|November 4, 2008|
Office of Workers' Compensation Programs (OWCP)
Division of Longshore and Harbor Workers' Compensation (DLHWC)
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
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.
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.
(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.