Entitlement To and Amount of Burial Benefits (D06)

A burial benefit is not considered an income benefit. Texas Labor Code (TLC) Section 401.011(25). If the death of an IE results from a compensable injury that occurred before September 1, 1999, the IC shall pay the lesser of the actual costs incurred for reasonable burial expenses or $2,500. If the death of the IE results from a compensable injury that occurred on or after September 1, 1999, and before September 1, 2015, the IC has to pay the lesser of the actual costs incurred for reasonable burial expenses or $6,000. If the death of the IE results from a compensable injury that occurred on or after September 1, 2015, the IC has to pay the lesser of the actual costs incurred for reasonable burial expenses or $10,000. TLC Section 408.186; 28 Texas Administrative Code (TAC) Section 132.13(b).

If the IE died away from his or her usual place of employment, the person who paid for costs of transporting the IE's body is entitled to reimbursement from the IC. However, the transportation costs as described, are limited to what it would cost to transport the IE's body from the place the IE died to his or her usual place of employment. 28 TAC Section 132.13(c).

Filing a Request for Reimbursement.

A request for payment of burial benefits shall be filed with the IC within 12 months of the date of the death of the IE. Bills showing the amount of burial and transportation costs shall be filed with the request. 28 TAC Section 132.13(a). The IC must either pay or deny the request within seven days of receipt. If the IC denies a claim for burial benefits, the IC must give written notice to the person claiming such benefits and DWC of its denial and the facts supporting such denial. 28 TAC Section 132.13(d).

NOTE: Amendments to 28 TAC Sections 124.2 and 124.3, effective on January 12, 2020, impact the timeframe in which the IC is required to pay or deny a request for payment of burial benefits in certain claims.

For a disease or illness identified by Texas Government Code, Chapter 607, Subchapter B (relating to Diseases or Illnesses Suffered by Firefighters, Peace Officers, or Emergency Medical Technicians), an IC may, under specified circumstances, file a Notice of Continuing Investigation (NOCI) with the IE and DWC. A NOCI must include a statement of all steps the IC has taken to investigate the disease or illness; a list of any claim-specific evidence, releases, or documentation the IC reasonably believes is relevant and necessary to complete its investigation; and contact information for the adjuster. A NOCI may be filed in response to claims for benefits received on or after June 10, 2019. A claim for benefits means the first written notice of injury as provided in 28 TAC Section 124.1.

The IC must file its NOCI within 15 days of its receipt of the notice of injury to postpone the 15-day deadline to initiate benefits or deny the claim. When this occurs, the IC is not required to pay or deny burial benefits within the seven-day period after it receives the payment request, as found in 28 TAC Section 132.13(d). Rather, the IC is required to pay or deny the claim for burial benefits within seven days of the following timeframes:

(1) the date the IC initiated benefits; or

(2) the date the IC filed a notice of denial.

28 TAC Section 124.3(e).

These timeframes may extend beyond seven days after the payment request is received by the IC.

IC Liable for Burial Benefits.

The IE suffered a heart attack. The AP affirmed the ALJ's determination that the IE's death was a result of the compensable heart attack. The IC's argument that reimbursement for burial benefits should be denied was dependent upon its argument that the IE's heart attack was not compensable. Because the IE's death resulted from the compensable injury, the determination that burial benefits should be reimbursed was affirmed by the AP. APD 012383.

The deceased employee was killed when the motorcycle he was riding was struck by another vehicle. The issues in dispute involved whether the employee was in the course and scope of employment at the time of the accident, whether the employee sustained a compensable injury that resulted in his death, and whether the claimant beneficiary was entitled to reimbursement for burial benefits from the IC. The ALJ’s determinations that the employee was not in the course and scope of employment at the time of the accident and that he did not sustain a compensable injury that resulted in his death were reversed and new decisions were rendered by the AP that the employee was in the course and scope of his employment at the time of the accident and that he did sustain a compensable injury that resulted in his death. Because the employee’s injury was found to be compensable, the ALJ’s determination that the claimant beneficiary was not entitled to reimbursement for burial benefits from the IC was also reversed and a new decision was rendered that the claimant beneficiary was entitled to such reimbursement. APD 171936.

IC Not Liable for Burial Benefits.

The IE suffered a heart attack resulting in his death. The ALJ’s determinations finding the heart attack and subsequent death to be compensable were reversed by the AP, which rendered a decision that the IE’s heart attack and death were not compensable. Also at issue in this case was whether the IC was liable to pay burial benefits. Since the IE’s heart attack and death were determined not to be compensable, the AP held that the IC was not liable to pay burial benefits. APD 91009.

Subclaimant Status.

An employer that paid burial expenses has subclaimant status where a claim for burial benefits is made by the employer but has not been paid by the date of the CCH. APD 002026.