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Ation Programs www.dol.gov/owcp/dlhwc/index.htm This form should be furnished by the employer to any employee covered by the Longshore and Harbor Workers' Compensation Act or a related law who reports an occupational injury or illness to his/her employer. This form is used to provide written notice of an injury or death. The information will be used to determine entitlement to benefits. 1. Employee's Name (Last, First, Middle) 2. Home Mailing Address (Number, Street, City, State, Zip Code) mi.

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The Longshore and Harbor Workers' Compensation Act (LHWCA) is a federal law that provides for the payment of compensation, medical care, and vocational rehabilitation services to employees disabled from on the job injuries that occur on the navigable waters of the United States, or in adjoining areas customarily used ...

The Federal Employees' Compensation Act (FECA) provides compensation benefits to civilian employees for disability due to personal injury or disease sustained while in the performance of duty. The FECA also provides for payment of benefits to dependents if a work-related injury or disease causes an employee's death.

The Longshore and Harbor Workers' Compensation Act (LHWCA) requires that private-sector firms provide workers' compensation coverage for their employees engaged in longshore, harbor, or other maritime occupations on or adjacent to the navigable waters of the United States.

The Longshore Act provides a number of workers' compensation benefits including medical benefits for covered injuries and illnesses, disability benefits to partially cover lost wages due to a work-related injury or illness, and survivors benefits to families of those workers who suffer fatal injuries on the job.

What Do Longshoremen Do? Twenty-four hours per day, seven days per week, longshoremen haul cargo off ships and onto the docks. They unload containers and send them off to warehouses or distribution centers. They secure arriving and departing ships.

Typically, if your employer is assisting you with the claims process, and you are advised to file an LS-203 form, called an “Employee's Claim for Compensation,” then you are likely filing a Defense Base Act claim.

If an employer offers modified or light duty to the worker, the worker can refuse to accept the modified duty. However, it will affect their workers' comp benefits. Workers can potentially lose vocational rehabilitation benefits and temporary disability benefits.

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.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232