Longshore and Harbor Workers Comp: Maritime Pharmacy Lien Access

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | March 29, 2026 | 10 min read

Maritime workers covered under the Longshore and Harbor Workers' Compensation Act (LHWCA) face unique medication access challenges. When a third-party negligence claim exists alongside the LHWCA claim, pharmacy liens provide unrestricted prescription access that the LHWCA system's employer-controlled medical benefits cannot guarantee.

A pharmacy lien provides maritime workers in third-party PI cases with immediate, unrestricted medication access that the Longshore and Harbor Workers' Compensation Act (LHWCA) medical benefit cannot consistently deliver. The LHWCA, codified at 33 U.S.C. 901-950, covers longshore workers, harbor workers, ship repairers, and other maritime employees for work-related injuries. When a third party — a vessel owner, a negligent contractor, or a defective equipment manufacturer — caused the injury, the worker can pursue a separate tort claim, and the pharmacy lien attaches to that recovery.

• The LHWCA provides medical benefits including prescriptions under 33 U.S.C. 907, but the employer selects the treating physician and controls the medical treatment plan
• Third-party tort claims are available under 33 U.S.C. 933 when a non-employer party caused the maritime injury — commonly vessel owners under the warranty of seaworthiness or negligent third-party contractors
• LHWCA medical benefits are employer-directed, meaning the employer or its insurer can challenge medication choices, require second opinions, and delay authorization
• LienScripts pharmacy liens operate outside the LHWCA system, providing unrestricted medication access funded by the third-party tort settlement
• LienScripts generates a MERIT (Medication Evaluation & Rationale for Injury Treatment) report for every case, documenting maritime injury medications with pharmacist-verified clinical detail
• According to James Wong, PharmD, founder of LienScripts, maritime injury cases often involve severe trauma — crush injuries, falls, heavy equipment accidents — requiring complex medication regimens that employer-controlled medical programs are slow to authorize

[!KEY] Maritime workers under the LHWCA face employer-controlled medical benefits that can delay or restrict prescription access. When a third-party tort claim exists, the pharmacy lien provides immediate, independent medication access.

Understanding the LHWCA Framework

The Longshore and Harbor Workers' Compensation Act covers employees injured on navigable waters or adjoining areas used for maritime employment — docks, piers, wharves, terminals, and shipyards. The Act provides no-fault compensation including:

Medical benefits (33 U.S.C. 907). The employer must provide all necessary medical treatment, including prescriptions, for the work injury. The employer has the right to select the treating physician, though the employee can request a change.

Disability benefits. Temporary total, temporary partial, permanent total, and permanent partial disability compensation based on the employee's average weekly wage.

Death benefits. Compensation to surviving dependents if the injury results in death.

The LHWCA is administered by the Department of Labor's Office of Workers' Compensation Programs (OWCP), the same agency that administers FECA for federal employees. However, LHWCA claims are handled by a separate division with its own administrative law judges.

Who Is Covered

The LHWCA covers a broad range of maritime workers:

• Longshore workers who load and unload vessels
• Ship repairers, shipbuilders, and ship breakers
• Harbor construction workers
• Marine terminal operators and employees
• Workers at adjoining piers, wharves, and terminals

The Act does not cover seamen (who are covered by the Jones Act) or employees of the United States government (covered by FECA). The distinction matters because the available third-party claims differ by coverage category.

[!TIP] If the injured worker might qualify as a seaman rather than a longshore worker, the Jones Act provides different remedies including negligence claims against the employer. Verify the worker's status before determining the available claims and pharmacy lien strategy.

Third-Party Claims in Maritime Cases

Under 33 U.S.C. 933, an LHWCA-covered worker who is injured by a third party can pursue a tort claim against that party. The LHWCA employer or insurer has a lien on the tort recovery for compensation and medical benefits paid.

Common third-party defendants in maritime injury cases:

Vessel owners. Under the doctrine of unseaworthiness, a vessel owner has an absolute duty to provide a seaworthy vessel. If a longshore worker is injured by an unseaworthy condition — defective equipment, inadequate crew, unsafe vessel structure — the vessel owner is liable regardless of negligence.

