GQ Corner

Q. I have a death claim and the date of death is September 23, 2008. I am paying weekly widow benefits and paying 2 dependents.

Paying widow $356.00; Paying dependent $178.00; Paying other dependent $178.00

The widow called me today and stated that she will remarry on July 28, 2017. Please confirm, that once widow remarries, I owe her 104 weeks commuted. But I will continue to pay the dependents $178.00 weekly. Will any additional amount of benefits be owed to the dependents since I no longer will be paying the widow?

A. I am assuming the decedent was not a first responder. If I am correct, then yes, you are correct. (Different death benefit rules sometimes apply to first responders.)

A surviving spouse who remarries will receive a lump sum payment of death benefits equal to two years (104 weeks) of the benefits. If there are dependent children who still qualify for the death benefit after the expiration of the 104 weeks, the entire benefit will be re-distributed and divided equally among the dependent children if there is more than one child.

So you will pay the spouse 104 weeks in a lump sum. Then pay the eligible children $178.00 each after the 104 weeks (two years) expires.

Q. Claimant was placed on return to work light duty on March 21, 2017. Recently the facility had a reduction in census and they had to let some people go and reduce the claimant’s hours. Do I owe her TPB for the hours that she is missing?

A. If she was earning her pre-injury wage while working restricted duty AND if the only reason she is now earning less is b/c of the facility’s reduction then arguably you do not owe TIBs. You will need evidence from the insured establishing that but for the facility’s reduction in hours the employer would have been able to continue providing appropriate restricted duty work at her pre-injury wages.

Q. I have a claimant who is upset with my handling of his claim therefore he sent me an email stating he “refuses” to deal with me any longer and will deal only with the employer (who is self- insured). This all stems from my denial of some of his travel requests. Accordingly, he has been sending DWC-48 travel reimbursement requests directly to the employer instead of the adjuster/TPA firm. He then calls the DWC to complaint about timely response when the employer doesn’t forward them to me immediately.

Is there a section in the statute that states that only an authorized and licensed adjuster can handle worker’s comp claims? In other words, I’m looking for something to quote to the claimant that informs him that the employer cannot handle his claim. I’ve already notified him verbally and in writing of his right to a BRC on any dispute.

A. Rule 134.110 requires that the request be filed with the insurance carrier and that it be done in the manner prescribed by the DWC. Form DWC48’s direction also include that requirement. A self-insured is required under 406.061 to designate a claim administrator. Therefore it is improper and ineffective for the IW to go to the employer instead of the TPA. This is supported further by 409.021(f) and (g) which provide that notice to a self-insured does not start the compensabililty timeclock for a dispute. That only begins when the TPA gets notice.

You should also have a conversation with your self-insured, however, to make sure that anything that the claimant forwards to its attention is brought to your attention promptly so that you can take action on it in a timely fashion.