texas 6796059 640

Compliance Corner: Texas Claims Procedure for Death Benefits

17 Dec, 2023 Frank Ferreri

texas 6796059 640
                               

Austin, TX (WorkersCompensation.com) -- No one wants to see a worker die, but unfortunately, it happens sometimes. When it does, Texas has procedural rules for how benefits are distributed. The following information breaks down those rules.

TopicsRules
FilingFor a legal beneficiary, other than the subsequent injury fund, to receive the benefits available because of the death of an employee that results from a compensable injury, a person must file a written claim for death benefits within one year after the date of the employee's death.
When a carrier receives a claimAn insurance carrier that receives a claim for death benefits must comply with rules governing receipt, records, and notice of death or claim for death.
Form and information requirementsThe claim should be submitted to the division or insurance carrier either on paper or via electronic transmission, in the form, format, and manner prescribed by the division, and should include the following:
(1) The potential beneficiary's name, address, telephone number (if any), Social Security number, and relationship to the deceased employee.
(2) The deceased employee's name, last address, Social Security number (if known), and workers' compensation claim number (if any).
(3) Other information, including --
+ A description of the circumstances and nature of the injury (if known).
+ The name and location of the employer at the time of the injury.
+ The date of the compensable injury and date of death.
+ Other known legal beneficiaries.
Required documentsA potential beneficiary must file with the division or insurance carrier a copy of the deceased employee's death certificate and any additional documentation or other evidence that establishes that the potential beneficiary is a legal beneficiary of the deceased employee.
The required documents or additional evidence may be filed separately either on paper or by electronic transmission.
One claim per personEach person must file a separate claim for death benefits, unless the claim expressly includes or is made on behalf of another person.
DeadlineFailure to file a claim for death benefits within one year after the date of the employee's death bars the claim of a legal beneficiary, other than the subsequent injury fund, unless:
(1) The legal beneficiary is a minor or otherwise legally incompetent.
(2) Good cause exists for failure to file the claim on time.
(3) For a legal beneficiary who is an eligible parent, the parent submits proof satisfactory to the commissioner of a compelling reason for the delay in filing the claim for death benefits.
Case exampleIn Zurich American Insurance Co. v. Diaz, 566 S.W. 3d 297 (Tex. Ct. App. 2018), a worker died after being burned by hot oil while cleaning a fryer in the kitchen where he worked. His surviving spouse filed her claim for benefits more than a year after the worker's death. The surviving spouse argued that the one-year period never began to run because the carrier did not file a report of death, only a report of injury.
According to the court, the law only required the employer to "report an injury that results in the absence of an employee of that employer from work for more than one day" and contained no requirement to file a second report if a properly reported injury later resulted in death.

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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