The Longshore Act covers maritime workers, harbor workers, and certain other workers on navigable waters

Benefits include medical treatment, temporary total disability (2/3 of average weekly wage), and permanent disability

You have the right to choose your own treating physician

Workers' Compensationmoderate

Employer's First Report of Injury (Longshore)

LS-202 · U.S. Department of Labor (OWCP)

Employer's First Report of Injury or Occupational Illness under the Longshore and Harbor Workers' Compensation Act. Must be filed within 10 days of injury.

Form Details

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Where to Submit This Form

🌐

OWCP Online Filing (recommended)

https://www.dol.gov/agencies/owcp/dlhwc

File your claim under the Longshore and Harbor Workers' Compensation Act.

📬

Mail to OWCP District Director

Send to the OWCP district office with jurisdiction over your area. Find your office at https://www.dol.gov/agencies/owcp/dlhwc/districtoffices

Filing Deadline

Within 1 year of the injury or within 1 year of the last payment of compensation. Written notice to employer required within 30 days of injury.

Required Attachments

📎 Completed LS-202 Employee's Claim for Compensation
📎 Medical records and treatment documentation
📎 Employer and insurance carrier information

Processing Time

Variable — the District Director will schedule an informal conference to resolve the claim. If unresolved, the case goes to a formal hearing before an ALJ.

What Happens Next

The OWCP District Director will review the claim and attempt to facilitate a resolution. You may be scheduled for an informal conference.

Tips for This Form

✓ The Longshore Act covers maritime workers, harbor workers, and certain other workers on navigable waters
✓ Benefits include medical treatment, temporary total disability (2/3 of average weekly wage), and permanent disability
✓ You have the right to choose your own treating physician
✓ More info: https://www.dol.gov/agencies/owcp/dlhwc

More Workers' Compensation Forms

First Report of Injury (Generic FROI)

FROI · State Workers' Compensation Agencies

Report of workplace injury or occupational disease filed with the state agency and insurer. Required within 3-10 days of injury depending on state. Establishes the claim in the system.

California Workers' Comp Claim Form

DWC-1 · California Division of Workers' Compensation

Employee claim form for workers' compensation benefits in California. Employer must provide within one working day of learning of a workplace injury or illness.

New York Employee Claim

C-3 · New York Workers' Compensation Board

Employee's claim for compensation filed with the NY Workers' Compensation Board. Must be filed within 2 years of the accident or within 2 years of when the claimant knew or should have known the condition was work-related.

Texas Employee's Claim for Compensation

DWC-041 · Texas Department of Insurance, Division of Workers' Compensation

Employee's claim for compensation for a work-related injury or illness in Texas. Must be filed within one year of injury or within one year of when the employee knew or should have known the condition was work-related.

Florida First Report of Injury or Illness

DFS-F2 · Florida Division of Workers' Compensation

Florida's first report of injury or illness form. Employer must file within 7 days of knowledge of an injury or within 24 hours if the injury results in death.

North Carolina Notice of Accident to Employer

Form 18 · North Carolina Industrial Commission

Notice of Accident to Employer and Claim of Employee. Must be filed when injured on the job in North Carolina. Written notice to employer required within 30 days; claim filed within 2 years.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the U.S. Department of Labor (OWCP) or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.