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 disabled from on-the-job injuries 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 for payment of survivor benefits to dependents if the work injury causes, 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.
Who Is Covered by the LHWCA?
The LHWCA covers employees in traditional maritime occupations such as longshore workers, ship-repairers, shipbuilders or ship-breakers, and harbor construction workers. The 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.
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.
Defense Base Act (DBA)—The DBA covers the following employment activities: (1) Work for private employers on U.S. military bases or on any lands used by the U.S. for military purposes outside of the United States, including those in U.S. Territories and possessions; (2) Work on public work contracts with any U.S. government agency, including construction and service contracts in connection with national defense or with war activities outside the United States; (3) Work on contracts approved and funded by the U.S. under the Foreign Assistance Act, which among other things provides for cash sale of military equipment, materials, and services to its allies, if the contract is performed outside of the United States; and (4) Work for American employers providing welfare or similar services outside the United States for the benefit of the Armed Services, e.g. the United Service Organizations (USO).
Outer Continental Shelf Lands Act (OCSLA)—The OCSLA covers 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.
Non-Appropriated Fund Instrumentalities Act (NAFIA) - The NAFIA covers civilian employees of non-appropriated fund instrumentalities of the Armed Forces (for example, military base exchanges and morale, welfare, and recreational facilities).
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; and
• 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; and
• Small vessel workers if exempt by certification of the Secretary of Labor under certain conditions.
What is the difference between the Jones Act and the LHWCA?
The Jones Act (46 U.S.C. § 30104) and the LHWCA (33 U.S.C. § 901-950) are mutually exclusive regimes providing compensation for work-related injuries suffered by different categories of maritime employees.
The LHWCA excludes from its coverage a "master or member of a crew of any vessel." Instead, crew members are covered by the Jones Act. The term "master or member of a crew" is refinement of the term "seaman" in the Jones Act. As a result, the key requirement for Jones Act coverage appears in the LHWCA.
The determination turns solely on the employee's connection to a vessel in navigation. It is not necessary that an employee aid in navigation or contribute to the transportation of the vessel to be a seaman under the Jones Act, but the employee must be doing the ship's work by contributing to the function of the vessel or the accomplishment of its mission.
Another important difference between compensation under the Jones Act and compensation under the LHWCA is that compensation under the LHWCA is in the traditional nature of workers’ compensation and is available for covered workplace injuries, regardless of who was at fault for the injury.
In contrast, compensation for pain, suffering, and lost wages in a Jones Act claim depends on the seaman or crew member’s ability to prove the negligence of a crew member, officer, operator, captain, or other person employed on the vessel who may have been at fault for the injury. And although a seaman or crew member’s recovery may be greater in a Jones Act claim, the recovery may be reduced by the seaman or crew member’s own fault in causing the injury.
An injured worker cannot file both a workers’ compensation claim under the LHWCA and a Jones Act lawsuit.
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 statutes, including the LHWCA, and its extensions. Within the OWCP, the Division of Longshore and Harbor Workers' Compensation (DLHWC) administers the LHWCA.
What does OWCP/DLHWC do for injured employees?
• The OWCP/DLHWC maintains records of injuries and deaths reported under the LHWCA and its extensions and reviews claims to determine whether appropriate benefits are paid promptly and accurately in compliance with the Act's provisions.
• Claims staff provides information and technical assistance regarding entitlement to compensation, medical benefits and vocational rehabilitation benefits to employers, insurance carriers, and injured employees.
• Should claim disputes arise, the OWCP/DLHWC assists the parties to resolve the disputes by conducting informal conferences and making written recommendations regarding benefit entitlement. If the parties cannot resolve their differences and any party requests a formal hearing before the Office of Administrative Law Judges (OALJ), the OWCP/DLHWC refers the case for a formal hearing.
• Vocational rehabilitation services are provided to permanently disabled employees in appropriate cases.
• The OWCP/DLHWC also administers the "Special Fund" which pays disability compensation to injured employees or their survivors in certain circumstances.
Where are the Longshore district offices located?
