If you qualify for benefits under the Longshore and Harbor Workers Compensation Act (LHWCA), you will need to file your claim using the U.S. Department of Labor Form LS-203. You must complete the form to the best of your ability, and omitting any information could lead to your claim being denied. While you can file Form LS-203 on your own, you can also hire a maritime injury lawyer to help you. This is the best option for many workers, as completing the form and securing benefits can often prove to be a challenge.
Information Required for Longshore and Harbor Workers Compensation Act Claims
Form LS-203 requires 36 different pieces of information, and only two can be omitted. All other sections of the form must be completed in order to successfully file for benefits under the Longshore and Harbor Workers Compensation Act. In addition to basic information such as your name, address and date of birth, the information you must provide when filing a claim for benefits under the LHWCA includes:
- The date and time of your accident
- The date and time that you stopped receiving pay
- The date and time that you returned to work (if applicable)
- Whether you were injured “while doing regular work” (if not, you must provide an explanation)
- Your weekly wage at the time of your accident
- Your total earnings during the year before your injury
- The number of years you have worked for your current employer
- Your supervisor’s name
- The “earliest date” your supervisor or employer knew about your accident (this may or may not be the date that you reported the accident)
- The “exact place” where your accident occurred (including the name of the vessel, pier, or terminal, if applicable)
You must also describe how your accident happened. Form LS-203 instructs claimants to: “Tell what the injured was doing at the time of the accident. Tell what happened and how it happened. Name any objects or substances involved and tell how they were involved. Give full details on all factors which led or contributed to the accident.”
Additional information that must be submitted when filing a claim for benefits under the LHWCA includes:
- The nature of your injury
- Whether you have received medical treatment
- The name and address of the medical provider that treated you
- Whether you are disabled as a result of your injury
- Whether you have gone to work despite being disabled
- Whether you have received any wages since your accident (and if so, on what date(s) you received payment)
- Your employer’s name and address, and a description of your employer’s business
As you can see, there is a lot of information you need to provide in order to successfully file a claim for benefits under the Longshore and Harbor Workers Compensation Act. If you have questions about completing form LS-203 or would like help filing your claim, contact us today.
Talk to a Maritime Injury Lawyer About Your Claim
Do you have questions about filing a claim for benefits under the Longshore and Harbor Workers Compensation Act? If so, we encourage you to get in touch. For a free, no-obligation consultation with maritime injury lawyer David Willis, please call 800-468-4878 or tell us about your claim online today.
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