DI 52115: Federal Workers' Compensation (WC) Payments

Effective Dates: 04/19/2011 - Present

BASIC (09-08)

The LHWCA provides compensation and medical care to employees disabled from injuries that occur on the navigable waters of the United States or in adjoining areas used in loading, unloading, repairing or building a vessel. Survivor benefits also are provided if the work-related injury causes the employee's death.

A. Types of LHWCA payments

Injured workers may receive compensation in four categories of disabilities. These are:

permanent total (PT) disability
temporary total (TT) disability
permanent partial (PP) disability, and
temporary partial (TP) disability.

Benefits are paid every 2 weeks and are based on a percentage of the injured employee’s pre-injury average weekly wage.

1. Permanent total (PT) and Temporary total (TT) disability

Benefits for PT and TT disability are calculated at two-thirds of the pre-injury average weekly wage, subject to a maximum amount. An injured employee’s average weekly wage is an average of the earnings over the past 52 weeks. Compensation for permanent total disability is adjusted effective October 1 of each year.

2. Temporary partial (TP) disability

Benefits for TP disability are paid at a rate of two-thirds the average weekly wage loss, based on loss of earning capacity.

The average weekly wage is based on the workers’ earnings in the prior 52 weeks.

3. Permanent partial (PP) disability

PP disability payments are intended to compensate the injured employee for the permanent loss of a body part or bodily function. The compensation for such a loss is based on a pay out schedule specified in the LHWCA. The schedule assigns a certain number of weeks of compensation the injured employee may receive for the compensable loss.

B. Obtaining proof from insurance carrier or self-insured employer

LHWCA payments are generally made by private insurance carriers or self-insured employers. If the injured worker is unable to provide the necessary proof:

Obtain a signed authorization from the worker for permission to release any payment information to SSA.
If unable to locate the address and telephone information for the private insurance carrier or self-insured employer, see DI 52145.005E - Obtaining Verification/Proof from Outside Sources.
Complete a Form SSA-1709, (Request for Workers’ Compensation/ Public Disability Benefits Information). For instructions, see DI 52145.010 - Completion and Receipt of Form SSA-1709; or
Complete a dictated letter with the appropriate field office (FO) or processing center (PC) return address including module or unit designation and the requestor’s name.

NOTE: If extensive information is needed, consider requesting computer printouts showing payment amounts, dates of payment, and the period covered by each payment.

1. FO development

If the case is in the FO, the FO will:

Follow the guidelines in DI 52115.005B. in this section.
Establish a tickle date for 35 days for return of proof.

When the tickle date matures:

Check for any paper responses.
If no response is received, contact the insurance carrier or self-insured employer via telephone.
Document the folder with a complete explanation of the issue that needs to be resolved.
Set a tickle date for another 35 days.

When the proof is received:

Cancel any development control.
Review the master beneficiary record (MBR) and the rest of the electronic record for any necessary adjustments.
Send the disabled worker a complete notice.
Retain proofs following the procedure in DI 52140.001A. - Field Office (FO) Responsibility for Workers’ Compensation/Public Disability Benefit (WC/PDB) Offset.

2. PC development

If the case is in the PC, the PC will:

Follow the guidelines in DI 52115.005B. in this section.
Set a diary date for 35 days for return of proof.
Place the action control record (ACR) in a development holding file (DHF) location. Do not send the ACR to Files In (FIN).

When the diary date matures:

Check for any paper and/or paperless responses. Be sure to check all ACRs regardless of type of event (TOE) levels.
If no response is received, contact the insurance carrier or self-insured employer via telephone.
. Document the paper folder or paperless folder with a complete explanation of the issue that needs to be resolved
Set a diary date for another 35 days.
Place the ACR in DHF. Do not send the ACR to FIN.

When proof is received:

Cancel any develop control.
Review the MBR and the rest of the electronic record for any necessary adjustments.
Send the disabled worker a complete notice.
Retain proofs following the procedure in DI 52140.015 - Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs.

3. No proof available

If unable to verify payments made by the private insurance carrier or self-insured employer, refer to DI 52145.001F. - Obtaining Verification (Proof) of Workers’ Compensation/Public Disability Benefits (WC/PDB).

