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If you have were injured aboard a vessel or due to the actions of a company other than your employer, contact the attorneys of Montagna Klein Camden at 877-622-8100 for a free consultation to discuss your case. Time limits apply to filing a claim. Make sure you maintain your rights as an injured longshoreman, linesman, or shipyard worker — Call Now.
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 workers disabled from injuries on the job and that occur on the navigable waters of the United States, or in adjoining areas customarily used in the loading, unloading, repairing, or building of a vessel.
The LHWCA also provides the payment of survivor benefits to dependents if a work injury causes, or contributes to, the employee’s death. These benefits are typically paid by the self-insured employer or by a private insurance company on the employer’s behalf. The term “injury” includes occupational diseases, hearing loss and illnesses arising out of employment.
The LHWCA covers employees in traditional maritime occupations such as longshore workers, ship-repairers , shipbuilders or ship-breakers, and harbor construction workers . His/her injuries must occur on the navigable waters of the United States or in the adjoining areas, including piers, docks, terminals, wharves, and those areas used in loading and unloading vessels. Non-maritime employees may also be covered if they perform their work on navigable water and their injuries occur there.
Congress extended the LHWCA to include other types of employment. Employees covered by these extensions are entitled to the same benefits, and their claims are handled in the same way as Longshore Act claims. The following are the extensions of the LHWCA:
The LHWCA specifically excludes the following individuals:
The LHWCA also excludes the following individuals if they are covered by a state workers’ compensation law:
The Office of Workers’ Compensation Programs (“OWCP”) is charged with oversight of four federal workers’ compensation programs, including the LHWCA. Within the OWCP, the Division of Longshore and Harbor Workers’ Compensation (“DLHWC”) administers the LHWCA.
The OWCP maintains records of injuries and deaths reported under the LHWCA and its extensions. The OWCP reviews each claim to make sure appropriate benefits are paid promptly. The OWCP provides general information about compensation, medical benefits and vocational rehabilitation to employers, insurance carriers, and claimants, and helps injured employees to file claims.
Should claim disputes arise, the OWCP assists the parties to resolve the disputes by conducting informal conferences and making written recommendations on benefit entitlement. If the parties cannot resolve their differences and any party requests a formal hearing before the Office of Administrative Law Judges, the OWCP refers the case for a formal hearing. The OWCP also provides vocational rehabilitation services to permanently disabled employees in appropriate cases. The OWCP administers the “Special Fund” which pays disability compensation to injured LHWCA employees or their survivors in certain circumstances. See FAQs 40-42 for additional information about the Special Fund.
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“Disability” means the inability to earn the same wages that the employee was receiving at the time of injury. The LHWCA provides for the payment of compensation for the following four types of disability: temporary partial, temporary total, permanent partial, and permanent total. Under the LHWCA, the type of disability depends on the answers to two main questions: (1) is the disability temporary or permanent, and (2) is the disability partial or total?
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A disability is “total” when the injured employee cannot do any work due to the work-related injury. A disability is “partial” if the injured employee cannot do the same job he or she was doing at the time of the injury but is able to work in a lighter or modified job, either with the same or with a different employer.
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All compensation benefits are paid based on the employee’s Average Weekly Wage (“AWW”) at the time of injury. In general, the AWW is the average weekly wages the employee was earning when injured. There are several methods to determine the AWW. Each method takes the employee’s average annual earnings and divides that figure by fifty-two (52) to obtain an Average Weekly Wage.
The law provides different methods for determining the AWW. If your wages in the 52 weeks prior to injury do not reflect your true earning capacity, for example, due to promotion, reduction in force (RIF), illness, or lack of work, or if the employment has not been permanent and continuous, there are other methods to calculate the AWW. You should contact the district office administrating the claim for more information. Be sure to provide the district office with documentation of earnings in the form of pay stubs, W-2 tax forms, earnings statements, or tax returns.
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Compensation payable under the Act is subject to the Maximum (“Max”) and Minimum (“Min”) rates. The Max and Min are determined each year on October 1 based on the National Average Weekly Wage (“NAWW”) determined by the DOL. The NAWW is calculated using national wage data published by the Bureau of Labor Statistics. The Max equals 200% of the NAWW; the Min equals 50% of the NAWW. For current and historical rates, see the NAWW Table at: http://www.dol.gov/owcp/dlhwc/NAWWinfo.htm.
In general, the aggregate weekly compensation payable cannot be higher than the Max in effect at the time of injury. If two-thirds (2/3) of the AWW falls below the Min, compensation is paid at the Min. If the AWW is below the Min, compensation is paid at the AWW. The Min does not apply to compensation paid under the Defense Base Act.
