Who can get death benefits?

When a person dies due to a work-related injury or illness, certain family members may be able to get death benefit payments. The family members who can get death benefits are called beneficiaries. Beneficiaries include:

• The wife or husband of the person who died.
• Children and stepchildren of the person who died. Children who are 17 or younger and children who are 24 or younger and going to school may be able to get death benefits.
• Adult children with disabilities, parents or other family members who depended on the person who died to pay some or all of their bills.
• Non-dependent parents and step-parents in some cases if the person who died did not have a spouse or children.

You must turn in this form to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) or the insurance carrier no later than one year after the employee’s death. After one year, you can only get death benefits if:

• You are requesting benefits for someone 17 or younger.
• You are requesting benefits for a person who is not competent or able to request benefits.
• You can show that you had a good reason for not requesting benefits earlier.

Where do I send this form and what documents are needed?

You can send this form to DWC or the insurance carrier. You must include a copy of the death certificate and documents to show how each person requesting benefits is related to the person who died. Examples include a certified copy of a marriage license, birth certificate, adoption decree, divorce decree, and related court orders. If sending to DWC, use the information below:

Fax: 512-804-4378
Mail: Texas Department of Insurance, Division of Workers’ Compensation
Claims and Customer Services, Mail Code CCS
PO Box 12050
Austin, Texas 78711-2050

Are there any other benefits available?

A person may request up to $10,000 in burial benefits. To request burial benefits, file a claim with the insurance carrier within one year of the employee’s death.

Questions?

If you have questions about death benefits and who can get them, there are many ways you can get help:

• Call DWC at 800-252-7031, Monday to Friday, 8 a.m. to 5 p.m., Central time.
• Call the Office of Injured Employee Counsel at 866-393-6432.
• Talk to your attorney.
• Contact the insurance carrier’s adjuster.
• Review Texas Labor Code Sections 408.181 – 408.187, 409.007 and 28 Texas Administrative Code (TAC) 122.100; 28 TAC 124.8 and 28 TAC Chapter 132 Death Benefits — Death and Burial Benefits.

Note: With few exceptions, on your request, you are entitled to:

• Be informed about the information DWC collects about you.
• Receive and review the information (Government Code Section 552.021 and 552.023).
• Have DWC correct information that is incorrect (Government Code Section 559.004).