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


5) Longshore/Defense Base Act FAQ’s: 81-95.



81. 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.

82. 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.

83. 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.

84. 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.

 

85. 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.


86. 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.


87. 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.


88. 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.


89. 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.


OCCUPATIONAL DISEASES

90. What is an “occupational disease”?
An occupational disease is an illness or medical condition which develops as a result of exposure to harmful conditions or substances in the workplace. For example, hearing loss resulting from exposure to excessive noise is an occupational disease. Other occupational diseases may be caused by exposure to harmful substances. These nclude pulmonary diseases such as asbestosis and mesothelioma (which result from asbestos exposure), auto-immune diseases, skin diseases, or asthma (which may result from exposure to chemicals or other elements involved in industrial processes). Many occupational diseases and conditions have a long latency period and do not become apparent until considerable time elapses after the workplace exposure has occurred.


91. Am I entitled to benefits if I suffer from an occupational disease?
You may receive compensation and/or medical treatment benefits if your illness can be associated with on-the-job exposure to harmful conditions or substances. You might even be entitled to benefits for an occupational disease where your symptoms or disability do not occur until after you have retired.


92. What should I do if I think I have an occupational injury or illness?
First, you should notify your employer and the Longshore District Office that you have an occupational disease using either the Form LS-201 or in writing. See FAQs 8-9 and 13 about how to report an injury and FAQ 14 about how to file a notice of injury. If your employer does not begin paying compensation, then you should file a claim for benefits using the Form LS-203. See FAQs 11 and 13 about how to file a claim. You should also try to obtain a medical report describing your work history, medical history, diagnosis of your condition, and explanation of the relationship between your past employment and your current medical condition. A copy of this report should be filed with your local Longshore District Office. See FAQ 13 about where to file. If you require medical treatment for your occupational illness or medical condition, you should obtain treatment as soon as possible. You are entitled to select a physician of your choice to treat the effects of your injury. See FAQ 50 about how to obtain authorization for medical treatment.


93. How much time do I have to file a claim for occupational injury or illness?
If you suspect you are disabled by an occupational disease , or if a doctor tells you that you need treatment for a medical condition which may have been caused by your employment, you have two years to file a claim. The two years begin to run from the date you first become aware of the relationship between the occupational disease, your disability, and your employment. You need not file a written claim, or form LS-203, until you have a disability associated with your occupational disease, or if you are retired, until you have been found to have a ratable permanent impairment. No time limit applies to a claim for medical benefits. See FAQs 47- 62 about medical benefits available under the Act.


94. Who is responsible for paying my benefits?
The employment where you were last exposed to injurious substances determines which empoyer is responsible for payments of compensation and medical benefits. See FAQ 17. If you cannot identify where your last harmful exposure took place, the Longshore District Office will investigate your claim and attempt to identify the potentially responsible employers and their insurance carriers.


95. How is my compensation amount determined?
Generally you are entitled to compensation only if your occupational illness results in a loss of wage-earning capacity (or you are the survivor of a worker whose death resulted from an occupational disease). However, you may also be entitled to compensation if you have a latent pulmonary disease that results in ratable permanent impairment. If you are still working, or if you retired within a year of your diagnosis with an occupational disease, your compensation will be based on your average weekly wage (AWW). In general, your AWW is the average weekly wages you were earning when injured. See FAQs 33 and 34 about how average weekly wage is determined. Your compensation rate is a percentage of your AWW depending on the extent of your loss of wage-earning capacity. . If your occupational disease is diagnosed more than one year after your voluntary retirement from the workforce, your compensation will be based upon the National Average Weekly Wage (NAWW) in effect at the time of diagnosis and the degree of ratable impairment assigned by your physician. See FAQ 37 about how compensation is paid. Even if you are not entitled to compensation, you are entitled to medical treatment if your medical condition is related to your employment. See FAQs 47-49 about medical treatment under the Act.


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








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