USL&H Form Instructions

LS -202 – Roles and Responsibilities 

Included below is information regarding how to report your claims, as well as jurisdictionally specific forms such as the LS-202. Previously, when an injury occurred under federal law, United States Longshore & Harbor (USL&H), the Insurance Carriers would assist in filling out and filing the LS-202 with the U.S. Department of Labor. Recent changes enforced by the U.S. Department of Labor require that employers be solely responsible for the completion and filing of the LS-202. 

On USL&H claims, the U.S. Department of Labor requires the employer to submit the LS-202 for any lost time claim within 10 CALENDAR DAYS of knowledge of the claim in order to avoid penalties of up to $22,587. 

Key Risk encourages timely reporting of all claims, whether they are medical only or lost time, to ensure the LS-202 can be filed properly and on time. Please note that if the claim is reported to the U.S. Department of Labor at any point after 10 days of notice of the claim, the potential penalty for not filing the LS-202 timely is the responsibility of the employer. 

It is encouraged for you to file the LS-202 by mail with a date stamp receipt as it must be postmarked by the 10th day. Below is the address for submitting the LS-202: 

United States Department of Labor   
Office of Workers’ Compensation Programs   
Division of Longshore and Harbor Workers Compensation   
201 Varick St., Room 740   
P.O. Box 249 New York, N.Y. 10014-0249 

You also have the option to fax in the LS-202 to 646-264-3002. Please only submit the LS-202 once to avoid duplicates.