Longshore has three compensation Districts: Eastern District, which has suboffices in: Boston, Massachusetts; New York, New York; and Norfolk, Virginia; Southern District, which has suboffices in: Jacksonville, Florida; New Orleans, Louisiana; and Houston, Texas; and Western District, which has suboffices in: Long Beach, California; San Francisco, California; and Seattle, Washington.
REPORTING A NEW INJURY
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 a 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.
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 when you become aware that you have an injury or disability related to the employment. You should use Form LS-201, Notice of Employee's Injury or Death, for this purpose.
What if I do not report the injury to my employer within 30 days?
Your entitlement to compensation 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 receiving the notice late.
Failure to report the injury within 30 days will not bar you from receiving medical care necessary for the treatment of your work injury.
How do I file a claim for compensation?
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 may 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 and deny compensation benefits should you become disabled due to the injury.
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.
What if the employee dies because of a work injury?
In the event of an employee's death, the eligible survivors, or their legal representatives must file Form LS-262, Claim for Death Benefits, with the OWCP within one (1) year after the date of death. The OWCP will require additional evidence to support the claim including the marriage certificate and birth certificates of eligible survivors, medical records of the deceased employee, and Form LS-265, Certification of Funeral Expenses.
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 (Form LS-201, Form LS-203, or Form LS-262) should be faxed to the Case Create Fax: (202) 513-6814 (the preferred method), uploaded via the SEAPortal, or sent to the address below. This is the address of the Jacksonville DLHWC Office, which is designated as the Central Case Create site for the entire program.
The OWCP/DLHWC website 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 suboffice with jurisdiction for the case.
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, Suite 63A, Box 28
Jacksonville, FL 32202
If you already have an OWCP file number, do not submit documents to this address.
You can use Longshore's Secure Electronic Access Portal (SEAPortal) to electronically upload documents directly to the OWCP case file. The SEAPortal can be found at this website:
https://seaportal.dol.gov/portal/?program_name=LS. Alternatively, you can submit documents to the Central Mail Receipt site.
OCCUPATIONAL DISEASES
What is an occupational disease?
An occupational disease is an illness or medical condition which develops because of exposure to harmful conditions or substances in the workplace. Occupational diseases may be caused by exposure to harmful substances resulting in conditions such as pulmonary diseases: asbestosis and mesothelioma (which results 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.
Am I entitled to benefits if I suffer from an occupational disease?
You may receive compensation and medical benefits if your illness is related to on-the-job exposure to harmful conditions or substances. You may even be entitled to benefits for an occupational disease where your symptoms or disability do not occur until after you have retired.
What should I do if I think I have an occupational injury or illness?
First, you should notify your employer that you have an occupational disease in the same way you would notify your employer of a work injury.
You should also file a claim and 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 sent to your employer and to the OWCP.
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 (2) 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 (Employee’s Claim for Compensation), 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.
Who is responsible for paying my benefits in an occupational disease claim?
The employment where you were last exposed to injurious substances determines which employer is responsible for payments of compensation and medical benefits. If you cannot identify where your last harmful exposure took place, the OWCP will review your claim and work history and attempt to identify the potentially responsible employers and their insurance carriers.
CLAIMS
I was injured at work and my doctor told me I should stay home because of my injury. How do I get 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 describes your medical condition and how long you should remain off work due to the injury. You should also notify the insurance claims adjuster for the insurance company handling your claim.
How do I obtain compensation for my disability? When do I get my first check?
If you are disabled more than 3 days, payments are to be issued 14 days from the date your employer first has knowledge of your loss in wages. However, payment is not overdue until 14 days after that date. This provides the carrier 28 days to issue the first payment. Thereafter, payments should be paid in bi-weekly installments except when the employer or insurance carrier disputes liability for benefits and files a Notice of Controversion, Form LS-207.
If you do not receive your initial compensation, check in a timely manner, contact the Longshore Claims Examiner handling your claim for assistance as there could be additional compensation due for the late payment of benefits.
I received a form called the Notice of Controversion. What does "Controversion" mean?
