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U.S. Department of Labor Office of Workers’ Compensation Programs 

Division of Federal Employees’,

Longshore and Harbor Workers' Compensation 

Washington, DC. 20210 

REQUIREMENTS FOR AUTHORIZATION TO WRITE INSURANCE UNDER THE 

LONGSHORE AND HARBOR WORKERS’COMPENSATION ACT AND/OR EXTENSIONS 

The following information and instructions pertain to the 

requirements for authorization to write insurance coverage under 

the Longshore and Harbor Workers’ Compensation Act, and 

extensions, the Defense Base Act, the Outer Continental Shelf 

Lands Act, and the Nonappropriated Fund Instrumentalities Act. 

INFORMATION AND MATERIAL WHICH MUST BE SUBMITTED along with the 

completed Application Form: 

(1) A letter signed by a corporate officer requesting authority

to write coverage, including a statement of the company’s

underwriting intentions;

(2) Most recent Statutory Annual Statement;

(3) Copy of the company Articles of Incorporation;

(4) Copy of the Corporate by-laws;

(5) Copy of the Certificate of Authority issued by a State

insurance department granting authority to write workers’

compensation insurance;

(6) Copy of the most recent examination report of the company

by a State Insurance Commissioner’s office;

(7) Copy of the forms of policies and endorsements that will be

used;

(8) The employer’s Identification Number (EIN) for each

applicant company. This should be furnished in the letter

signed by the corporate officer requesting the authority to

write coverage.
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(9) A certification by the corporate officer stating that the

applicant company will perform the following:

1. Comply with all statutory and regulatory obligations,

including timely paying benefits and reporting information

[Sections 14(a) – (i) and Sections 30 (a) – (f)];

2. Utilize the informal dispute resolution mechanisms in

good faith by raising only issues that are ready for

resolution (i.e. all documentation is available) and sending

representatives who are both prepared and have authority to

resolve disputes;

3. Monitor and be held responsible for the performance in

items 1 – 2 above of their Third Party Administrator (TPA) or

other claims handlers acting on their behalf.

4. Respond to all penalty assessments in a timely manner.

[Sections 14(g), 30(e), and 48a];

5. Comply with data reporting and proof of coverage

processes including submitting each policy and endorsement

issued by the carrier to an employer and providing notice of

cancellation of a contract or policy of insurance to NCCI and

the applicable Independent Rating Bureaus.

6. Comply with annual Industry Notices for Advance and Final

Assessment for the Special Fund, posted on the DLHWC website

at: https://www.dol.gov/owcp/dlhwc/, to ensure timely payment

of Section 44 annual assessments. To the greatest extent

possible, make payments to the Special fund through

Electronic Funds Transfers (EFTs).

7. Provide DLHWC with all information necessary, including

access to the carriers’ automated claims system, for DLHWC to

audit and confirm the accuracy of the carrier’s Report of

Payments (LS-513) and Report of Injury Experience (LS-274).

The statements of fact and supporting evidence shall be verified 

by the notarized oath of the officer of the Applicant Company who 

signs the application. 

All business written under the Longshore and Harbor Workers’ 

Compensation Act, and its extensions, is subject to a security 

deposit. In conjunction with this application, any insurance 

carrier seeking to be exempt from depositing a security with the 

Department of Labor must provide documentation that demonstrates 
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that they have been awarded the highest financial ratings for both 

the current rating year and the immediately preceding year by the 

following rating organizations: the A. M. Best Company; Standard & 

Poor's; and Fitch Ratings. NOTE: The highest available rating by

the A. M. Best Company is “A++”, Standard & Poors is “AAA” and 

Fitch Ratings is “AAA”.

In any state where the state guarantee, or analogous, fund will 

not fully protect all of the Longshore obligations of an insolvent 

carrier, insurance carriers will be required to post security to

secure these obligations. Security must be in the form of a 

surety bond issued by a surety company holding a Certificate of 

Authority from the U.S. Treasury Department as acceptable sureties 

on federal bonds, or a deposit of fully guaranteed negotiable 

securities with a Federal Reserve Bank, or a bank issued letter of 

credit from an approved bank. 

This request will also be considered for waiver for all business 

written through the National Reinsurance Pool operated by the 

National Council on Compensation Insurance or any other assigned 

risk pool providing full protection for Longshore Act benefits. 

Finally, this waiver request will also be considered on receipt of

supporting documentation demonstrating that the company is a state 

insurance fund or agency of the state government with the full 

faith and credit of the state. 

The request and supporting information should be sent to the 

following address: 

U.S. Department of Labor 

OWCP/DFELHWC, Room S-3229

200 Constitution Ave., NW

Washington, DC 20210

ATTN: Cheryl Jordan 

For further information, please contact Cheryl Jordan at (202) 

354-9634. 

Director,

Division of Federal Employees’,

Longshore and Harbor Workers' Compensation