New Forms to Request DLHWC Intervention

To expedite delivery of benefits to injured workers covered by the Longshore and Harbor Workers’ Compensation Act and its extensions, the Office of Workers’ Compensation Program’s (OWCP) DLHWC (DLHWC) has created six new forms for parties to use when requesting DLHWC’s action in a claim. The forms are now available on the OWCP/DLHWC website at https://www.dol.gov/owcp/dlhwc/lsforms.htm

• Form LS-4 - Attorney Fee Approval Request
• Form LS-5 - Application for Special Fund Relief
• Form LS-6 - Communication Application
• Form LS-7 - Request for Intervention
• Form LS-8 - Settlement Approval Request Section 8(i)
• Form LS-9 - Stipulation Approval Request

The forms will be used by OWCP to obtain required information and documents, and to formalize, in a uniform manner, requests for DLHWC action.  

 

If a party wishes to request DLHWC intervention in a claim, the appropriate form(s) must be completed and submitted to OWCP for the corresponding request. The party must use the correct form for the intervention requested, or the request will not be considered complete. Use of the correct form will speed processing of requests for action by DLHWC.  

 

For a brief description of each form and when it should be used are explained in the Industry Notice 180 on the OWCP/DLHWC website at https://www.dol.gov/owcp/dlhwc/lsindustrynotices/industrynotice180.htm

 

With the exception of the From LS-8 Settlement Approval Request (please see submission instructions above), forms should be submitted to the OWCP via one of the following methods:

1. DLHWC’s Secure Electronic Access Portal (SEAPortal) uploads the forms directly to the case file and is the preferred method. (See Industry Notice No. 148, issued October 31, 2014.) The SEAPortal can be accessed at https://seaportal.dol-esa.gov.
2. Alternatively, the forms may be sent by mail or commercial delivery service to the DLHWC central mail receipt site:

U.S. Department of Labor, Office of Workers’ Compensation Programs
Division of Longshore and Harbor Workers’ Compensation
400 W Bay St
Suite 63A, Box 28
Jacksonville, FL 32202

 

Any questions regarding the Industry Notice should be directed to the DLHWC Director, Washington, D.C.

ANTONIO A. RIOS
Acting Director, Division of Longshore and Harbor Workers’ Compensation