Your employer, insurance carrier, or the OWCP may require you to report any earnings you receive because your compensation benefits may be based upon your ability to earn. You should report any earnings from employment or self-employment in order to avoid overpayment of benefits. By law, your employer or insurance company can deduct any overpayment from future payments of compensation due.
Generally, disability compensation is payable for as long as the disability continues. The two exceptions are temporary partial disability benefits, which cannot exceed 5 years, and the “Scheduled” permanent partial disability benefits, which are limited to a fixed number of weeks. The employer or insurance carrier may require medical documentation of your continuing disability. To ensure that you receive benefits without interruption, you should provide the documentation when requested.
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If the work injury causes, contributes to, or hastens the employee’s death, death benefits are paid to certain specified survivors up to an aggregate of two-thirds (2/3) of the deceased employee’s Average Weekly Wage. Funeral expenses up to $3,000 are also payable.
A widow or widower receives one-half (1/2) of the decedent’s AWW for life or until remarriage. Additional compensation at one-sixth (1/6) of the AWW is payable for one or more children. If there is no widow or widower, 1/2 of the AWW is paid for one child, or two-thirds (2/3) of the AWW if there are two or more children. Benefit payments to children terminate when they reach age 18 but may be extended to age 23 if the beneficiary is a full-time student. Death benefits may be paid to an adult “child” who is totally disabled and incapable of self-support.
If there is no surviving spouse or child, death benefits may be payable to other dependents at various rates fixed by law. The death benefit is adjusted annually for cost-of-living as calculated by the DOL. Call Montagna Klein Camden for help during this stressful time. We’ll file all the paperwork.
The “Special Fund,” also known as the “Second Injury Fund”, pays certain types of claims and expenses authorized by the LHWCA. The OWCP’s Longshore National Office processes payments from the Special Fund, and the U.S. Treasury issues the compensation benefit checks. In certain circumstances, an employer or insurance company may be responsible to pay your compensation benefits for only the first 104 weeks of permanent disability.
The Special Fund then pays disability compensation for the duration of your entitlement. However, the employer or insurance company remains liable for paying for your medical treatment related to your injury, and the employer retains the right to challenge the employee’s continuing disability even if the Special Fund is paying the claim.
The Special Fund also may pay compensation and medical benefits when both the responsible employer and its insurance carrier are insolvent or are out of business. Additionally, the Special Fund pays the cost of vocational rehabilitation services authorized by the OWCP in appropriate cases.
If you currently receive benefits from the Special Fund and need to report a change of address, you should contact your local district office because it maintains your claim records. 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.
In some states, 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. You cannot receive any more than the weekly compensation rate under whichever statute would pay you the larger weekly benefit.
Other states prohibit receiving compensation under the state workers’ compensation system if LHWCA benefits are payable. This is true for Virginia as of July 1, 2012.
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.
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.
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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.
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.
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.
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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.
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: http://www.gsa.gov/portal/content/100715
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.
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.
You, your attorney, the employer, or insurance company may request that the OWCP district office evaluate you for vocational rehabilitation services as soon as your doctor determines that you will be unable to return to your previous job and that you are medically able to participate in vocational rehabilitation activities. You may ask for services by contacting the district office where your claim is administrated. A complete list of the contact information for the district offices can be found at: http://www.dol.gov/owcp/dlhwc/lscontactmap.htm.
No, participation in vocational rehabilitation services is entirely voluntary. However, if you decide not to take advantage of these free services, the employer or insurance company may ask that you be evaluated by a vocational rehabilitation counselor to determine if there are jobs in the open labor market that you can perform. Your compensation may be reduced on the basis of this evaluation.
All insurance-related matters are handled by the DLHWC National Office, Branch of Financial Management, Insurance and Assessment, located in Washington, DC. Address inquiries to the address shown at: http://www.dol.gov/owcp/dlhwc/lscontac.htm.
DISCLAIMER: The OWCP Longshore Frequently Asked Questions and responses (“FAQs”) were created solely to assist employees and employers in gaining a general understanding of portions of the Longshore and Harbor Workers’ Compensation Act (“LHWCA”) and its extension acts. These FAQs may not constitute the complete or official opinion of the Department of Labor, the Office of Workers’ Compensation Programs, or the Division of Longshore and Harbor Workers’ Compensation on any subject. This page does not necessarily contain an exhaustive or current treatment of the LHWCA and its extension acts and should not, under any circumstances, substitute for a party’s own research into the statutory, regulatory, and case law authorities on any given subject addressed by the following FAQs. The FAQs are an informational tool, not a final authority, and should not be cited or otherwise considered an authoritative statement of agency policy.