U. S. Department of Labor Office of Workers’ Compensation Programs
Division of Longshore and
Harbor Workers’ Compensation
200 Constitution Avenue, Room C-4319
Washington, DC 20210

DATE February 26, 2018
Industry Notice No. 166

TO: LONGSHORE EMPLOYERS, LONGSHORE CLAIMANTS, INSURANCE CARRIERS, SELF-
INSURED EMPLOYERS, AND OTHER INTERESTED PERSONS

SUBJECT: FAX SUBMISSION OF CASE CREATE FORMS AND CHANGE OF MAILING ADDRESS
FOR CENTRAL CASE CREATE SITE

To aid in the efficient administration of the Longshore and Harbor Workers’ Compensation Act
(LHWCA), and its extensions, the Director hereby notifies all parties that effective March 1,
2018, the Division of Longshore Harbor Workers’ Compensation (DLHWC) is decommissioning
the New York District Office's current fax number and replacing it with a program-wide system
for creating new cases through fax submission. The following forms result in DLHWC creating a
new case and are referred to here as “case create” forms:

e LS-201 (Notice of Employee’s Injury or Death)
e LS-202 (Employer’s First Report of Injury or Occupational Illness)
e LS-203 (Employee’s Claim for Compensation)
e LS-262 (Claim for Death Benefits)
1. Effective March 1, 2018, all reports of, and claims for, new injuries may be submitted by

fax. Fax is now DLHWC’s preferred method for receiving “case create” forms. A New Case
Create Fax Number — (202) 513-6814 — has been established for this purpose. Submitting these
forms to DLHWC by fax will have several advantages over more traditional delivery methods.
Fax submission will reduce costs for the sender and speed delivery of the forms to DLHWC.
Receiving the documents via fax also allows DLHWC to more quickly assign an OWCP case file
number to the case.

Important Reminder — Please do not fax any other documents to this fax number. This fax
number is strictly for submitting “case create” documents for cases that have not been previously
assigned an OWCP case file number. Once DLHWC has created a case, you will receive a notice
with the OWCP number, which you should use in submitting other documents.

Guidelines for Submission of Documents via the fax (202) 513-6814. To facilitate efficient and
timely filing and processing of “case create” documents, please adhere to the following
guidelines:

a. Please submit each “case create” form individually. Please do not use a cover sheet.



b. Please do not fax documents in a case that already has an assigned OWCP case number
or that exceed four pages. DLHWC will not accept such submissions via this fax number.

c. Complete all fields on the form legibly, and include the employer and carrier number, if
known.

d. Submit only one copy of a form.

e. Parties are encouraged to submit “case create” forms via fax to (202) 513-6814 and to
avoid duplicate submissions, e.g., do not submit the same documents via fax and mail.

2. Alternatively, if a party prefers to submit a “case create” form by mail, please send it to
this new mailing address:

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
FAX (202) 513-6814

Effective March 1, 2018, “case create” documents should no longer be sent to the New York
District office.

3. After DLHWC creates a case, you may submit all case-specific mail electronically to the
file through the DLHWC's Secure Electronic Access Portal (SEAPortal). (See Industry Notice 148,
issued October 31, 2014). SEAPortal is accessed at the following web address:
https://seaportal.dol-esa.gov. If you prefer to use mail, the address above in Jacksonville
continues to be the “Central Mail Receipt” site, as announced in Industry Notice No. 144, on
November 14, 2013.

4. For specific questions or concerns related to a claim, including questions pertaining to
the creation of a case or the receipt of a document, please contact the district office
administering the claim for assistance. Please do not contact the Central Case Create or Central
Mail Receipt site for assistance unless the New York or Jacksonville DLHWC District Offices are
managing the claim, respectively.

5. Any general questions concerning this Industry Notice may be directed to the DLHWC
Branch of Policy, Regulations and Procedures, Washington, DC. You may also visit our website
(http://www.dol.gov/owcp/dihwc/) to find a list of questions and answers related to this
change.

Le hee’

Director, Division of
Longshore and Harbor Workers’ Compensation