 (if you are insured by a carrier) or LS-242 (if you are permissibly self-insured) at each place where you conduct business. The form should include the name and address of the insurance carrier, the policy number, the person you have designated to receive the employees' notices of injury, and the address of the Longshore district office where notices of injury and claims should be filed. (See FAQ #14.)
  2. You should notify your insurance carrier promptly of all work-related injuries.
  3. You should authorize medical care upon request from the injured worker.
  4. You must submit the Form LS-202, Employer's First Report of Injury, to the OWCP within 10 days of your knowledge of any injury which causes loss of one or more shifts.

82. What are the consequences of failure to obtain Longshore insurance?

An employer who fails to secure the payment of compensation under the Act through an insurance carrier or to obtain authorization to be self-insured may face criminal prosecution and be subject to imprisonment and/or fines. If the employer is a corporation, the president, secretary and treasurer can be prosecuted individually and may be personally and severally liable for compensation and other benefits.

If the employer is not insured, an injured employee also may elect to either claim compensation under the LHWCA or sue for damages for his/her injury under general tort law. In such a lawsuit, the employer may not rely on the customary tort defenses that the employee is prevented from recovery by (1) his/her own contribution to the cause of the injury or (2) his/her own negligence or wrong-doing.

83. What are the consequences of failure to post the Form LS-241?

The posting of the Form LS-241, Notice to Employees, is mandatory. The employer's failure to designate a person to receive notices of injuries from employees and to post this information in a conspicuous place will be ground for excusing the employee's late reporting of his/her injury.

84. How can an employer obtain an up-to-date Form LS-241 or LS-242?

The Form LS-241 is provided to each insured employer by its insurance carrier. Upon confirmation or renewal of insurance coverage, the insurance carrier should give the insured employer an up-to-date Form LS-241 for posting. The OWCP will supply the Form LS-242 to an employer upon its initial authorization as a self-insured employer.

Because of the nature and purpose of these forms, they are not available for download from the internet. The DLHWC National Office will mail additional blank forms to authorized carriers or self-insured employers upon request. Contact information is at http://www.dol.gov/owcp/dlhwc/lscontac.htm.

85. What are the consequences of failure to file the Form LS-202 within 10 days of the employer's knowledge of the injury?

Failure to file the Form LS-202, Employer's First Report of Injury, within the required timeframe may subject the employer to civil penalties up to $11,000. Such penalties are assessed by the District Director. Such failure also extends the time limitation for an employee to file a claim. The time to file a claim does not begin to run until the employer has filed the Form LS-202 with the OWCP.

86. What are the consequences of failure to authorize medical treatment?

If the employer fails to authorize medical care upon the receipt of a report of injury and a request for treatment from the employee, the employer and its insurance carrier may be liable for the payment of reasonable and necessary medical costs incurred by the employee as well as the employee's attorney fees and costs incurred in obtaining necessary medical treatment and payment of medical bills.

87. Is the Form LS-1 the only way to authorize medical treatment?

No; medical treatment may be authorized verbally; however, the verbal authorization should be followed by written authorization to the medical provider from either the employer or the employer's insurance carrier representative.

88. As an employer, what can I do if my insurance carrier denies my employee's claim which I believe should be paid?

Contact your insurance carrier and find out why the claim is being denied; the denial may be based simply on the lack of documentation. If necessary documentation cannot be provided or if you disagree with your insurance carrier's reason for denying the claim, you may contact your insurance broker or the Longshore district office for guidance.

89. How can an employer take advantage of payments made by the Special Fund?

The employer or insurance company must apply for relief under § 8(f) of the LHWCA and comply with various legal and evidentiary requirements set out in the statute and the regulations. Refer to federal regulations at: Title 20 Part 702.

