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§ 132.10. Payment of Death Benefits to the Subsequent Injury Fund

(a) If a compensable death occurs and the carrier’s investigation, as described in § 132.17 of this title (relating to Denial, Dispute, and Payment of Death Benefits), has confirmed that the deceased employee has no legal beneficiaries, or if a claim for death benefits is not made in a timely manner, the insurance carrier shall, without order from the Commission, pay to the administrator of the Subsequent Injury Fund (SIF) an amount equal to 364 weeks of death benefits for deposit in the SIF. This payment shall be accompanied by the Employer’s First Report of Injury and the Wage Statement.

(b) If, after a carrier has paid death benefits to all legal beneficiaries, all legal beneficiaries cease to be eligible to receive death benefits prior to the carrier paying a full 364 weeks of benefits, the carrier shall, without order from the Commission, pay the remainder of the 364 weeks of death benefits to the administrator of the SIF. The remainder to be paid to the SIF shall be computed by subtracting the total amount paid, including any applicable remarriage payment, from the 364 weeks of death benefits that the carrier is required to pay. This payment shall be accompanied by the Employer’s First Report of Injury, the Wage Statement, a detailed payment record showing the dates of payments, the amounts of the payments, the payees, the periods of benefits paid, and any other documentation reasonably required by the SIF administrator.

(c) The payments required by subsections (a) and (b) shall be made no later than the seventh day after the latest of:

(1) the day that there has been final adjudication that a death is compensable and/or that the carrier is liable for death benefits (if a denial of compensability or liability had been filed in accordance with § 132.17 and § 124.2 of this title (relating to Carrier Reporting and Notification Requirements and Denials));

(2) the sixtieth day after the carrier received written notice of the injury;

(3) one year after the date of the employee’s death, if no claims of beneficiary entitlement have been made;

(4) the day that beneficiary entitlement disputes are finally adjudicated with the beneficiary being found to not be entitled to death benefits; or

(5) the day that all previously eligible beneficiaries are no longer eligible to receive death benefits.

(d) If a carrier has denied compensability of or liability for a death pursuant to § 124.2 of this title and § 132.17, and no claim of entitlement has been filed by a potential beneficiary by the 60th day after the date the carrier received written notice of the injury/death, the carrier shall provide to the SIF administrator within 14 days: copies of all reports, notices, witness statements, and investigation notes relating to the compensability of the death or the carrier’s liability for payment of death benefits.

(e) If a carrier has disputed compensability of or liability for a death and no claim of entitlement has been filed by a potential beneficiary by the 60th day after the date the carrier received written notice of the injury, the SIF may pursue the issue of compensability or liability through dispute resolution.

(f) The carrier may elect to commute the amount to be paid under subsections (a) and (b) in a lump sum payment. If the carrier does not elect to commute benefits, the Commission may order that the death benefits payable to the SIF be commuted to a lump sum payment. The amount of a commuted payment shall be discounted at the rate established under § 401.023 of the Act compounded annually.

(g) If, after the carrier has paid the death benefits to the SIF, a beneficiary makes a claim for death benefits which the carrier accepts or a final award of the Commission or the final judgment of a court of competent jurisdiction determines that the beneficiary is entitled to the death benefits, the carrier shall pay benefits in accordance with the award or order and request a refund for the amount overpaid to the SIF as provided in § 116.11 (relating to Request for Reimbursement or Refund from the Subsequent Injury Fund).

(h) If no claim for death benefits is filed with the Commission on or before the first anniversary of the death of the employee and the carrier’s investigation has confirmed that the deceased has no legal beneficiaries, it shall be presumed, for the purpose of this section and § 403.007 of the Act only, that no legal beneficiary survived the deceased employee.

(i) The presumption created under subsection (h) of this section does not apply against a minor beneficiary, or an incompetent beneficiary for whom no guardian has been appointed.

(j) The SIF as a potential beneficiary in the case of any fatality may bring or enter into any dispute as a party.

The provisions of this § 132.10 adopted to be effective January 1, 1991, 15 TexReg 7023; amended to be effective March 13, 2000, 25 TexReg 2106.

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At a Glance:

Title:

§ 132.10. Payment of Death Benefits to the Subsequent Injury Fund

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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