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Office of the Assistant Secretary for Policy

DOL Form LS-203

View OWCP-DLHWC's Form LS-203 Online htm
Title: DLHWC (Longshore) LS-203, Employee's Claim for Compensation
Form Description: DLHWC (Longshore) LS-203, Employee's Claim for Compensation: This form is submitted by the employee or appointed representative making a formal claim for compensation benefits under the Longshore Act due to traumatic injury or occupational illness. A letter delineating the same information may be submitted in lieu of the form. Information from the form will be used to assist in determining entitlement to workers' compensation benefits. The filing of this form does not automatically guarantee entitlement to benefits.
OMB Control Number: 1240-0014