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You are here: Home . wc . news . advisories . ad99-03

Advisory 99-03

REVISED FORM TWCC-42, NOTICE OF FATAL INJURY OR OCCUPATIONAL DISEASE AND
CLAIM FOR COMPENSATION FOR DEATH BENEFITS

Effective December 20, 1999, the Commission has adopted a new Form TWCC-42, Notice of Fatal Injury or Occupational Disease and Claim for Compensation for Death Benefits, to provide beneficiaries information regarding the increase in burial benefits set forth in the amendment to Texas Labor Code, §408.186 and amended Rule 132.13. Further, some blocks requesting information have been reconfigured on the form to make it easier for a beneficiary to complete the form.

The recent amendment to §408.186 increases the maximum burial benefit from $2,500 to $6,000. This is the amount an insurance carrier is required to pay for a death which results from a compensable workers' compensation injury. The increased amount is applicable only to a claim for burial benefits based on a compensable injury that occurs on or after September 1, 1999. The amendment to Rule 132.13 similarly reflects this change in the burial benefit amount.

The new form is available in English and Spanish on the Commission's web site at www.tdi.texas.gov. A single copy of the document in English and Spanish may be ordered from TWCC Forms Management at (512)804-4333.

Adopted this 20th day of December, 1999

Leonard W. Riley, Jr., Executive Director

Attachment: Form TWCC-42, Notice of Fatal Injury or Occupational Disease and Claim for Compensation for Death (Rev 12/99)

Distribution: TWCC Staff, Carrier Representatives, Forms Notification



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