Longshore/Defense Base Act

The United States Department of Labor, Office of Workers’ Compensation Program administers claims under the Longshore and Harbor Workers’ Act.


Longshore/Defense Base Act FAQ’s: 1-20 | 21-40 | 41-61 | 62-80 | 81-95


3) Longshore/Defense Base Act FAQ’s: 41-61.


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

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

43. Can I receive Social Security Administration (“SSA”) benefits and Longshore benefits at the same time?
The Longshore Act does not prohibit the receipt of both SSA and Longshore benefits. However, SSA may reduce the benefits it pays to you based on the amount of workers’ compensation payments you receive. You should notify SSA if you receive both SSA and Longshore benefits to ensure that you have not been overpaid.

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


MEDICAL

45. 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.

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


47. 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.


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


50. Do I have to select a doctor from an approved list of medical providers?
There is no enrollment program or network of approved medical providers under the LHWCA.


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


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


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


54. 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.


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


56. 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.


57. 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.


58. 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.


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


60.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.


61. 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.




Next List of Longshore/Defense Base Act FAQ’s: 1-20 | 21-40 | 41-61 | 62-80 | 81-95








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