| LONGSHORE AND HARBOR WORKERS COMPENSATION ACT (LHWCA) PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
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The Longshore and Harbor Workers' Compensation Act (LHWCA) provides
employment-injury and occupational-disease protection to approximately
500,000 workers who are injured or contract occupational diseases occurring on
the navigable waters of the United States, or in adjoining areas, and for certain
other classes of workers covered by extensions of this Act.
These benefits are paid directly by an authorized self-insured employer; or
through an authorized insurance carrier; or, in particular circumstances, by a
special fund administered directly by the Division of Longshore and Harbor
Workers' Compensation, Office of Workers' Compensation Programs within the
U.S. Department of Labor (DOL).
Division of Longshore and Harbor Workers' Compensation (DLHWC)
Fact Sheet ESA 91-22
Workers' Compensation under the Longshore and Harbor Workers'
Compensation Act
Coverage and Benefits
The Longshore and Harbor Workers' Compensation Act provides compensation
benefits to approximately 500,000 workers for disability due to an injury or an
employment-related occupational disease occurring on the navigable waters of
the United States, or in adjoining shoreside areas, and for certain other classes of
workers covered by extensions of this act.
Benefits Provided
The act provides medical, surgical and hospital services and supplies. The
employee is allowed a choice treating physician, as authorized by the Secretary
of Labor.
For Disability
An injured employee is eligible to receive compensation for disability at the rate
of 66 2/3 percent of the employee's weekly salary, subject to the specified
maximum in effect at the time of injury, for as long as the effects of the injury
continue. Compensation is also available for permanent impairment of specified
limbs, for hearing loss, and to replace loss of earning capacity.
Minimum and Maximum Compensation
The minimum rate of compensation is 50 percent of the national average weekly
wage or the employee's full wage if less. The maximum compensation rate is 200
percent of the current national average weekly wage as determined by the
Secretary of Labor.
For Death
Benefits are paid to a widow or widower or other eligible survivors, if an injury
causes death. Funeral expenses are paid up to $3000. The surviving spouse of a
covered employee receives 50 percent of the average weekly wages of the
deceased employee for life or until remarriage. Awards to dependent siblings,
children, and grandchildren end when they reach age 18, but may be extended if
the child is a student or is incapable of self-support.
Hearing, Review, and Appeal Rights
If an employee or his or her survivors, or an employer or insurance carrier
disagree with a recommendation of the Office of Workers' Compensation
Programs, a formal hearing may be requested before an administrative law judge.
Appeal from an administrative law judge's decision may be taken to the Benefits
Review Board. Subsequent appeal from the Benefits Review Board may be
taken to the U.S. Court of Appeals and finally to the United States Supreme
Court.
Source of Benefit Payments
Employers are responsible for insuring the payment of compensation and
medical benefits to injured employees. This is provided through private
insurance carriers, or by employers who are authorized to become self-insured.
Benefits under this program are not funded by the government.
Compliance Assistance
Regulatory Library
About OWCP
OWCP Programs
DFEC
DEEOIC
DLHWC
DCMWC
Contact OWCP
OWCP Customer Assistance
OWCP News Releases
District of Columbia Workers' Compensation Act - Provides information on
coverage under the Longshoremen’s and Harbor Workers’ Compensation Act for
disability or death resulting from injury to employees in certain employment in
the District of Columbia who sustained injuries or illnesses as a result of
employment prior to July 26, 1982.
DOL CONTACTS*
Office of Workers' Compensation Programs (OWCP)
Division of Longshore and Harbor Workers' Compensation (DLHWC)
200 Constitution Avenue, NW
Room C-4315
Washington, DC 20210
Email: DLHWC-Public@dol.gov
Tel: 1-866-4-USA-DOL (1-866-487-2365) (1-866-487-2365), or 202-693-0038
TTY: 1-877-889-5627
Local Offices
For questions on other DOL laws,
please call DOL's Toll-Free Help Line at 1-866-4-USA-DOL (1-866-487-2365).
Live assistance is available in English and Spanish, Monday through Friday from
8:00 a.m. to 8:00 p.m. Eastern Time. Additional service is available in more than
140 languages through a translation service.
Tel: 1-866-4-USA-DOL (1-866-487-2365)
TTY: 1-877-889-5627
employment-injury and occupational-disease protection to approximately
500,000 workers who are injured or contract occupational diseases occurring on
the navigable waters of the United States, or in adjoining areas, and for certain
other classes of workers covered by extensions of this Act.
These benefits are paid directly by an authorized self-insured employer; or
through an authorized insurance carrier; or, in particular circumstances, by a
special fund administered directly by the Division of Longshore and Harbor
Workers' Compensation, Office of Workers' Compensation Programs within the
U.S. Department of Labor (DOL).
Division of Longshore and Harbor Workers' Compensation (DLHWC)
Fact Sheet ESA 91-22
Workers' Compensation under the Longshore and Harbor Workers'
Compensation Act
Coverage and Benefits
The Longshore and Harbor Workers' Compensation Act provides compensation
benefits to approximately 500,000 workers for disability due to an injury or an
employment-related occupational disease occurring on the navigable waters of
the United States, or in adjoining shoreside areas, and for certain other classes of
workers covered by extensions of this act.
Benefits Provided
The act provides medical, surgical and hospital services and supplies. The
employee is allowed a choice treating physician, as authorized by the Secretary
of Labor.
