Printer-Friendly Version
INSTRUCTIONS FOR SUBMITTING FORM LS-513, REPORT OF PAYMENTS, FOR
DETERMINATION OF ASSESSMENT UNDER THE LONGSHORE AND HARBOR WORKERS'
COMPENSATION ACT, AND EXTENSIONS
GENERAL - Pursuant to Section 44 of the Longshore
and Harbor Workers' Compensation Act, all authorized insurance carriers and
self-insured employers under the Longshore Act and extensions, including the
District of Columbia Compensation Act, are required each year to complete and
file with the Office of Workers' Compensation Programs the attached Form
LS-513. The form must be completed to show the number of cases and all
compensation and medical payments made under the Act(s) during calendar year
2007.
NOTE: A detailed listing must be submitted with
the LS-513 supporting the figures and it must contain the following:
(1)Claimants Name (2)OWCP File Number (3)Social Security Number (4)Date of
Injury (5)Indemnity/Medical paid in CY 2007. This report must be mailed to the
Washington D.C. address (on page #2) and should not be sent to the post office
box. This report may also be submitted in an electronic version.
* DEFINITION OF WHAT MUST BE REPORTED ON FORM
LS-513
- All categories of compensation (under Sections 6,8,9, and
44(c)(1) ) paid during calendar year 2007 and reportable on an LS-208 must be
reported on the LS-513. This includes additional compensation under Section
14(e) and (f). Compensation is considered paid when a check is issued and not
when the check is cashed.
- Attorney's fees assessed against the employer/carrier
under Section 28(a) & (b) are NOT considered compensation; however,
attorney's fees which are a lien on compensation under 28(c) are reportable.
- All penalties and interest payable to the claimant ARE considered compensation and therefore reportable.
- Section 8(i) settlements, (including annuities) are fully
reportable as compensation and/or medical in the year paid.
- Reimbursement to employer/carriers on cases where Section
8(f) relief is ultimately granted are NOT to be deducted from total
payments.
- Medical payments should include impartial medical
examinations ordered by OWCP but paid by the employer/carrier. Compensation may NOT be reduced or credited due to actual or anticipated subsequent
events, reversal on appeal, salary continuance, or credit under a State Act. .
- Third party recoveries may NOT be deducted from
payments.
- Compensation may NOT be reduced or credited due to
actual or anticipated subsequent events, reversal on appeal, salary
continuance, or credit under a State Act.
- Under the DISTRICT OF COLUMBIA COMPENSATION ACT only compensation and medical payments made during calendar year 2007 where the
injury date is prior to 7/26/82 should be reported.
- All payments for reimbursement from an excess/reinsurance
Carrier or a national/state assigned risk pool MUST BE REPORTED by the primary
employer/carrier.
- Any payments made directly to claimants by an excess or
reinsurance carrier MUST BE REPORTED by the primary employer/carrier.
- Any payments made under a so-called "deductible" policy
provision MUST BE REPORTED by the insurance carrier that issued the policy.
- Payments made under the DEFENSE BASE ACT must be
reported. No credit is allowed for cases which may be recoverable under the War
Hazards Compensation Act.
- When an employer continues to pay full salary to an
employee, the amount of compensation which is due the claimant must be
reported. Payments must be reported for employees who are disabled and given
sheltered employment during the period of recovery.
- All payments made under state compensation statutes to
concurrent longshore workers must be reported. If the state amount exceeds that
due under Longshore only the lesser amount is reportable. If the state amount
is less than that due under Longshore than both must be reported. Such payments
must be reported even if a formal claim has not been filed under the Longshore
Act and also must be reported if subject to a state assessment formula.
- The employer/carrier is ultimately responsible for
reporting payments correctly. Third party adjusters or other agents are
responsible to their principals for accurate reports. When a third party
supplies the data the principal must sign and attest to the correctness of the
LS-513.
- Medical payments must be reported on all lost time
claims, including hearing loss claims, closed cases, and claims paid under
Section 8(f) and claims where only compensation has been settled under Section
8(i).
- A CORRECT and ACCURATE LS-513 is due by March 5, 2008.
Amendments are discouraged and must submitted by July 1, 2008. Late amendments
may not result in an assessment change.
- If the employer/carrier reports zero ($0) payments a
report must be submitted showing the total payroll for covered Longshore
employees during the calendar year. If there is no payroll the report must
confirm this.
REQUIREMENT FOR CERTIFICATION OF LS-513
Form LS-513, Report of Payments, must be certified as to
the accuracy of the information submitted. This certification must be signed by
an independent certified public accountant. The certification must conform to
the attached format (Attachment #1). The certifying individual cannot be: (1)
an employee of the company submitting the Form LS-513; (2) any subsidiary or
affiliate of that company; (3) anyone affiliated with an organization who
provides claims services to a self insured employer. The certification must be
submitted on the letterhead of the individual or firm performing the audit
The certification need not accompany the filing of Form
LS-513. It must however be submitted no later than 12/31/08 to allow for
certification during each company's annual financial audit.
EXEMPTIONS
The certification requirement applies to all Forms LS-513,
except the following:
(1) Forms LS-513 showing compensation payments less then
$200,000 which need only be signed on the form.
(2) Forms LS-513 submitted by self-insured nonappropriated
fund instrumentalities need not be certified, other than by an official on the
Form LS-513.
Attachment #1
(NAME OF COMPANY)
We have audited the compensation and medical payments (as
defined in the Longshore and Harbor Workers' Compensation Act, and extensions)
included on the accompanying Form LS-513, Report of Payments, of the above
Company for the year ended December 31, 2007. Form LS-513 is prepared for the
purpose of complying with the Longshore and Harbor Workers' Compensation Act
(the "Act") and is the responsibility of the Company's management. Our
responsibility is to express an opinion on Form LS-513 based on our audit.
We conducted our audit in accordance with generally
accepted auditing standards. Those standards require that we plan and perform
the audit to obtain reasonable assurance about whether Form LS-513 is free of
material misstatement. An audit includes examining, on a test basis, evidence
supporting the amounts and disclosures in Form LS-513. An audit also includes
assessing the accounting principles used and significant estimates made by
management, as well as evaluating the overall presentation. We believe that our
audit provides a reasonable basis for our opinion.
In our opinion, Form LS-513 referred to above presents
fairly, in all material respects, the compensation and medical payments made by
the above Company during the year ended December 31, 2007, as defined in the
Act referred to in the first paragraph.
This report is intended solely for the information and use
of the board of directors and management of the above company and the Division
of Longshore and Harbor Workers' Compensation and should not be used for any
other purpose.
_____________________ Signed
_____________________ Date
| |
|