90. What are the funding sources of the Special Fund?

The Special Fund is primarily funded by annual assessments made by all authorized LHWCA insurance carriers and self-insured employers. The annual amount is determined by the total amount of compensation benefits paid yearly by the Special Fund, and contributions from each participating employer or insurance company are pro-rated according to the number of cases and total amounts paid out by the Special Fund on behalf of each employer or insurance company. Civil penalties paid by employers and carriers under the LHWCA also go to fund the Special Fund. For more information, refer to Section 44 of the Act and to the implementing regulations.


OCCUPATIONAL DISEASES

91. What is an "occupational disease"?

An occupational disease is an illness or medical condition which develops as a result of exposure to harmful conditions or substances in the workplace. For example, hearing loss resulting from exposure to excessive noise is an occupational disease. Other occupational diseases may be caused by exposure to harmful substances. These nclude pulmonary diseases such as asbestosis and mesothelioma (which result from asbestos exposure), auto-immune diseases, skin diseases, or asthma (which may result from exposure to chemicals or other elements involved in industrial processes). Many occupational diseases and conditions have a long latency period and do not become apparent until considerable time elapses after the workplace exposure has occurred.

92. Am I entitled to benefits if I suffer from an occupational disease?

You may receive compensation and/or medical treatment benefits if your illness can be associated with on-the-job exposure to harmful conditions or substances. You might even be entitled to benefits for an occupational disease where your symptoms or disability do not occur until after you have retired.

93. What should I do if I think I have an occupational injury or illness ?

First, you should notify your employer and the Longshore District Office that you have an occupational disease using either the Form LS-201 or in writing. See FAQs 8-9 and 13 about how to report an injury and FAQ 14 about how to file a notice of injury. If your employer does not begin paying compensation, then you should file a claim for benefits using the Form LS-203. See FAQs 11 and 13 about how to file a claim. You should also try to obtain a medical report describing your work history, medical history, diagnosis of your condition, and explanation of the relationship between your past employment and your current medical condition. A copy of this report should be filed with your local Longshore District Office. See FAQ 13 about where to file. If you require medical treatment for your occupational illness or medical condition, you should obtain treatment as soon as possible. You are entitled to select a physician of your choice to treat the effects of your injury. See FAQ 50 about how to obtain authorization for medical treatment.

94. How much time do I have to file a claim for occupational injury or illness?

If you suspect you are disabled by an occupational disease , or if a doctor tells you that you need treatment for a medical condition which may have been caused by your employment, you have two years to file a claim. The two years begin to run from the date you first become aware of the relationship between the occupational disease, your disability, and your employment. You need not file a written claim, or form LS-203, until you have a disability associated with your occupational disease, or if you are retired, until you have been found to have a ratable permanent impairment. No time limit applies to a claim for medical benefits. See FAQs 47- 62 about medical benefits available under the Act.

95. Who is responsible for paying my benefits?

The employment where you were last exposed to injurious substances determines which empoyer is responsible for payments of compensation and medical benefits. See FAQ 17. If you cannot identify where your last harmful exposure took place, the Longshore District Office will investigate your claim and attempt to identify the potentially responsible employers and their insurance carriers.

96. How is my compensation amount determined?

Generally you are entitled to compensation only if your occupational illness results in a loss of wage-earning capacity (or you are the survivor of a worker whose death resulted from an occupational disease). However, you may also be entitled to compensation if you have a latent pulmonary disease that results in ratable permanent impairment. If you are still working, or if you retired within a year of your diagnosis with an occupational disease, your compensation will be based on your average weekly wage (AWW). In general, your AWW is the average weekly wages you were earning when injured. See FAQs 33 and 34 about how average weekly wage is determined. Your compensation rate is a percentage of your AWW depending on the extent of your loss of wage-earning capacity. . If your occupational disease is diagnosed more than one year after your voluntary retirement from the workforce, your compensation will be based upon the National Average Weekly Wage (NAWW) in effect at the time of diagnosis and the degree of ratable impairment assigned by your physician. See FAQ 37 about how compensation is paid. Even if you are not entitled to compensation, you are entitled to medical treatment if your medical condition is related to your employment. See FAQs 47-49 about medical treatment under the Act.