C. Obtaining proof from DOL Special Fund

Under certain circumstances, LHWCA payments are made via the DOL Special Fund. DOL can only provide information on payments made by the DOL Special Fund. If the injured worker cannot provide proof of the amount of the payments, verify the claim number with the worker to facilitate contact with DOL.

The LHWCA claim number is an 8-digit number with the first two numbers separated from the remaining six by a hyphen (e.g. 01-234567). The first two numbers identify the Department of Labor (DOL), Division of Longshore and Harbor Workers’ Compensation (DLHWC) district office (DO) handling the account when it was first filed.

To obtain proof of these payments:

Send an SSA-1709 (Request for Workers’ Compensation/Public Disability Benefits Questionnaire) to the DLHWC DO where the claimant resided on the date of the injury.
Refer to DI 52145.010 - Completion and Receipt of the Form SSA-1709.

NOTE: DLHWC DO addresses and phone numbers can be located at: http://www.dol.gov/owcp/dlhwc/lscontactmap.htm

In some cases, current proof is also attainable via on-line access to DOL’s website at:

http://www.oalj.dol.gov/HOW.HTM It provides access to Office of Administrative Law Judges and Benefit Review Board decisions for LHWCA and Black Lung benefits. Access can be obtained without a password. This link can also be useful in obtaining lump-sum settlements.

1. FO development

Establish a tickle date for 35 days for return of the proof from DOL.

When the tickle date matures:

Check for any paper responses.
If DOL has not responded, contact the DOL office the request was mailed to.

CAUTION: Make contact with the same office the SSA-1709 was mailed to locate the DOL representative handling the number holder’s (NH) claim.
Document the folder with a complete explanation of the issue that needs to be resolved.

When the proof is received:

Cancel any development control.
Review the master beneficiary record (MBR) and the rest of the electronic record for any necessary adjustments.

NOTE: The proof from DOL is a third party report and therefore, due process is needed prior to any reduction in the disability benefits per GN 03001.015 - Notices Required Before And After Taking A Title II Adverse Action and GN 03001.025 - Processing Third Party Reports. Due process notices are found in NL 00703.511-.NL 00703.513.
Retain proofs following the procedure in DI 52145.015 - Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs
Diary for the next annual increase

2. PC development

Set a diary date for 35 days for return of the proof from DOL and place the action control record (ACR) in a development holding file (DHF) location. Do not send the ACR to FIN. When the diary matures:

Check for any paper and/or paperless responses. Be sure to check all ACRs regardless of type of event (TOE) levels.
If no response is received, contact the DOL office the request was mailed to.

CAUTION: Make contact with the same office the SSA-1709 was mailed to locate the DOL representative handling the worker’s claim.
Document the paper folder or paperless folder with a complete explanation of the issue that needs to be resolved.

When proof is received:

Cancel any develop control
Review the MBR and the rest of the electronic record for any necessary adjustments.

NOTE: The proof from DOL is a third party report and therefore due process is needed prior to any reduction in the DIB benefits. See GN 03001.015 - Notices Required Before And After Taking A Title II Adverse Action and GN 03001.025 - Processing Third Party Reports. Due process notices are in NL 00703.511-.NL 00703.513).
Retain proofs following the procedure in DI 52145.015 - Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs.
Diary for the next annual increase.

3. No proof is available

If unable to verify LHWCA payments:

Use maximum compensation rate if no previous proven rate in file.
If a proven rate is in file, apply the annual cost of living increases. To obtain LHWCA national average weekly rates beginning 1973, use the Department of Labor link: http://www.dol.gov/owcp/dlhwc/NAWWinfo.htm and
http://www.dol.gov/owcp/dlhwc/lsindustrynotices/industrynotice133.htm .
The maximum LHWC benefit is 200 percent of the Average Weekly Wage in the U.S. or the employees’ full weekly wage, whichever is less.
As a last resort convert the LHWCA payment up to the present date because the LHWC rates are subject to change.
Post rates as proven for Interactive computation facility (ICF) processing.
Complete any triennial redeterminations of the ACE that might be due.
Document the master beneficiary record (MBR) with a special message stating the WC payments cannot be proven. Be sure to document the paperless or paper file with all attempts (even unsuccessful attempts) to locate proof.
Diary for the next annual increase.
Send the disabled worker a complete notice.
Send the ACR to FIN.