Medical Disability Payments
The Longshore and Harbor Workers’ Compensation Act (LHWCA) provides that injured workers receive medical and disability payments, and payments to cover rehabilitation from injuries and vocational rehabilitation from the employer or insurance carrier. Injured employees must notify their employer that their doctor has not cleared them to return to work and how long they will be unable to work. The employee may file a claim with the Office of Workers’ Compensation Programs (OWCP), the Division of Longshore and Harbor Workers’ Compensation (DLHWC).
Once the employer or insurance carrier receives notice of the work injury and disability, they may deny responsibility to provide disability compensation and medical benefits. The LHWCA requires the employer or insurance carrier to file Form LS-207 (Notice of Controversion of Right to Compensation) stating their reasons for denying benefits, and a copy of the form must be provided to the injured employee. The employee then has the option to contact the DLHWC district office servicing the claim to get help receiving benefits. The DLHWC will require supporting documentation including earnings records, wage statements and medical reports for review. Often claims are initially denied because of a lack of proper documentation. The servicing district office can issue a written recommendation based upon the evidence submitted, but that recommendation is not binding on the parties. Either party may disagree with the written recommendation and request a formal hearing before a Department of Labor Administrative Law Judge (AJ). The AJ has the authority to award or deny benefits. In order to request a formal hearing, either party may submit Form LS-18 (Pre-Hearing Statement) to OWCP. Copies must be sent to all other parties at that time.
Injured employees are entitled to reasonable and necessary medical, surgical, and hospital treatment. Medical treatment, unless an emergency, must be authorized by the employer or insurance carrier before it begins. Employees are also entitled to medical supplies and services including diagnostic tests, physical therapy, necessary prescription medications, hearing aids, prosthetics, health care aides, and the travel costs incurred to obtain treatment. There is no time limit on necessary medical benefits for the care and services needed for the work-related injury. Medical benefits also apply to conditions which may arise from the injury or from treatment related to the injury. The injured employee may be reimbursed for reasonable transportation expenses necessary for treatment of the work injury, including mileage, parking, and tolls. Mileage reimbursement is based on the mileage rates effective when the travel occurred. The rates for privately owned vehicles are set by the General Services Administration (GSA). The past and current rates are listed on the GSA website.
If an employee is disabled for more than 3 days, the first compensation payment should be paid within 14 days of the date of the notice of disability. Payment of compensation benefits will not be considered overdue until 14 days after the first payment should have been made, so the employer or insurance carrier really has 28 days to issue the first payment. Once payments begin, they should be paid bi-weekly. Payments will not be made if the employer or insurance carrier files a Notice of Controversion disputing their responsibility for liability payments. If the first compensation check does not arrive within the time provided above, the injured employee should contact the servicing district office for assistance. Additional compensation may be possibly due for the late payment of benefits.
There is a fund known as the “Special Fund,” for payment of certain types of claims and expenses authorized by the LHWCA. Special Fund payments are only made after an application by a self-insured employer or an authorized insurance carrier or by Order of the District Director or AJ. In some cases, an employer or insurance company may only be responsible for paying compensation benefits for the first 104 weeks of a permanent disability. The Special Fund will pay the disability compensation for the duration of the disability. Employers or insurance carriers will remain liable for medical treatment payments related to the disability. The Special Fund also pays compensation and medical benefits in the rare case when both employer and insurance carrier are insolvent or out of business. Payments for the cost of authorized vocational rehabilitation services are made by the Special Fund.
The LHWCA allows an injured employee to receive compensation for the injury under state workers’ compensation rules and the LHWCA. It is possible any payments received under the state system will reduce what the employer must pay under the LHWCA. Some states prohibit receiving state workers’ compensation if LHWCA benefits are payable. Payments to the employee are capped based on whichever statute would pay the larger weekly compensation benefit. An injured employee may receive both Social Security Administration (SSA) payments and LHWCA benefits. SSA may reduce payments based on the amount of workers’ compensation payments the injured employee receives. The SSA should be notified if an injured employee receives both SSA and LHWCA benefits.