How to Fill Out and Submit LS Forms: LS-201, LS-203, and LS-262

To file a Longshore claim, you fill out and submit LS forms through the Department of Labor’s Office of Workers’ Compensation Programs, either by uploading them to the SEAPortal or mailing them to the centralized intake address in Jacksonville, Florida. Which form you use depends on your role in the claim and what stage you’re at: an injured worker starts with the LS-201 notice and follows with the LS-203 claim; a surviving dependent files the LS-262; employers and carriers handle the LS-202, LS-207, and LS-208. Every form has its own deadline, and missing one gives the employer grounds to fight the claim.

Pick the Right LS Form

The Longshore program uses more than a dozen numbered forms, but most claims turn on a short list. Match the form to your role.

If you are the injured worker:

LS-201, Notice of Employee’s Injury or Death, tells your employer in writing that an on-the-job injury or illness happened.
LS-203, Employee’s Claim for Compensation, is what actually requests disability and medical benefits from OWCP.
LS-200, Report of Earnings, comes back to you during the benefit period when DOL, the employer, or the carrier asks what you’ve been earning.
LS-204, Attending Physician’s Supplementary Report, is completed by your treating doctor, not you, but you need to make sure it gets done.

If you are a surviving spouse, child, or dependent, you file the LS-262, Claim for Death Benefits.

If you are the employer or its carrier, the LS-202 reports the injury, the LS-207 formally disputes a claim, and the LS-208 reports the final payment. Blank PDFs of all these forms are on the DOL Longshore Forms page.

Deadlines You Cannot Miss

The Longshore Act imposes strict windows at every stage.

30 days to give notice of injury. You have 30 days from the date of injury to give written notice to your employer and to the District Director in your compensation district. For an occupational disease that doesn’t cause immediate disability, the clock runs from when you became aware, or reasonably should have become aware, of the link between your work and the condition, and the window expands to one year. Late notice is not always fatal. If your employer already knew about the injury, or the District Director finds the employer was not prejudiced by the delay, the claim can still proceed, but those exceptions are risky to rely on.¹

One year to file a formal claim. The LS-203 must be filed within one year of the injury or death. If the employer has been paying you voluntarily without a formal award, the one-year clock restarts from the date of the last payment. For occupational diseases with delayed onset, the deadline stretches to two years from the date you became aware of the connection to your job.²

10 days for the employer’s first report. The employer files the LS-202 within ten days of any injury that causes at least one missed shift, or within ten days of learning about a covered occupational disease.³ Knowingly failing to file can trigger a civil penalty of up to $29,980 per violation.⁴

14 days to controvert. An employer that wants to dispute the claim files the LS-207 within 14 days of learning about the alleged injury, stating the grounds.⁵

16 days after final payment. The employer or carrier files the LS-208 within 16 days of the last compensation payment.⁶

Filling Out the LS-201 (Notice of Injury)

The LS-201 is essentially a one-page notification. Your employer should hand you a blank copy when you report the injury, but you can download it directly from DOL.⁷

Provide your full legal name, Social Security number (required by law), and contact information. Enter the date and hour of the injury and the exact location, including the name of the vessel, pier, or terminal if it applies. Write a clear description of what happened and which body part was injured. List witnesses and the name and address of your treating physician.⁷

If OWCP has already assigned a case number, include it. If you’re filing for the first time, leave that field blank; a case number gets created when your paperwork enters the system. Keep a copy of everything you submit.

Filling Out the LS-203 (Claim for Compensation)

Filing the LS-201 alone does not get you paid. The LS-203 is the form that requests disability payments and medical benefits, and it needs information from several categories.⁸

Employer and Insurance Details

Enter your employer’s full legal name, business address, and the nature of the business, along with the name and address of the employer’s insurance carrier. Getting the carrier wrong is one of the most common problems on this form and can stall payments for weeks. If you’re unsure, ask your employer directly or check the workplace notices they are required to post.

Wage and Employment Information

The form asks for your weekly wages at the time of injury (including overtime), your total earnings during the year before the injury, the number of days per week you usually worked, and how long you worked for the employer. This information feeds the average weekly wage calculation that determines your benefit amount. Report accurately. Overstating wages is fraud; understating them shortchanges your benefits.

Accident and Injury Description

Describe where the accident happened, with street address, city, and the name of any vessel, pier, or terminal. Explain how the accident occurred in enough detail that someone who wasn’t there can follow the sequence. Identify the body part injured and note whether the injury caused permanent disability, amputation, or serious disfigurement. State whether you stopped work immediately, when your pay stopped, and whether you’ve returned to work.⁸

Sign and date the declaration, which states you are claiming compensation for disability or death from a workplace injury and requesting benefits under the Act.⁸

Filling Out the LS-262 (Death Benefits)

Surviving dependents file the LS-262 within one year of the worker’s death, or within two years for occupational disease deaths where the link to employment wasn’t immediately apparent. A surviving spouse must have been living with or dependent on the worker at the time of death. Eligible children include unmarried children under 18, dependent adult children unable to support themselves due to disability, and full-time students up to age 23.⁹

