U.S. Department of Labor Office of Workers’ Compensation Programs
Divsion of Longshore and

Harbor Workers’ Compensation
Washington, D.C. 20210

January 3, 2012 NOTICE No.138

TO: ALL AUTHORIZED CARRIERS REPORTING WORKERS’ COMPENSATION
POLICIES THROUGH THE WORKERS’ COMPENSATION INSURANCE RATING
BUREAU OF CALIFORNIA, DELAWARE COMPENSATION RATING BUREAU, INC.,
INDIANA COMPENSATION RATING BUREAU, WORKERS’ COMPENSATION RATING
AND INSPECTION BUREAU OF MASSACHUSETTS, COMPENSATION ADVISORY
ORGANIZATION OF MICHIGAN, MINNESOTA WORKERS’ COMPENSATION
INSURERS ASSOCIATION, INC., NEW JERSEY COMPENSATION RATING AND
INSPECTION BUREAU, NEW YORK COMPENSATION INSURANCE RATING BOARD,
NORTH CAROLINA RATE BUREAU, PENNSYLVANIA COMPENSATION RATING
BUREAU, OR WISCONSIN COMPENSATION RATING BUREAU, AND OTHER
INTERESTED PERSONS

SUBJECT: ELECTRONIC REPORTING OF ISSUANCE OF POLICIES AND
ENDORSEMENTS AND NOTICE OF CANCELLATIONS OF POLICIES PROVIDING
COVERAGE UNDER THE LONGSHORE AND HARBOR WORKERS’ COMPENSATION
ACT

Authorized carriers are required to report the issuance of policies and endorsements under the
Longshore and Harbor Workers’ Compensation Act and its extensions, the Defense Base Act,
Outer Continental Shelf Lands Act and Non-Appropriated Fund Instrumentalities Act, to the
Department of Labor’s Office of Workers’ Compensation Programs (OWCP). 20 CFR §
703.116. The current manner of submission of these reports with respect to Longshore employers
located in California, Delaware, Indiana, Massachusetts, Michigan, Minnesota, New Jersey, New
York, North Carolina, Pennsylvania, and Wisconsin is by mailing a paper, signed original DOL
Form LS-570 to the District Director, OWCP. Effective January 2010, the Form LS-570
(Carrier’s Report of Insurance Issuance) replaced the 3 x 5 index card Form LS-570 (Card
Report of Insurance). The Form LS-570 (January 2010) is accessible, fillable, and printable
online at http://www.dol.gov/owcp/dlhwe/Is-570.pdf. It is not possible to submit the form
electronically, however. The Card Report of Insurance (3 x 5 index card) is no longer accepted.

In addition, carriers are also prohibited from cancelling a policy of insurance under the
Longshore and Harbor Workers’ Compensation Act and its extensions prior to the expiration
date specified in the policy unless the carrier satisfies the notice requirements under the Act and
regulations. 33 U.S.C. § 936(b); 20 C.F.R. § 703.114. To cancel an insurance policy prior to its
specified expiration date, the carrier must provide both the insured and the District Director with
30 days advance notice of the proposed cancellation.

It is our intention to eventually phase out hard-copy reporting to OWCP of policy issuance,
endorsement, cancellation and renewal information and replace it with electronic data


interchange (EDI) to the national office of OWCP’s Division of Longshore and Harbor Workers’
Compensation (DLHWC).

We have authorized the Workers’ Compensation Insurance Rating Bureau of California,
Delaware Compensation Rating Bureau, Inc., Indiana Compensation Rating Bureau, Workers’
Compensation Rating and Inspection Bureau of Massachusetts, Compensation Advisory
Organization of Michigan, Minnesota Workers’ Compensation Insurers Association, Inc., New
Jersey Compensation Rating and Inspection Bureau, New York Compensation Insurance Rating
Board, North Carolina Rate Bureau, Pennsylvania Compensation Rating Bureau and the
Wisconsin Compensation Rating Bureau to act on the industry’s behalf, as Data Collection
Organizations (DCOs), to collect, translate and electronically transmit reports of policy
issuance, endorsement, and notices of cancellation, in approved format to the National Council
on Compensation Insurance, Inc. (NCCD, for EDI transmission to DLHWC. Carriers who
submit Longshore insurance policy data to DLHWC through DCOs/NCCI are not required to
report policy issuance and endorsements to the District Director using Form LS-570.

PLEASE NOTE that with respect to notice of cancellation, electronic submission through EDI
transmission from NCCI to DLHWC does not eliminate the requirements under the Act and
regulations for 30 days advance written notice to the insured of an intended policy cancellation.
To cancel an insurance policy prior to its spécified expiration date, the carrier must provide both
the insured and the District Director with 30 days advance notice. Notice to the District Director
of cancellation may be satisfied by EDI data transmittal from NCCI to DLHWC. The date
indicated in the electronic data field “Cancellation Mailed to Insured Date” will be considered
the date of notice to the District Director. However, notice to the Insured of cancellation must be

delivered to the insured or be sent by mail.

We emphasize that each DCO acts on behalf of the reporting entities to submit this information
by electronic means. The DCOs and the NCCI are not under contract with the US Department of
Labor. Please direct any technical questions to the appropriate DCO.

If you have any questions relating to this notice, please contact Brandon Miller at 202-693-0925

or I idl you for your cooperation.

MIRANDA CHIU
Director
Division of Longshore and Harbor Workers’ Compensation