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This form is used to document the approval of a compromise of a third-party cause of action related to disability or death benefits under the Longshore and Harbor Workers' Compensation Act. It requires
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How to fill out form ls-33 - dol
How to fill out Form LS-33
01
Obtain Form LS-33 from the Department of Labor's website or your local office.
02
Fill in your personal information at the top of the form, including your name, address, and contact information.
03
Provide the details of your employment, including your job title, company name, and duration of employment.
04
If applicable, list any injuries or illnesses related to your employment.
05
Sign and date the form to certify the information provided is accurate.
06
Submit the completed Form LS-33 to the appropriate regional office of the Department of Labor.
Who needs Form LS-33?
01
Individuals seeking compensation for work-related injuries or illnesses.
02
Employees who are filing a claim under the Longshore and Harbor Workers' Compensation Act.
03
Employers who need to report incidents related to work-related injuries or illnesses.
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People Also Ask about
What is a notice of controversion of right to compensation?
A notice of controversion under the DBA is essentially a denial from the employer insurance company denying an injured worker's claim. They file what's called an LS207 form with the Department of Labor and within that form, they list their various defenses and reasons for denial.
What is the LS18 form?
Pre-Hearing Statement. Longshore and Harbor Workers' Compensation.
What is an LS 207?
Instructions: This form may be used by the employer/carrier to controvert the right to compensation. 33 U.S.C. 914(a) requires the employer to pay compensation promptly and without an award unless the right to such. compensation is controverted by the filing of this form.
What is a notice of controversy?
A “Notice of Controversion” is, simply put, a denial of your workers' compensation claim under the Defense Base Act (or a claim under the Longshore and Harbor Workers' Compensation Act).
What does notice of compensation mean?
A Notice of Compensation Payable (NCP), is an acknowledgment letter indicating that a workers' compensation claim has been accepted, by the employer and the insurance company; and the payout of compensation benefits are to begin.
What is Form LS 203?
ls-203 - Employee's Claim for Compensation.
What does "notice of controversion" mean?
I received a form called the Notice of Controversion. What does "Controversion" mean? After receiving notice of the work injury and disability, the employer or insurance carrier may deny responsibility to provide compensation and medical benefits.
What does it mean when a claim has been controverted?
The insurance carrier can contest, or controvert, the claim for a variety of reasons (e.g., the injury was not work-related or the employee is not injured to the extent claimed.) An employer can also request that the insurance carrier contest the claim.
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What is Form LS-33?
Form LS-33 is a document used for reporting claims related to specific employment matters, typically involving compensation and wage-related issues.
Who is required to file Form LS-33?
Employers and employees involved in certain compensation claims under the Longshore and Harbor Workers' Compensation Act are required to file Form LS-33.
How to fill out Form LS-33?
To fill out Form LS-33, you need to provide accurate details about the claimant, employer, nature of the claim, and any relevant supporting documentation to substantiate the claims.
What is the purpose of Form LS-33?
The purpose of Form LS-33 is to formally document and facilitate the processing of compensation claims, ensuring that all necessary information is collected for evaluation.
What information must be reported on Form LS-33?
Form LS-33 must report information such as the claimant's name, employer's details, the nature of the claim, dates of employment, injury details, and any prior claims made.
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