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    Danae Hammitt   

Workers' Compensation Death Benefits
Frequently Asked Questions

Effective Jan. 1, 2010, Senate Bill 110 enhances death benefits for surviving family members by expanding the scope of the burial benefit and doubling it to 20 times the state average weekly wage; creating a new benefit for college-aged surviving children; and clarifying that if the worker has no surviving spouse or dependents, the insurer must pay the full remainder of permanent partial disability payments to the worker's estate. (See OAR 436-060-0012.)

We have included some helpful tips we've gathered from working with the industry for processing fatal claims. These suggestions are intended to help you process fatality claims; however, they are not a substitute for following the requirements of statute and rules.

This document will be updated as we receive additional questions. If you have questions about the information contained in this document, please contact the Benefits and Certifications Unit at 800-452-0288.
When a claim has been filed and the worker dies before a compensability determination is made, is the insurer required to accept or deny the claim?
Yes. In all circumstances, the insurer is required to issue a Notice of Acceptance or claim denial for all claims, regardless of the cause of death. The Notice of Acceptance or denial should be addressed to the worker's estate.

If the worker dies after the claim is accepted, but before a Notice of Closure is issued, is the insurer required to close the claim?
Yes. If the claim has been accepted and classified as disabling, the insurer must issue a Notice of Closure, regardless of the cause of death. The Notice of Closure should be addressed to the worker's estate.
  Tip: All permanent partial disability awarded by the Notice of Closure must be paid to the worker's surviving beneficiaries or estate. (See ORS 656.218.)

What other notices are required?
Other notices required under Oregon Administrative Rules chapter 436 intended for the worker are not required when the worker is deceased. (See OAR 436-060-0013(3).)
  Tip: Consider the purpose of the notice. If the notice is intended for the sole use of the worker, it may not be appropriate to send it.
How long does the insurer have to accept or deny a fatal claim?
The insurer has 60 days from the date of knowledge to investigate the accident or cause of death and issue a notice of acceptance or deny the claim.
  Tip: The insurer has 60 days to accept or deny the worker's claim. However, if there are no questions or concerns regarding the compensability, the insurer may want to issue the acceptance notice early. This may alleviate some of the stress the family is dealing with regarding funeral bills and financial responsibilities.

Are interim temporary disability or fatal benefits due prior to the insurer's notice of acceptance or claim denial?
In regard to instant fatality (within 24 hours of the injury), fatal benefits payable to beneficiaries are not due while the claim is in a deferred status. If the claim is accepted for a fatality, the initial payment of fatal benefits to beneficiaries must be paid no later than the 30th day after the notice of acceptance. (See OAR 436-060-0150(8).)

The initial payment must include any fatal benefits due for the deferred period unless previously paid. Subsequent monthly payments to beneficiaries must be made in a predictable monthly sequence. (See OAR 436-060-0150(9).) Fatal benefits are not paid in advance; they are paid after they have accrued.
  Tip: An insurer may begin paying fatal benefits prior to accepting the worker's claim (though it is not required). If compensability is not in question and you're simply gathering additional information before issuing the acceptance notice, you may begin paying fatal benefits. This may be helpful to the worker's family, especially if the worker was the primary or sole wage earner.
  In regard to delayed fatality (more than 24 hours post injury), the insurer should determine if interim temporary disability benefits are due and payable. The first payments of interim temporary disability benefits are due within 14 days of the date of knowledge. (See OAR 436-060-0150(5).) Subsequent interim temporary disability benefits must be paid at least once every 14 days. (See OAR 436-060-0150(6).) Interim temporary disability benefits are due until the date of death or denial. If death is determined to be compensable, eligibility for fatal benefits begins on the date of death.
Is the insurer responsible for paying for the burial or funeral expenses?
If the worker dies as a result of a compensable workers' compensation injury or occupational disease, the insurer is responsible for paying expenses related to the funeral and disposition of the body. The insurer should pay the expenses up to 20 times the state's average weekly wage. (See Bulletin 111 for current amount.)

Funeral establishments are not required to directly bill the insurer. If the insurer receives direct billing for related expenses, it may directly pay the establishment. If the insurer receives a reimbursement request for related expenses, it may directly pay the requestor. Any unpaid balance must be paid to the worker's estate no later than 60 days from date of acceptance.
  Tip: To avoid questions about what expenses have been paid and remain unpaid, the insurer may consider sending a copy of the paid and unpaid bills (invoices) to the worker's estate.

What are the benefits for the surviving spouse and dependents?
Unlike temporary disability benefits, fatal benefits are determined by the state's average weekly wage, not the worker's average weekly wage:

The current total combined monthly benefit for all beneficiaries is $4,643.36. The benefit amounts are adjusted annually, please consult Bulletin 111 for up-to-date information.
  Tip: For high-wage earners, the spousal benefit may be less than 66 2/3 percent of the worker's average weekly wages. The insurer may want to explain this to the surviving spouse so he or she can budget accordingly.

How do I determine whether a dependent is eligible for benefits?

Ask for the following documentation:

Spouse or domestic partner: Marriage certificate, certificate of registered domestic partnership, or divorce decree.
Children: Birth certificate or adoption paperwork
Children in higher education: School records to confirm registration and course load to confirm attending at least half-time status. (see ORS 656.204(8)(c).)
Other dependents: Evidence that the dependent received at least 50 percent of their average monthly support from the worker during the prior 12 months.

If you have questions about this webpage, please contact Danae Hammitt, 503-947-7018.