Contractors and subcontractors. When multiple contractors work at a maritime terminal or shipyard, a worker employed by one contractor may be injured by the negligence of another contractor's employees or equipment.

Equipment manufacturers. Defective cranes, forklifts, winches, or other maritime equipment that cause injury give rise to product liability claims against the manufacturer.

Property owners. The owner of a dock, pier, or terminal facility may be liable for unsafe conditions on the premises.

Why LHWCA Medication Access Is Problematic

Maritime injuries are often severe. Crush injuries from container operations, falls from heights on vessels, heavy equipment accidents, and exposure to hazardous materials create complex medical needs that require multi-drug regimens.

The LHWCA's employer-controlled medical benefit creates problems in this context:

Employer physician selection. The employer selects the treating physician, who may not specialize in the type of injury the worker sustained. Medication prescribing may be conservative or inadequate.

Authorization delays. The employer or insurer must authorize medical treatment, and complex medication regimens face longer review times. Pain management protocols, specialty medications, and compound prescriptions are frequently delayed.

Disputed claims. If the employer disputes that the injury is work-related or occurred in the course of maritime employment, all benefits including prescriptions may be contested. The dispute goes before an OWCP administrative law judge, a process that can take months.

Section 907 limitations. While 33 U.S.C. 907 broadly requires the employer to provide medical treatment, the employer's obligation extends only to treatment that is reasonable and necessary for the injury. This language gives insurers room to challenge expensive medications.

As Amar Lunagaria, PharmD, LienScripts' Chief Pharmacist explains, maritime injuries disproportionately involve musculoskeletal trauma that requires extended pain management, anti-inflammatory therapy, and nerve pain medications — exactly the drug categories that employer-controlled programs most frequently restrict.

[!KEY] Maritime injuries are typically severe, requiring complex medication regimens. Employer-controlled LHWCA medical benefits are poorly suited to managing these regimens, creating the gap that pharmacy liens fill.

Pharmacy Liens for Maritime Third-Party Cases

The pharmacy lien works the same way in maritime cases as in any third-party PI case. The attorney enrolls the client in the LienScripts program, the patient receives a pharmacy benefit card, and prescriptions are filled at zero upfront cost at participating pharmacies.

The lien attaches to the third-party tort settlement — the unseaworthiness claim against the vessel owner, the negligence claim against the contractor, or the product liability claim against the equipment manufacturer. The lien does not attach to LHWCA compensation benefits.

Settlement allocation in maritime third-party cases:

1. Gross tort recovery (from the third party)
2. Less: attorney fees and costs
3. Less: LHWCA employer/insurer lien (compensation and medical benefits paid)
4. Less: medical liens including pharmacy lien
5. Net to client

The pharmacy lien covers medications the LHWCA employer did not pay for, so there is no overlap with the employer's compensation lien.

Attorney Considerations

Identify all third-party defendants early. Maritime cases often involve multiple potentially liable parties — vessel owners, contractors, manufacturers. The pharmacy lien attaches to the total tort recovery from all defendants.

Document LHWCA medication gaps. Every authorization delay, denial, and restriction from the employer's medical program is evidence in the tort case. The MERIT report creates a clean timeline showing which medications the employer covered and which the lien provided.

Coordinate with the 33 U.S.C. 933 election. The LHWCA requires the employee to either accept comp benefits and assign the tort claim to the employer, or retain the tort claim. If the employee retains the tort claim, the employer has a lien on the recovery. The pharmacy lien is a separate medical lien that does not affect this election.

[!TIP] Maritime injury cases involving vessel unseaworthiness often produce larger tort recoveries than standard negligence cases because the vessel owner's duty is absolute. Larger recoveries provide more room for pharmacy lien satisfaction alongside the employer's compensation lien.

Related Resources

• Workers Comp vs. PI Liens
• Federal Workers Comp (FECA) and Pharmacy Liens
• What Is a MERIT Report?
• Zero Upfront Cost Prescriptions for PI Clients