DLHWC (Longshore) LS-265, Certification of Funeral Expenses
Form Description:
DLHWC (Longshore) LS-265, Certification of Funeral Expenses: This form is submitted by the provider of funeral services to notify the Department of Labor and self-insured employer/insurance carrier of the costs of funeral services for a deceased employee. It is used to determine the amount of funeral expenses allowable in a death case, subject to the maximum allowable.
