GQ Corner

Q. We received funeral expenses from the surviving mother.  I know that burial benefits are due within 7 days of receiving the request for reimbursement.  However, since we are still within the 60 day compensability investigation window, but after the 15 day window, are we able to wait until the 60th day to pay this?  I am not sure if I can file a continuing investigation notice, or PLN-11 on the received reimbursement request. In summary, we received a request for death benefits, and we are still investigating the claim to determine if it is compensable, how do we not pay the funeral benefits until the investigation is complete, or must we pay them within 7 days?

A. The Chapter 132 rules are somewhat unclear on this question, and we have yet to get any kind of interpretation from DWC on it. Here is how we advise to handle it.

You have the full 60 days to investigate the death before being liable to pay death benefits. You never have less than 75 days to initiate payment. But burial benefits are not “death benefits” and are treated differently (and they have their own rule, 132.13).

There is no exception under that rule for taking action within seven (7) days by either paying or denying the claim for burial benefits.  Any administrative complaints we have seen against Carriers by DWC in this area have dealt with the failure of the Carrier to take action within seven (7) days.

Note however that the denial can be based on the fact that the claim is still being investigated and a final decision will be made no later than 60 days from the date the claim was received on whatever date.