Elements for

Section 8(i) Applications

____ Complete Form LS-8 Settlement Approval Request

____ Self-sufficient

____ Signed by all parties

____ Contains a brief summary of the facts including:

 date of injury 

 name and address of claimant, all employers, 

insurance carriers and third party administrators

 description of the incident

 description of the nature of the injury

 degree of impairment

 degree of disability

 availability of the type of work claimant can perform

____ Claimant's:

 date of birth

 In death claims, date of death and list of dependents 

with their dates of birth

 work status and ability to work

 educational level, work history, other factors that 

could effect future employability

____ Benefits:

 summary of compensation paid

 average weekly wage

 compensation rate

 a full description of the terms of the settlement

 settlement amount for compensation

 settlement amount for survivor’s benefits

 amount for attorney's fees itemized in accordance 

with Section 702.132 (if claimant was represented by 

more than one attorney, each attorney should itemize 

fees)

____ Contains the reason for the settlement and any issues 

still in dispute

____ Current medical report containing:

 description of injuries relating to impairment

 description of any other unrelated conditions

 date of maximum medical improvement 

 anticipated future disability and needed medical 

treatment

____ Statement of why settlement is adequate

____ Statement that the settlement was not procured under 

duress

____ If medical benefits are covered in settlement:

 an itemized list of amounts paid for medical treatment 

during the three previous years 

 settlement amount for medical treatment 

 an estimate of claimant's need for future medical 

treatment and the cost of the treatment which should 

indicate the inflation factor and/or the discount rate

 information on any collateral sources available to pay 

for future medical expenses

 a statement that the parties have considered Medicare 

requirements

____ If mental disability or incompetence alleged:

 is there medical opinion/report as to claimant's 

capacity to understand the consequences of entering 

into a settlement

 is there an indication that the claimant can administer 

a lump sum settlement

 if the answer to the above is no, is there a court 

appointed guardian or personal representative, 

separate and distinct from the claimant's legal 

counsel
 An Order or Notice of Deficiency will be 

issued by the Department of Labor within 30 

days.

 You must pay the settlement within 10 days 

from the date of the Order and you must file 

Form LS-208 with the Department of Labor 

within 16 days from the date of the last 

payment. Failure to do so will result in 

penalties.

Upload directly to file online:

https://seaportal.dol-

esa.gov/portal/?program_name=LS

Mailing address:

U.S. Department of Labor 

Office of Workers’ Compensation Programs

Longshore and Harbor Workers’ Compensation

400 West Bay Street

Room 63A, Box 28

Jacksonville, FL 32202

Website:

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

A guide to 

preparing a 

complete 

Section 8(i) 

settlement