GQ Corner
Q. I have a death claim in which death benefits have been paid to a minor child, but the child has turned 18 years old. The child’s mother explained he is not enrolled in school, but is in fact home-schooled due to medical issues. She stated that due to his condition he will be dependent on her for the rest of his life. What are the rules regarding continuation of DBs in this scenario?
A. Under these facts you have an argument that the beneficiary is no longer entitled to DBs as of his 18th birthday. Here is the analysis.
Regarding the education requirement, Rule 132.8(a) provides as follows: a child, who is eligible to receive death benefits because the child is a minor on the date of the employee’s death, is entitled to receive benefits until the date on which the child turns 18. However, if the child is enrolled as a full-time student in an accredited educational institution on that date, benefits continue as described in subsection (b) of this section.
Subsection (b) then provides that a child, who is eligible to receive death benefits as a full-time student in an accredited educational institution on the date of the employee’s death or on the child’s 18th birthday, is entitled to receive benefits until the earliest of:
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- the date on which the child ceases, for the second consecutive semester (excluding summer semesters), to be enrolled as a full-time student;
- the date on which the child turns 25; or
- the date on which the child dies.
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Importantly, note that subsection (c) mandates that the insurance carrier may request proof that a child eligible for benefits is enrolled as a full-time student in an accredited educational institution; the child shall furnish such proof within 20 days of receiving such request.
Note also Rule 132.4(f), which provides that “a child who is a full-time student at the time of the employee’s death and is less than 25 years old shall submit evidence of enrollment at an accredited educational institution. A child shall only be considered a full-time student if the child meets the educational institution’s requirements for a full-time student in the child’s course of study.” There is no provision for home schooling to qualify under the WC Act or rules.
Regarding a child who is mentally or emotionally disabled, the child would be entitled to DBs under 132.4(d) if they can establish that they are eligible to receive death benefits because the child had a mental or physical handicap and was dependent on the employee because of the handicap on the date of the employee’s death. This arguably means that if the handicap developed after the employee’s death, they could not qualify.
Under Rule 132.4(g), a physically or mentally handicapped child “also shall submit medical evidence of the handicap.”
And, under 132.4(e), once each year, the insurance carrier may request proof that a child eligible under subsection (d) of this section is still mentally or physically handicapped. The carrier shall pay all reasonable medical and travel related expenses incurred in obtaining the requested proof.
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