After receiving notice of the work injury and disability, the employer or insurance carrier may deny responsibility to provide compensation and medical benefits. In this instance, the LHWCA requires the employer or insurance carrier to file with the OWCP a Form LS-207 (Notice of Controversion of Right to Compensation), stating the reasons for the denial of benefits. The LS-207 represents the employer's or insurance carrier's formal basis for denying the claim; a copy of the form must be provided to you.
If you disagree with the denial of benefits, please contact the Longshore Claims Examiner servicing your claim to seek assistance. Provide your rationale and any supporting documentation, such as earnings records, wage statements and medical reports from your doctor, for review.
I have not been paid any benefits and my claim is denied. What can I do?
Often the employer or insurance carrier denies the claim because the documents necessary to pay benefits have not been submitted. You should contact the employer or insurance carrier to ask what additional information is needed to accept and pay your claim.
If you disagree with the reasons for the denial, you may also contact the Longshore Claims Examiner handling your claim to seek assistance and guidance. Provide your rationale and any supporting documentation, such as earnings records, wage statements and medical reports from your doctor, for review. You should submit copies of documents and correspondence to the OWCP and the employer or the insurance carrier. Keep copies of all documents, forms, reports, and correspondence.
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 suboffice 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 or deny benefits.
How do I get a hearing before an Administrative Law Judge?
Either party may request a formal hearing before an Administrative Law Judge by submitting a Form LS-18 (Pre-Hearing Statement), to OWCP. A copy should be sent to all other parties when it is submitted to OWCP. The district suboffice will review the LS-18 and prepare the case to be referred to the Office of Administrative Law Judges for a formal hearing on the disputed issues.
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 your attorney, if one has been retained; otherwise, contact the Office of Administrative Law Judges in Washington, DC, or the assigned judge, if you have any questions regarding a hearing date or procedures before that office. Contact information may be obtained on the website for the Office of Administrative Law Judges.
Can my employer retaliate against me for filing a claim?
Under Section 49 of 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 LHWCA 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.
COMPENSATION
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.
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.
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 light or modified job, either with the same or with a different employer.
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. The AWW is the average weekly wage the employee was earning when injured. There are several methods to determine the AWW, but generally, each method usually takes an employee's average annual earnings and divides that figure by fifty-two (52) to obtain a fair and reasonable AWW that represents the injured employee's pre-injury earning capacity.
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, lack of work, or if the employment has not been permanent and continuous, there are other methods to calculate the AWW.
You should contact your servicing Longshore Claims Examiner for more information. Be sure to provide the claims examiner with documentation of your earnings in the form of pay stubs, W-2 tax forms or earnings statements.
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.
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.)
How much compensation do I get when I am temporarily disabled?
Temporary Total Disability (TTD)—Compensation is paid at two-thirds (2/3) of the employee's Average Weekly Wage (AWW), subject to 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)—Compensation 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 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 your servicing district office for guidance.
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 once the employee reaches Maximum Medical Improvement and found 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.
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 in Section 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).
If you have any questions about how your compensation benefits are calculated in this instance, contact your servicing district office for guidance.
How is my compensation amount determined if I have an occupational disease?
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 a 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). 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.
Even if you are not entitled to compensation, you are entitled to medical treatment if your medical condition is related to your employment.
Do I have to report earnings to the OWCP while I am receiving compensation benefits?
Your employer, insurance carrier, and/or the OWCP will require you to report any earnings you receive because your compensation benefits may be based upon your ability to earn wages. You should report any earnings from employment or self-employment in order to avoid an overpayment of benefits. Under the LHWCA, your employer or the insurance carrier can deduct any overpayment from future payments of compensation due.
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.
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 (AWW). 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 LHWCA. Benefits may be adjusted annually based on increases in the National Average Weekly Wage.
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 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 your medical treatment related to your injury, and the employer retains the right to challenge your continuing disability even if the Special Fund is paying the claim.
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.
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 submit a written notice to DOL with a copy to the employer or insurance carrier. Please include your full name, address, the OWCP claim number, and a day-time telephone number.
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.
Can I receive Social Security Administration (SSA) benefits and Longshore benefits at the same time?
The LHWCA 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.
Do I have to pay income tax on my compensation benefits?
If you receive workers' compensation benefits, you 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 regarding tax implications, please contact the Internal Revenue Service.
