U.S. DEPARTMENT OF LABOR 

EMPLOYMENT STA?<."'DA1l.Ds AowNISTRATioN 

Office of Workmen's Compensation Programs Washington, D.C. 2021 l 

No. 15 

January 30, 1974 

NOTICE TO INSURANCE CARRIERS AND SELF-INSURED EMPLOYERS 

SUBJECT: 1974 Assessment for the Special Fund Under Amended 

Section 44 of the Longshoremen's and Harbor Workers' 

Compensation Act, as extended 

Attached to this notice is Form LS-513, Report of Payments, upon which your company should report the following information to the 

Office of Workmen's Compensation Programs, for each workmen's 

compensation act listed on the form under which your company made 

any compensation or medical payments during calender year 1973: 

(l) Number of cases on which medical or compensation payments 

were made during 1973; 

(2) Total dollar amount of compensation payments made between 

January l, 1973 and December 31, 1973; and 

(3) Total dollar amount of medical payments made between 

January l, 1973 and December 31, 1973. 

The following payments need not be included in your report: (1) Payments made under the Defense Base Act for which you can reasonably be expected to be reimbursed under the provisions of the War Hazards 

Compensation Act, even though claim for reimbursement has not yet 

been made; and (2) adjusted payments made to beneficiaries for the 

additional amounts authorized by section lO(h)(l) of the Longshore Act, for which insurance carriers and self-insurers will be reimbursed 

by the Department of Labor. The regular payments in all such cases, 

however, should be reported. All other payments for compensation and 

medical benefits should be reported. This includes all payments made 

during calender year 1973, even though the date of injury or death was 

prior to 1973. Do not make any deductions before reporting for any 

compensation or medical benefits which your company recovered as a 

result of a third party action. 

If payments under the District of Columbia Workmen's Compensation Act 

are reported to both the Department of Labor and to the Superintendent 

of Insurance for the District of Columbia, please be certain that the 

amounts reported to this Office for compensation and medical substantially agree with the amounts shown on page 14 of the carrier's annual 

statement which is filed with the Superintendent of Insurance for the 

District of Columbia. You will be asked to explain to this Office any significant discrepancies. 

Inclw:k your mldreu, ZIP code, <1nd file number on "II cme,pondence 
- 2 -

When completing Form LS-513, please make certain that all payments 

are entered in the proper spaces provided on the form. Enter "None" 

in all spaces where no payments were made. The reverse of the form 

must be signed by an officer or official of the company duly authorized to file the report, who has examined the facts reported, and 

certifies that they are true to the best of his knowledge. Printed 

signatures cannot be accepted, and reports bearing them will be 

returned. The,properly completed Form LS-513 should be returned to 

this Office no later than thirty days after receipt of this notice. 

After all reports have been received, this Office will advise you of 

the total amount of estimated needs of the Special Funds for calender 

year 1974 under the Longshore Act and related statutes, and under the 

District of Columbia Act, and of the amount of your company's prorated 

assessment for each fund. 

For further information about submitting the data required by Form 

LS-513, please address inquiries to Mr. John E. Stocker, Acting Deputy Director, Office of Workmen's Compensation Programs, U. S. Department of Labor, Washington, D. C. 20211. You may also call (Area Code 202-

382-1336). 

~,f:J( A ~a< ti. 

HERBERT A. DOYLE, JR. 

Acting Director, Office of 

Workmen's Compensation Programs 

Attachment