GQ Corner
Q: Can we request reimbursement from SIF if a claimant has a second job with a different employer?
A: For a compensable injury that occurs on or after July 1, 2002, Rule 116.11(a)(3) states a Carrier may request reimbursement from the SIF for the amount of income benefits paid to an injured employee attributable to multiple employment and paid pursuant to Labor Code §408.042, which is the section dealing with the DWC-3ME and payment of AWW for multiple preinjury employment.
Q: What is the current cap on burial benefits? Is it $6,000 or has it increased?
A: The burial benefit cap has increased to $10,000 but the DWC has yet to amend Rule 132.13. The rule still reads:
(a) When an employee has died as the result of a compensable injury, a person claiming burial benefits shall file a request for payment of burial benefits and the bills showing the amount of burial and transportation costs incurred. The request and the documentation shall be filed with the insurance carrier within 12 months of the date of death of the employee.
(b) The person who incurred liability for the costs of burial is entitled to receive the lesser of:
(1) the actual costs incurred for reasonable burial expenses; or
(2) $2,500–if burial benefits are paid based on a compensable injury that occurs before September 1, 1999; or
(3) $6,000–if burial benefits are paid based on a compensable injury that occurs on or after September 1, 1999.
(c) The person who incurred liability for the costs of transporting the body of the employee is entitled to be reimbursed for the reasonable cost of transportation if the employee died away from the usual place of employment. The insurance carrier’s liability for transportation costs under this subsection shall not exceed the cost equivalent to transporting the body from the place the employee died to the employee’s usual place of employment.
(d) The insurance carrier shall review each claim for burial benefits. The insurance carrier must either pay or deny the claim within seven days of the date the claim was received by the carrier. If the claim is denied, the insurance carrier must notify the person claiming burial benefits and the Commission in writing of its denial and the facts supporting the denial.
The increase to $10,000 was effective September 1, 2015 pursuant to SB 653. This amount applies to a claim for workers’ compensation burial benefits based on a compensable injury that occurs on or after September 1, 2015.
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