GQ Corner

Q. I have a general question in regards to death benefits eligibility. We had a fatality claim, which we accepted as compensable and we received a DWC-42 from a person claiming to be a beneficiary. How long do we have to accept or deny the request for benefits? I do not see a timeframe or instructions on the DWC-42 and nothing states a time frame on TDI’s website.

A. You have 15 days from the latest of the following events to either pay death benefits or file a dispute:

1. 1. 1. Receiving the claim for death benefits;
      2. Final adjudication on a compensability/liability dispute;
      3. The expiration of the carrier’s right to dispute compensability/liability.

It sounds like #2 will not be applicable if you are accepting the claim.  Thus, you have 60 days to raise the dispute, so you have 15 days past the 60-day mark, or if the claim for death benefits does not come in during the 60-day period, you have 15 days from whenever the claim for death benefits is filed with the carrier. 

Q. The claimant’s TIBs were terminated via PLN-11 due to no-show for a designated doctor’s exam. The claimant rescheduled the DD appointment and attended the examination. The DD back dated the MMI date that includes the period her TIBs were terminated based on the reason above. Is the claimant owed IIBs for that period based on DD’s report?

A. Under the current statutory provision, only TIBs are affected by non-attendance, not IIBs. As an aside, for the future, you should use the PLN-9, not the PLN-11, under these circumstances.