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November 4, 2008 DOL Home > Find It! By Form > DOL Form

DOL Form LS-207

View ESA-OWCP-DLHWC's Form 1215-0023 Online htm

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Agency:	ESA-OWCP-DLHWC
Title:	DLHWC (Longshore) LS-207, Notice of Controversion of Right to Compensation
Form Description:	DLHWC (Longshore) LS-207, Notice of Controversion of Right to Compensation: This is a required form, submitted by the self-insured employer/insurance carrier in response to a claim. This document notifies the Department of Labor and injured worker that no compensation benefits will be paid to the claimant at that time, pending investigation or because they disagree with some part of or the entire claim.
OMB Control Number:	1215-0023
OMB Expiration Date:	Wednesday, December 31, 2008