LS-200 Report of Earnings

Under the LHWCA you are required to provide periodic reports to your employer as well as the Department of Labor of any earnings that you have earned in the recent past. You are required to document your earnings on an LS-200 form. The purpose of the LS-200 is to provide information and notice to both your employer as well as the Department of Labor concerning any earnings or wages that you have made during the period covered by the LS-200 form. It is illegal and fraudulent if you falsify an LS-200 form and not only will you be forfeiting your rights under the Longshore Act, but you may also face civil and criminal penalties due to the fraudulent completion of an LS-200 form. If you are requested to complete an LS-200 form, it is very important that you are truthful and honest and that you report all of your earnings on the LS-200 form. You should also know that any earnings which you report may result in a reduction or termination of your Longshore compensation benefits depending upon the amount of the earnings and the rate of your then compensation benefits. The obvious purpose of the LS -200 is to determine if your employer is being given proper credit for any earnings which you have earned in the past.

ls-200 Report of Earnings-click to enlarge