U.S. Department of Labor 

July 14, 2004 

Employment Standards Administration 

Office ol Workers' Compensation Programs 

Division of Longshore and 

Harbor Workers' Compensation 

Washington, D.C. 20210 

File Number: 

INDUSTRY NOTICE No.116 TO INSURANCE CARRIERS AND SELFINSURED EMPLOYERS LONGSHORE AND HARBOR WORKERS' COMPENSATION 

ACT AND EXTENSIONS 

SUBJECT: CY 2004 ASSESSMENT FOR THE SPECIAL FUND, SECTION 44 

OF THE LONGSHORE AND HARBOR WORKERS' COMPENSATION 

ACT. 

On January 27, 2004, pursuant to Section 44 of the Longshore 

and Harbor Workers• Compensation Act, a Notice was sent to 

all insurance carriers and self-insured employers authorized 

under the Act and its extensions (including the District of 

ColUillbia Compensation Act), requesting a report of the 

amount of all compensation and medical payments made during 

calendar year 2003. Form LS-513, Report of Payments, was 

attached to the Notice. This form must be independently 

certified and this certification must be submitted not later 

than December 31, 2004. Please refer to the January notice 

for details and updated requirements for CY 2004. 

All payments made during calendar year 2003 by insurance 

carriers and self-insured employers have now been reported. 

A total of $368,359,339 in compensation payments has been 

reported under the Longshore Act and three extensions, the 

Defense Base Act, the Outer Continental Shelf Lands Act, and 

the Nonappropriated Fund Instrumentalities Act. A total of 

$4,268,280 has been reported under the District of ColUillbia 

Compensation Act for compensation and medical payments in 

cases where the date of injury arose prior to July 26, 1982. 

This Office has determined that for calendar year 2004 a 

total of $137,000,000 is needed for the Special Fund under 

the Longshore Act and extensions(excluding the D.C. Act) and 

a total of $11,000,000 is needed for the Special Fund under 

the District of ColUillbia Act. Proceeds from the Special Fund 

assessment are used for payments under Sections 8(f), l0(h), 

and 18(b) plus other payments provided for under Section 44 

of the Act. 

Working for America's Wbrkfon:-e 
This notice transmits the total amount of your CY 2004 

assessment. The attached billing form shows the calculation 

on which your assessment is based. Under the Longshore Act 

and extensions (except the D.C. Act) the assessment is based 

on (1) the ratio of the amount each carrier or self-insurer 

paid during the prior calendar year for compensation 

benefits in relation to the amount all such carriers and 

self-insurers paid during that period, and (2), the ratio 

of the amount of payments made by the Special Fund 

attributable to each carrier or self-insurer for cases being 

paid under Section 8(f) of the Act during the preceding 

calendar year in relation to the total of such payments. 

The resulting sum of the percentages is divided by two and 

multiplied by the estimated expenses of the Fund. The 

amount paid for the advance assessment is credited against 

the total assessment and the amount now due is shown as the 

last figure. 

Under the District of Columbia Compensation Act the ratio of 

the amount each carrier or self-insurer paid during the 

prior calendar year for compensation and medical benefits in 

relation to the amount all such carriers and self-insurers 

paid during that period is multiplied by the estimated 

expenses of the Fund. 

PLEASE MAKE YOUR CHECK PAYABLE TO THE U.S. DEPARTMENT OF 

LABOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS, AND MAIL IT 

TO: 

Department of Labor - Longshore 

P.O. Box 371088M 

Pittsburgh, PA 15251 

Payment must be received no later than 30 days from the date 

of this Notice. Please provide the Sequence No. and bill No. 

with any payments and include a copy of the bill with all 

checks. Please direct any inquires concerning your 

assessment to Mr. Carl Abildso of this office at (202) 693-

8 

~. 

or F~ _6_9=-1380. 

/ MICHAEL NISS 

Director, Division of Longshore 

and Harbor Workers' Compensation