Go to navigation Go to content
Phone: 619-304-1000
The Turley Law Firm P.C.

What forms do I need for my Defense Base Act claim?

Defense Base Act Forms
“I give you answers to your Defense Base Act questions in simple, easy to understand English. No legal mumbo-jumbo, lawyer talk.”
Defense Base Act Lawyer Bill Turley


Defense Base Act Forms

What forms should I know about for my Defense Base Act case? 

The Defense Base Act (DBA) is an extension of the Longshore and Harbor Workers Compensation Act (LHWCA).  They both use the same forms.  The forms are all in a series.
 
The first two letters for the DBA forms are “LS.” Which stands for Longshore.
 
Then there is a dash and a series of numbers afterwards. For example, “LS-203.”  Which is the “Employees Claim for Compensation.”
 
In this article I discuss each of the important DBA forms. Meaning, the ones that you should know about. I also give you a little insight into each form or a link to an article that discusses the respective form in more detail.
 
I tell you what the forms are for and some important information about the forms.

A word to the wise - Don’t try this at home kids

What you will see is there is potential peril every step of the way when you bring a DBA claim.  All of these forms have potential for disaster if you fill them out incorrectly. It is always better to have your attorney fill out the forms for you.
 
Because, if your attorney signs the form - such as an LS-203 and a mistake is made - it is much harder to impeach you, because you didn’t fill out the form.
 
Some forms you have to sign yourself - like the LS-200 Report of Earnings. Still, having your attorney’s input can be invaluable.
 

I know it sounds like I'm only trying to get you to hire me

I know it sounds all self-serving to tell you repeatedly to hire a DBA lawyer.  But you don't have to contact my office. You just shouldn't think that you can go this alone. 
 
Hey, I realize that lawyers have bad reputations. I get it.
 
If you're worried about having to pay for your lawyer, read this article.  You should never pay your DBA lawyer. The DBA insurance company has to pay your lawyer fees. 
 
If you’re concerned about hiring a DBA lawyer and what will happen - check out this article - 10 DBA Questions.
 
You should also be aware. There are some DBA lawyer that are on the first page of Google, that really don’t know much about the DBA. You need a lawyer that specializes in DBA cases. Seriously.
 
I have a whole section in my 5 Star book - Win Your Defense Base Act Case - that gives you a step by step guide about how to find and choose the right DBA lawyer for you. I strongly suggest you read it BEFORE you hire a lawyer, fill out and sign any of these forms, talk to the adjuster or give a recorded or written statement.
 
Win Your Defense Base Act Case - Bill Turley
5 Stars on Amazon.com

 

I suggest you check out the 5 Star reviews of the book on amazon.com 

Don't do anything until you read my book!!!

Before you do anything related to your DBA case - including, but not limited to - talking to the insurance adjuster, signing any forms (do not sign any forms, releases, etc.!!), giving a statement (don't give a statement!!!), don't hire a DBA lawyer...

 

"It stinks when good people lose their DBA case because they fall for one of the insurance company's tricks or traps. This is why I  give it to you straight. No sugar added.  No lawyer talk, no double talk. Just  old fashioned, unsweetened truth.  So you'll understand how to avoid tanking your case. That's the last thing that you want to do - is lose your case because you made a mistake that's completely avoidable if only you had known."

Bill Turley -  author of the 5 Star book Win Your Defense Base Act Case

 

Defense Base Act Forms

LS-1

Request for Examination and/or Treatment

This is the form that the DBA insurance carrier will send to a physician that is your free choice of physician. It authorizes your medical treatment.
 
If your free choice physician checks the box 7.B. which indicates the doctor has doubts about whether your condition is related to you injury, then you’re got a problem.

LS-18

Pre-Hearing Statement

This is the form that either you or the insurance company will file requesting a trial of you case before a Judge. It’s called a “Hearing” in the DBA world.
 
You will need to have had an Informal Conference before you file this form. You need to make sure that all of the issues in your case are both listed on the LS-18 form and were addressed at the Informal Conference.
 
 
Once the Department of Labor (DOL) Office of Administrative Law Judges (OALJ) receives the LS-18, they will issue a Notice of Hearing and Pre-Hearing Order which places your case on a trial calendar.  For more on this, see below.

LS-200

Report of Earnings

The DBA insurance company will send you this form (it’s called “serve” you this form in legal terms).  You must report all of your earnings that you have made within the time limits on the form.
 
If you fail to fill out this form in a timely manner, your DBA benefits may be suspended.
 
Never, ever fail to report income on this form. The DBA insurance company is hoping that you will not report income so they can impeach you at your trial. Seriously.
 
Further, if you aren’t receiving DBA benefits - then I would consider not responding to this form. Meaning, not filling it out. Of course, talk to your DBA lawyer about this before you take this course.
 