Attach a certified death certificate, proof of marriage (and proof that any prior marriage ended, if applicable), and certified birth certificates or adoption orders for children. If a legal guardian has been appointed for minor children, include certified letters of guardianship. Claimants must also disclose their own income for the year before the death and describe the financial support the deceased provided.⁹

Supporting Forms During Your Claim

LS-200 (Report of Earnings)

If you’re collecting compensation and DOL, the employer, or the carrier sends you an LS-200, complete and return it within 30 days, even if you had no earnings to report. “Earnings” covers wages, salaries, tips, commissions, fees, piecework, and all self-employment revenue, including businesses that operated at a loss. Knowingly omitting or understating earnings can forfeit your right to compensation for the period the report covers.¹⁰

LS-204 (Attending Physician’s Report)

Your treating doctor completes the LS-204 to document the medical evidence behind your claim: diagnosis with subjective complaints and objective findings, treatment provided and expected duration, an opinion on whether the work incident caused the injury and disability, and an estimate of when you can return to limited or regular work. If the injury caused permanent impairment or disfigurement, the physician describes it.¹¹

Make sure your doctor completes this form thoroughly. Vague or incomplete medical evidence is one of the most common reasons claims stall. The causation opinion, confirming that the workplace incident was the “competent producing cause” of your condition, matters most when the employer is likely to dispute the claim.

What the Employer Files

You won’t fill these out, but knowing what your employer owes DOL helps you spot problems.

The LS-202 is the employer’s first report of injury, due within ten days of any injury causing a lost shift.¹² It captures the employer’s business name and address, your identifying information, the cause and nature of the injury, and when and where it occurred. Employers must keep a record of every workplace injury, even those that don’t cause a missed shift.³

The LS-207, Notice of Controversion, is how the employer or carrier formally disputes a claim. Under the Longshore Act, an employer must start paying compensation promptly without waiting for a formal award, unless it controverts. Filing the LS-207 within 14 days relieves the employer of that immediate payment obligation while the dispute plays out. An employer that neither controverts nor pays faces penalties and interest.¹³

The LS-208, Notice of Final Payment, closes out the payment record within 16 days of the last check.⁶

Where to Submit LS Forms

Every LS form goes to DOL through one of two channels: the SEAPortal or centralized mail.

SEAPortal (Online)

The SEAPortal is a web application that lets anyone with internet access upload PDF or TIF documents into an active Longshore case file. You need an official OWCP case number and other identifying information to submit.¹⁴ After you upload, the system returns a tracking number so you can confirm OWCP received the document.¹⁵

If you don’t yet have a case number, which is common on an initial filing, you can’t use the SEAPortal. Submit by mail instead, and a case number will be created when your documents are processed.

Mail

All paper filings go to one centralized address regardless of which district office handles your claim. Do not mail documents to any other DOL office.¹⁶

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

What Happens After You File

Your claim gets assigned to one of three compensation districts (Eastern, Western, or Southern) based on where the injury occurred, and to a District Director within that district.¹⁷ If the employer is not controverting, the first compensation installment becomes due on the 14th day after the employer received notice of the injury or otherwise learned about it, whichever came first.⁵

The District Director tries to resolve disputes early through phone calls, written correspondence, or in-person conferences.¹⁸ If the parties can’t agree, an informal conference is scheduled to narrow the issues and, ideally, produce a settlement. When that fails, the case is referred to an Administrative Law Judge for a formal hearing.¹⁹

1
Office of the Law Revision Counsel. 33 USC 912 – Notice of Injury or Death
2
Office of the Law Revision Counsel. 33 USC 913 – Filing of Claims
3
Office of the Law Revision Counsel. 33 USC 930 – Reports to Secretary
4
eCFR. 20 CFR 702.204 – Employer’s Report; Penalty for Failure to Furnish
5
Office of the Law Revision Counsel. 33 USC 914 – Payment of Compensation
6
U.S. Department of Labor. Form LS-208 Notice of Payments
7
U.S. Department of Labor. Notice of Employee’s Injury or Death
8
U.S. Department of Labor. Employee’s Claim for Compensation
9
U.S. Department of Labor. Claim for Death Benefits
10
U.S. Department of Labor. Report of Earnings (Form LS-200)
11
U.S. Department of Labor. Attending Physician’s Supplementary Report
12
U.S. Department of Labor. Employer Page – Section: Employer Responsibilities
13
U.S. Department of Labor. Notice of Controversion of Right to Compensation
14
U.S. Department of Labor. Division of Longshore and Harbor Workers’ Compensation – Secure Electronic Access Portal
15
U.S. Department of Labor. Claimant/Injured Worker Page
16
U.S. Department of Labor. Our Mailing Address Has Been Centralized
17
U.S. Department of Labor. Division of Longshore and Harbor Workers’ Compensation
18
eCFR. 20 CFR 702.311 – Informal Conferences
19
eCFR. 20 CFR 702.312 – Informal Conferences