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E-mail This PageDOL Form LS-203
| Agency: | OWCP-DLHWC |
| Title: | DLHWC (Longshore) LS-203, Employee's Claim for Compensation |
| Form Description: | DLHWC (Longshore) LS-203, Employee's Claim for Compensation: This form is submitted by the employee or appointed representative making a formal claim for compensation benefits under the Longshore Act due to traumatic injury or occupational illness. A letter delineating the same information may be submitted in lieu of the form. Information from the form will be used to assist in determining entitlement to workers' compensation benefits. The filing of this form does not automatically guarantee entitlement to benefits. |
| OMB Control Number: | 1240-0014 |
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