Death/Burial Benefit Issues:
When the insurance carrier refuses a request for reimbursement from a subclaimant for compensation or health care provided to the deceased injured worker or beneficiary resulting from a compensable injury. A subclaimant may be a party to an existing proceeding, or may request a proceeding not currently before the Division to address the carrier's liability when an insurance carrier denies a subclaimant's request for reimbursement. A party should be prepared to discuss the following information at a BRC on a death/burial dispute.
DWC Forms
- DWC Form-001, Employer's First Report of Injury or Illness (paper copy if filed electronically).
- PLN 1 or PLN 11, Carrier's Notice of Disputed Issue(s) and Refusal to Pay Benefits, to show carrier's denial of the requested benefit.
- DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC), if conference was requested by the subclaimant.
Additional Information
- Information to support the total amount requested for reimbursement from the insurance carrier was for compensation or health care provided to the injured worker or their beneficiary(s).
Exchange of Information
- Must be exchanged with the Division and other parties per Rule 141.4.
- Must be exchanged no later than 14 days prior to a BRC (5 days if BRC was expedited).
- Bring information that is obtained after the exchange deadline to the conference in sufficient copies for filing and exchanging at the conference.
Definition of Terms
"Injury" means damage or harm to the body, including infections from the injury. See §401.011(26).
"Benefit" means a medical, income, death or burial benefit based on a compensable injury. See 401.011(5).
"Compensable Injury" means an injury in the course and scope of employment. See §401.011(10).
"Course and Scope of Employment" means an activity performed by the injured worker originating in the work of the employer. See §401.011(12).
"Occupational Disease" means a disease or repetitious trauma injury arising from the injured worker's employment. See §401.011(34).
"Repetitive Trauma Injury" means damage to the body from repetitious activities related to the injured worker's employment. See §401.011(36).
"Subclaimant" means any person who has been denied reimbursement from an insurance carrier for compensation or health care provided to an injured worker or their beneficiary. See §409.009.