Report a Claim by LS-202
Effective December 1, 2010, USL&H claims can no longer be reported by phone and must be reported using Form LS-202 (Employers First Report of Injury). The completed form should be uploaded via SEAPortal or mailed to the Department of Labor at the following address:
U.S. Department of Labor
Office of Workers’ Compensation Programs
Division of Longshore and Harbor Workers' Compensation
400 West Bay Street, Suite, 63A, Box 28, Jacksonville, FL 32202
A copy of the completed form should also be sent to Gallagher Bassett by email or fax.
Email: AIGDBACLAIMS@gbtpa.com
Fax (New Loss): (833)460-2359
Fax (Correspondence): (833)592-9035