MEDICAL
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.
Is there a time limit to claim medical benefits?
There is no time limit to request medical treatment for a work injury; however, the injured employee 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, the right to medical care related to the work injury is never time barred.
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.
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 carrier. Once authorized by the employer or insurance company, your treating physician may refer you for diagnostic testing and non-surgical treatment as necessary.
Do I have to select a doctor from an approved list of medical providers?
No. There is no enrollment program or network of approved medical providers under the LHWCA.
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, 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 treat your injury.
Chiropractors are considered physicians under the LHWCA but may only provide treatment consisting of manual manipulation of the spine to correct subluxation shown by x-ray; they may not provide treatment for any other body part except the spine.
Can 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 not a spinal subluxation, a chiropractor may not be your treating physician.
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 above are not physicians defined under the Act, even if they are licensed under state law. They may only provide treatment under a prescription from an authorized treating physician.
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 servicing district office for guidance.
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.
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 U.S. Department of Labor (DOL) will use the OWCP Medical Fee Schedule as a guide to resolve the disputed fee. The OWCP Medical Fee Schedule may be found online on the OWCP website.
I want specialized medical care available only at a location far away 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. However, 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 regarding medical treatment authorization, contact your servicing district suboffice for guidance.
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 Longshore District Director (or his or her designee, the Claims Examiner) 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.
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 claims 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.
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 tolls, are reimbursable costs. 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 U.S. General Services Administration (GSA).
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, etc.), and the mileage to and from that destination.
Although 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.
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 you must attend or risk suspension of your compensation. If you have any questions about this process, contact your servicing district suboffice for guidance.
VOCATIONAL REHABILITATION
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.
Who is eligible to receive vocational rehabilitation services?
You are eligible to receive vocational rehabilitation services if:
• You are an injured worker in receipt of compensation payments (or will likely be in receipt of compensation payments) due to a work-related disability;
• You are unable to return to your regular job due to some remaining permanent disability; and
• There are appropriate return-to-work opportunities in your commuting area.
How do I obtain vocational rehabilitation services?
You, or your attorney, may ask for services by contacting your Longshore Claims Examiner. For a list of phone numbers, visit the Contact Us page of the DOL website by copying this URL in your browser: https://www.dol.gov/agencies/owcp/dlhwc/lscontac.
Also, your Longshore Claims Examiner, or your employer or insurance carrier, may refer you for vocational rehabilitation if you will be unable to return to your previous job due to your work injury.
ATTORNEYS
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. OWCP 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.
How do I find an attorney to handle my claim—will OWCP appoint an attorney for me?
The OWCP cannot appoint an attorney to represent you or refer you to one.
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 for paying 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.
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 contingency fee (a percentage of your award) for representing you in your claim. All requests for attorney fees must be submitted to the OWCP, Office of Administrative Law Judges 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.
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.
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. Failure to timely pay the settlement may result in the payment of additional compensation for the late payment.
COVID-19 EMPLOYEES
Am I covered under the Longshore and Harbor Workers’ Compensation Act if I contract COVID-19 at work?
If you believe that you contracted COVID-19 at work, you may have a covered injury. Be prepared to provide evidence that you were diagnosed with COVID-19 and that it is related to your work exposure.
You should generally follow the guidelines for “What to do if you are injured” found on these website pages, which you may copy into your internet browser:
https://www.dol.gov/agencies/owcp/dlhwc/claimant#2 (English)
https://www.dol.gov/agencies/owcp/dlhwc/claimant_Spanish (Español)
Specifically, you should:
• Notify your employer immediately and request authorization to obtain medical treatment from your employer by using Form LS-1, Request for Examination and/or Treatment. Be sure to include your choice of physician, if desired.
• Provide written notice of injury to your employer and our Office of Workers’ Compensation Programs using Form LS-201, Notice of Employee’s Injury or Death.
• File a written claim for compensation on Form LS-203, Employee’s Claim for Compensation, or on Form LS-262, Claim for Death Benefits.
Where do I submit Forms LS-201, LS-203 or LS-262?
