(a) In order for a legal beneficiary, other than the subsequent injury fund, to receive the benefits available as a consequence of the death of an employee which results from a compensable injury, a person shall file a written claim for compensation with the Division within one year after the date of the employee’s death.
(b) The claim should be submitted to the Division either on paper or via electronic transmission, in the form, format, and manner prescribed by the Division, and should include the following:
(1) the claimant’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); and
(3) other information, as follows:
(A) a description of the circumstances and nature of the injury (if known);
(B) the name and location of the employer at the time of the injury;
(C) the date of the compensable injury, and date of death; and
(D) other known legal beneficiaries.
(c) A claimant shall file with the Division a copy of the deceased employee’s death certificate and any additional documentation or other evidence that establishes that the claimant is a legal beneficiary of the deceased employee.
(1) If the claim is filed with the Division in paper format, the additional evidence regarding legal beneficiary status shall be filed at the same time as the claim.
(2) If the claim is filed via electronic transmission, the additional evidence regarding legal beneficiary status may be filed separately in paper format and sent either by mail, facsimile, or hand delivery.
(d) Each person must file a separate claim for death benefits, unless the claim expressly includes or is made on behalf of another person.
(e) Failure to file a claim for death benefits within one year after the date of the employee’s death shall bar the claim of a legal beneficiary, other than the subsequent injury fund, unless:
(1) that legal beneficiary is a minor or otherwise legally incompetent;
(2) except as provided by paragraph (3) of this subsection, good cause exists for failure to file the claim in a timely manner; or
(3) for a legal beneficiary who is an eligible parent as defined by § 132.6(e) of this title (relating to Eligibility of Other Surviving Dependents and Eligible Parents To Receive Death Benefits), the parent submits proof satisfactory to the Commissioner of Workers’ Compensation of a compelling reason for the delay in filing the claim for death benefits.
The provisions of this §122.100 adopted to be effective January 25, 1991, 16 TexReg 174; amended to be effective September 12, 2004, 29 TexReg 8560; amended to be effective October 12, 2008, 33 TexReg 8393; amended to be effective March 21, 2010, 35 TexReg 2190.