Part 2 of the Longshore Workers Compensation Podcast
How do I file a claim for Longshore 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 should use Form LS-203, Employee's Claim for Compensation, to file your written claim. If a written claim is not filed with OWCP within the required timeframe, the employer may object and deny compensation benefits should you become disabled due to the injury.
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.
How do I contact my Claims Examiner?
You can call the District Suboffice that maintains your case file to speak with your Claims Examiner. Office contact information can be found in the Contact Us section on our website. See FAQ 18 and 19 for more information on determining where a case is located.
You may also submit a written inquiry to the following address: U. S. Department of Labor, Office of Workers' Compensation Programs, Division of Longshore and Harbor Workers' Compensation, 400 West Bay Street, Suite 63A, Box 28, Jacksonville, FL 32202. This is the address of our Jacksonville DLHWC District Suboffice, which is designated as the Central Mail Receipt site for the entire program.
Where should I submit case file documents?
If you already have an OWCP file number, you can use Longshore's Secure Electronic Access Portal (SEAPortal), located at https://seaportal.dol.gov
The SEAPortal is a web-based application (This is ECOMP for LONGSHORE) that allows any eligible Longshore or Maritime employee with internet access to upload documents (in pdf or tif format) directly into a case file. Users do not need to register or enroll to use the SEAPortal. This can be used by you, or your doctor. You simply need the OWCP case number and the injured worker's last name, date of birth and date of injury.
The SEAPortal provides important advantages over other means of submitting documents to OWCP, such as same-day delivery to the appropriate case file and OWCP employee, and the elimination of costs associated with traditional delivery methods.
SEAPortal submissions are delivered to the OWCP examiner within four (4) hours of your submission, and you have the ability to track the document using a tracking number that is generated by the website. A Digital Control Number! If a document is submitted via the SEAPortal, please do not submit a hard copy of the document.
To learn more about the SEAPortal, see the Frequently Asked Questions (FAQs) on the SEAPortal site. I am attaching the link to how to use the SEAPORTAL site : https://seaportal.dol.gov/portal/?program_name=LS
Alternatively, case file documents can be sent
11. 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.
13. 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. See FAQ 41.
14. What if the employee dies as a result 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.
15. 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 uploaded to our SEAPortal case create site (the preferred method) along with a Notice of Retainer, if applicable. Or, it can be faxed to our Case Create Fax: (202) 513-6814, or sent to the address below. This is the address of our Jacksonville DFELHWC Office, which is designated as the Central Case Create site for the entire program. This site creates cases for all new injuries, regardless of the location of injury or claimant's home address.
What medical benefits are available under the LHWCA?
An injured employee is entitled to reasonable and necessary medical, surgical, and hospital treatment and other medical supplies and services required by the work-related injury or illness, such as prescription medications, diagnostic tests, physical therapy, prostheses, hearing aids, attendant care, and the cost of travel for such treatment. An injured employee is entitled to select a physician of his/her choice to provide medical treatment for the work injury.
48. Is there a time limit to claim medical benefits?
There is no time limit to request medical treatment for a work injury; however, 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.
49. Is there a time limit to how long medical benefits are paid?
There is no time limit for receiving medical treatment necessary for the work-related injury. The injured employee is entitled to medical care related to the injury for as long as the nature and extent of injury or the process of recovery may require. This includes conditions which may arise from the injury, or from treatment related to the injury, after the initial period of treatment.
50. How do I obtain medical treatment for my injury?
Before receiving medical treatment other than emergency treatment, you must request authorization from the employer or from the insurance carrier. Once authorized by the employer or insurance company, your treating physician may refer you for diagnostic testing and non-surgical treatment as necessary.
51. Do I have to select a doctor from an approved list of medical providers?
No. There is no enrollment program or network of approved medical providers under the LHWCA.
52. What kinds of doctors are allowed to treat my injuries?
The LHWCA defines the term "physician" to include doctors of medicine (MDs), 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.
53. 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.
54. Is there any type of doctor that is not authorized to be my treating physician?
Naturopaths, faith healers, and other health care providers not listed in FAQ 52 are not "physicians" defined under the Act, even if they are licensed under state law. They may 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.
55. How do I change doctors?
Once you have selected a treating physician for your injury, you may not change doctors without the permission of the employer or insurance company or the OWCP. In general, if specialty care is required for your injury, your treating physician will refer you to the appropriate specialist. If the employer or insurance company objects to the referral or to your request for a change of physician, the Longshore District Director may order a change of treating physician if good cause exists for the change. The employer or insurance company may also request that your treating physician be changed for good cause. Again, such change will be made by the District Director after considering the reasons from both sides.
56. Is there a limit on what my doctor may charge for medical treatment under the LHWCA?
Medical fees are paid at the customary rate for the area in which you live. If a dispute arises between the employer or insurance company and the medical provider over the rate charged for a medical service, we will use the OWCP Medical Fee Schedule as a guide to resolve the disputed fee. The OWCP Medical Fee Schedule may be found on line on the OWCP website.
57. 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.
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 Longshore District Director (or his/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.
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 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.
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 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 US General Services Administration (GSA). The past and current rates are listed on the GSA website.
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, 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 you must attend or risk suspension of your compensation. If you have any questions about this process, contact your servicing district suboffice for guidance.
I am attaching a link on the podcast to the Frequently Asked Questions on the Longshore Act page of the OWCP site: https://www.dol.gov/agencies/owcp/dlhwc/FAQ/Document_Submission_and_Communication_with_owcp-FAQ#7