You may submit the completed forms by any of the following methods:
• Online at https://seaportal.dol.gov/portal/. Use the “Submit New Claim or Report of Injury” section to submit a new claim;
• By fax: 202-513-6814; or
• By mail: OWCP/DFELHWC, 400 West Bay Street, Room 63A, Box 28, Jacksonville, FL 32202.
When does coverage for COVID-19 begin?
Coverage begins as soon as the illness requires medical testing or treatment, but only if it is established to be a compensable work-related illness. If your claim is accepted by the self-insured employer or carrier as work-related and compensable, coverage of reasonable and necessary medical treatment should begin.
If I contracted COVID-19 at work and cannot work, am I entitled to wage loss compensation?
If you can’t work for more than three days due to a work-related exposure to COVID-19, you are due compensation for loss of wages related to the COVID-19 diagnosis. If you are incapacitated from work for more than 14 days, you are entitled to compensation starting from the first day of disability.
Will OWCP accept electronic signatures on documents, including claims for compensation?
Yes, OWCP will accept documents with electronic signatures.
Can OWCP help me file a claim for compensation?
Yes. Call 202-513-6809 for help.
COVID-19 EMPLOYERS/CARRIERS
What should I do if an employee notifies me that they believe they have contracted COVID-19 at work?
File Form LS-202, Employer’s First Report of Injury or Occupational Illness, within 10 days of learning of the illness. You may be subject to civil monetary penalties for late filings.
Does a worker have to establish a causal connection to the course and scope of employment?
Yes. Injured workers need to establish their initial claim by making out a prima facie case. That is done by showing that harm was sustained and could have been caused by employment conditions.
Once an employee makes out a prima facie case (one that appears to be valid on its face), Section 20(a) of the LHWCA aids the employee with a presumption establishing that the injury/illness is work related in the absence of substantial evidence to the contrary. The employer/carrier then has the burden to refute the employee’s showing. The employer could do so, for example, by establishing that the claimant was not exposed to the virus at work or contracted it elsewhere.
Does OWCP have any other specialized guidance regarding COVID-19 and the Longshore Act?
No—generally, you should treat COVID-19 like any other illness that may be work-related.
What information can the Department of Labor provide?
On request, the DOL will explain benefits and proceedings under the Act and provide information and technical assistance on the procedures involved in reporting injuries. Call them at 202-513-6809.
How does an employer notify employees what to do if the employee suspects COVID-19 was contracted at work?
All employers should post the LS-241/LS-242, Notice to Employees, in a conspicuous place in and around the place of business so that employees know what to do when injured at work or when a workplace illness is suspected. This information must be posted both in English and Spanish or any other language that is widely used by employees.
How are employers required to protect employees from COVID-19?
Employers should follow the guidance on how to handle or prevent the spread of the disease provided by the Occupational Safety and Health Administration (https://www.osha.gov/coronavirus) and the Centers for Disease Control and Prevention (https://www.cdc.gov/coronavirus/2019-ncov/index.html).
The Longshore and Harbor Workers' Compensation Act (LHWCA) is a federal law that provides compensation, medical care, and vocational rehabilitation services to employees who sustain on-the-job injuries on the navigable waters of the United States or in adjoining areas used in maritime activities. In Texas, as in other states, the LHWCA covers employees such as longshore workers, ship-repairers, shipbuilders, and harbor construction workers, but excludes seamen, government employees, and those covered by state workers' compensation law for certain types of work. The LHWCA is extended by acts like the Defense Base Act, Outer Continental Shelf Lands Act, and Non-Appropriated Fund Instrumentalities Act to cover additional employment activities. Claims under the LHWCA are administered by the Office of Workers' Compensation Programs (OWCP) and the Division of Longshore and Harbor Workers' Compensation (DLHWC). The LHWCA is distinct from the Jones Act, which covers seamen and requires proof of negligence for compensation. Injured workers or their dependents must report injuries and file claims within specific timeframes to receive benefits, which are typically paid by the self-insured employer or through insurance. The LHWCA also includes provisions for survivor benefits, medical benefits, and vocational rehabilitation services. Disputes may be resolved through informal conferences or formal hearings, and the OWCP/DLHWC can assist with claim disputes and provide information to all parties involved.
