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This form is used to request earnings information from claimants to determine their correct compensation rate under the Longshore and Harbor Workers' Compensation Act.
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How to fill out form ls-426 - dol
How to fill out Form LS-426
01
Obtain Form LS-426 from the relevant website or office.
02
Read the instructions included with the form carefully.
03
Start with the identification section: fill in your name, address, and contact information.
04
Provide the details of the injury or illness, including date and location.
05
Complete the section regarding employment status and job details.
06
Attach any required supporting documentation, such as medical records or incident reports.
07
Review the form for accuracy and completeness.
08
Sign and date the form in the designated area.
09
Submit the completed form to the appropriate authority.
Who needs Form LS-426?
01
Form LS-426 is typically needed by maritime employees who have sustained a work-related injury or illness.
02
It may also be required by employers for reporting purposes under maritime law.
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People Also Ask about
Who is covered under the Longshore and Harbor Workers Compensation Act?
Who is covered by the LHWCA? The LHWCA covers employees in traditional maritime occupations such as longshore workers, ship-repairers, shipbuilders or ship-breakers, and harbor construction workers.
What is the most common workers' comp claim?
Common Causes of Workers' Compensation Claims Strains and Sprains. Strains and sprains are by far the most common on-the-job injury for workers. Cuts and Punctures. Severe Cuts and Lacerations. Overuse or Repetitive Stress Injuries, Including Back Injuries. Fractures.
What is form LS 203?
ls-203 - Employee's Claim for Compensation.
What benefits do longshoremen get?
What are the benefits of the Longshoreman and Harbor Workers Act? The benefits include medical care, disability compensation, and vocational rehabilitation for eligible workers.
Will my workers' comp claim be denied?
If you file a claim for an injury that occurred on the job and your employer states that it didn't happen the way you said in your report, your insurance company can deny the claim. Your employer must agree with your statement for a valid compensation claim.
What is a LS 203 form?
ls-203 - Employee's Claim for Compensation.
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What is Form LS-426?
Form LS-426 is a document used for reporting the amount of compensation received by employees who worked in covered employment under the Longshore and Harbor Workers' Compensation Act (LHWCA).
Who is required to file Form LS-426?
Employers who are liable for compensation under the Longshore and Harbor Workers' Compensation Act (LHWCA) must file Form LS-426 to report payments made to injured employees.
How to fill out Form LS-426?
To fill out Form LS-426, provide the required employer and employee information, detail the compensation paid, including dates and amounts, and submit the form to the appropriate office as instructed in the form's guidelines.
What is the purpose of Form LS-426?
The purpose of Form LS-426 is to ensure compliance with reporting requirements under the LHWCA and to keep accurate records of workers' compensation payments made to employees.
What information must be reported on Form LS-426?
Form LS-426 requires information such as the employer's details, employee's details, compensation amounts, dates of payment, and any other pertinent information related to the compensation claims under the LHWCA.
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