Earnings are defined as:
 
“all monies received from any employment and includes but is not limited to wages, salaries, tips, sales commissions, fees for services provided, piecework and all revenue received from self- employment even if the business or enterprise operated at a loss or if the profits were reinvested.”
 
When in doubt, include monies or income on the form. Or talk to your DBA lawyer about it.

LS-201

Report of Earnings

This is the form for you to file if you are filing your claim within 30 days of the date of your injury.  See the discussion regarding LS-203.

LS-202

Employer’s First Report of Injury or Occupational Illness

If you haven’t filed your injury claim within one year or your occupational disease claim within two years, this is a very important form for you. If this is you, I suggest you listen up.
 
This form must be filled out by your employer (read: the DBA insurance company) following your injury overseas. If your employer has notice of your injury (read: knows of your being injured) and doesn’t file an LS-202, then your statute of limitations is tolled. Meaning, it hasn’t started yet and you can still file your claim.
 
Thus, if there is a potential statute of limitations issue in your case, you need to request the file from the OWCP in order to see if the employer/ DBA insurance carrier actually filed an LS-202.

LS-203

Employee’s Claim for Compensation

This is the claim form that you (read: the Claimant) need to file in order to receive DBA benefits.  There are deadlines about when you must file the claim. These are called statutes of limitation.
 
Again, I strongly suggest that you have your DBA lawyer file this claim for you. I also suggest that you don’t sign your claim form. Instead, have your lawyer sign it for you.
 
Make sure you put every body part that was injured (no matter how small the injury may seem) on the LS-203.  What may seem minor now, in comparison to your other injuries, may end up becoming a serious medical issue.

LS-206

Payment of Compensation Without Award

This is the form filed by the DBA insurance company (by the adjuster) that notifies the DOL that they are providing DBA benefits to you. “Without Award” means that there is no Judges Decision and Order Awarding Benefits. Meaning, the DBA insurance company is paying you DBA benefits “voluntarily.” That is, without a Judge making them pay your DBA benefits.
 

LS-207

Notice of Controversion

The DBA insurance company will file this form when they are denying or contesting your claim.  The DBA insurance companies deny legitimate claims, just like yours, all the time.
 
Two points here. First, check out this article on Notice of Controversions. Second, it is time to lawyer-up, once you receive this form.
 

LS-208

Notice of Final Payment or Suspension of Compensation

This is the form the DBA insurance company files when they are saying that they have paid you all the DBA benefits that you are due.
 
Again, it’s usually time to lawyer-up when you get this form.

LS-262

Claim for Death Benefits

This is the form you file when your family member died while overseas. This form should be filed within one year of an overseas related death from a traumatic event and two years if the death was due to occupational disease. Here is an article on Defense Base Act death claims.

LS-265

Certification for Funeral Expenses
 
This is the form you file in order to receive funeral benefits. If the death is related to being overseas, the DBA insurance carrier is required to pay up to $3,000 in funeral benefits.
 

LS-266

Application for Continuation of Death Benefit for Student

If the deceased had a child that is over 18 and still enrolled in school, they can continue to receive death benefits though the age of 23.

Part B of the form needs to be completed by the school administrator. For example, the college registrar.
 

A few suggestions are in order.

 
First, if you haven’t hired a good, honest DBA lawyer, now is the time to hire one. Today. Like pronto. There is no way you are going to be able to handle your DBA claim from here on out. It’s not going to end well for you.
 
Second, there are going to be many dates and actions that you must take that are stated in the Pre-Hearing Order. You must treat these dates like gospel. Meaning, if you don’t comply with these dates/ deadlines, then you may have your evidence or issues excluded at trial. Not good.
 
Again, go hire a DBA lawyer right now.
 

Need help today?

 

Call us at 619-304-1000  - If you call after regular business hours, when you leave a message, be sure to repeat your name and telephone number twice, so we get it correctly. And be sure to indicate whether it's okay if we respond by text.

 

Text us at 858-281-8008 - Be sure and put "new DBA case" in your text.

 

Or you can leave us a message on this web page.

 

This article isn't legal advice

These discussions and/or examples are not legal advice. All legal situations are different. These testimonials, endorsements, photos and/or discussions do not constitute a guarantee, warranty, or prediction regarding the outcome of your legal matter, or your particular case/ situation. Every case is different. There are any number of reasons why DBA cases are not won and/or are not as successful folks might have hoped for.

Just because we have gotten great results in so many other Defense Base Act cases, doesn't guarantee in particular result in other cases. Including, your DBA case. Every case is different.

William Turley
Connect with me
“When I seek out professional advice, I don’t want B.S., I want it straight up. I figure you do also.”