For Disability
An injured employee is eligible to receive compensation for disability at the rate
of 66 2/3 percent of the employee's weekly salary, subject to the specified
maximum in effect at the time of injury, for as long as the effects of the injury
continue. Compensation is also available for permanent impairment of specified
limbs, for hearing loss, and to replace loss of earning capacity.
Minimum and Maximum Compensation
The minimum rate of compensation is 50 percent of the national average weekly
wage or the employee's full wage if less. The maximum compensation rate is 200
percent of the current national average weekly wage as determined by the
Secretary of Labor.
For Death
Benefits are paid to a widow or widower or other eligible survivors, if an injury
causes death. Funeral expenses are paid up to $3000. The surviving spouse of a
covered employee receives 50 percent of the average weekly wages of the
deceased employee for life or until remarriage. Awards to dependent siblings,
children, and grandchildren end when they reach age 18, but may be extended if
the child is a student or is incapable of self-support.
Hearing, Review, and Appeal Rights
If an employee or his or her survivors, or an employer or insurance carrier
disagree with a recommendation of the Office of Workers' Compensation
Programs, a formal hearing may be requested before an administrative law judge.
Appeal from an administrative law judge's decision may be taken to the Benefits
Review Board. Subsequent appeal from the Benefits Review Board may be
taken to the U.S. Court of Appeals and finally to the United States Supreme
Court.
Source of Benefit Payments
Employers are responsible for insuring the payment of compensation and
medical benefits to injured employees. This is provided through private
insurance carriers, or by employers who are authorized to become self-insured.
Benefits under this program are not funded by the government.
Compliance Assistance
Regulatory Library
About OWCP
OWCP Programs
DFEC
DEEOIC
DLHWC
DCMWC
Contact OWCP
OWCP Customer Assistance
OWCP News Releases
District of Columbia Workers' Compensation Act - Provides information on
coverage under the Longshoremen’s and Harbor Workers’ Compensation Act for
disability or death resulting from injury to employees in certain employment in
the District of Columbia who sustained injuries or illnesses as a result of
employment prior to July 26, 1982.
DOL CONTACTS*
Office of Workers' Compensation Programs (OWCP)
Division of Longshore and Harbor Workers' Compensation (DLHWC)
200 Constitution Avenue, NW
Room C-4315
Washington, DC 20210
Email: DLHWC-Public@dol.gov
Tel: 1-866-4-USA-DOL (1-866-487-2365) (1-866-487-2365), or 202-693-0038
TTY: 1-877-889-5627
Local Offices
For questions on other DOL laws,
please call DOL's Toll-Free Help Line at 1-866-4-USA-DOL (1-866-487-2365).
Live assistance is available in English and Spanish, Monday through Friday from
8:00 a.m. to 8:00 p.m. Eastern Time. Additional service is available in more than
140 languages through a translation service.
Tel: 1-866-4-USA-DOL (1-866-487-2365)
TTY: 1-877-889-5627
OVERVIEW
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.
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.
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).
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 individuals employed to repair
any recreational vessel or dismantle any part of a recreational vessel in connection with such repair;
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.
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.
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.
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.
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.
MEDICAL
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.
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.
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.
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.
There is no enrollment program or network of approved medical providers under the LHWCA.
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.
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.
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.
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.
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:
http://www.dol.gov/cgi-bin/leave-dol.asp?exiturl=http://www.gsa.gov/Portal/gsa/ep/contentView.do?contentType=GS
A_BASIC|contentId=9646&exitTitle=GSA%20Mileage%20Reimbursement%20Rates
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.
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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.
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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.
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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.
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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.
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.)
You should notify your insurance carrier promptly of all work-related injuries.
You should authorize medical care upon request from the injured worker.
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.
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.
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.
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).
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 individuals employed to repair
any recreational vessel or dismantle any part of a recreational vessel in connection with such repair;
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.
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.
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.
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.
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.
MEDICAL
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.
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.
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.
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.
There is no enrollment program or network of approved medical providers under the LHWCA.
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.
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.
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.
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.
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:
http://www.dol.gov/cgi-bin/leave-dol.asp?exiturl=http://www.gsa.gov/Portal/gsa/ep/contentView.do?contentType=GS
A_BASIC|contentId=9646&exitTitle=GSA%20Mileage%20Reimbursement%20Rates
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.
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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.
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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.
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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.
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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.
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.)
You should notify your insurance carrier promptly of all work-related injuries.
You should authorize medical care upon request from the injured worker.
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.
MEDICAL
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.
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.
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.
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.
There is no enrollment program or network of approved medical
providers under the LHWCA.
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.
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.
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.
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.
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:
http://www.dol.gov/cgi-bin/leave-dol.asp?exiturl=http://www.gsa.gov/Portal/gs
a/ep/contentView.do?contentType=GSA_BASIC|contentId=9646&exitTitle=
GSA%20Mileage%20Reimbursement%20Rates
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.
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.
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.
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.
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.
There is no enrollment program or network of approved medical
providers under the LHWCA.
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.
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.
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.
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.
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:
http://www.dol.gov/cgi-bin/leave-dol.asp?exiturl=http://www.gsa.gov/Portal/gs
a/ep/contentView.do?contentType=GSA_BASIC|contentId=9646&exitTitle=
GSA%20Mileage%20Reimbursement%20Rates
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.