Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.17 - Denial, Dispute, and Payment of Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon being notified of a death resulting
				from an injury, the insurance carrier (carrier) shall: investigate whether the
				death was a result of the injury and, if the carrier has not already done so in
				compliance with §
									124.3
				of this title (relating to Investigation of an Injury and Notice of
				Denial/Dispute) due to the injury being reported separately, conduct an
				investigation relating to the compensability of the death, the carrier's
				liability for the death, and the accrual of benefits. The carrier shall have 60
				days from notification of the death or from written notice of the injury that
				resulted in the death (whichever is greater) to conduct its
				investigation.
(b) If the carrier
				believes that it is not liable for the death or that the death was not
				compensable, the carrier shall file the notice of denial of a claim (notice of
				denial) in the form and manner required by §
									124.2
				of this title (relating to Carrier Reporting and Notification Requirements). If
				the notice of denial is not filed by the 60th day as required, the carrier may
				not raise an issue of compensability or liability and is liable for any
				benefits that accrued and shall initiate benefits in accordance with this
				section.
(c) A carrier that is made
				aware of a death under subsection (a) of this section shall attempt to identify
				all potential beneficiaries, other than the subsequent injury fund (SIF), and
				the carrier shall maintain documentation relating to its attempt to identify
				potential beneficiaries.
(d) A
				carrier that identifies or becomes aware of a potential beneficiary shall
				notify the potential beneficiary of potential entitlement to benefits, using a
				plain language notice containing language and content prescribed by the
				Commission. This notice shall be sent within seven days of the date the carrier
				identified or was otherwise made aware of the identity and means of contacting
				the potential beneficiary.
(e) If
				the carrier receives a claim for death benefits in accordance with §
									122.100
				of this title (relating to Claim for Death Benefits), the carrier shall review
				the evidence provided by the beneficiary to determine whether the person is
				entitled to death benefits as provided in §132.2 through §
									132.6
				of this title (relating to Determination of Facts of Dependent Status;
				Eligibility of Spouse to Receive Death Benefits; Eligibility of a Child to
				Receive Death Benefits; Eligibility of a Grandchild to Receive Death Benefits;
				Eligibility of Other Surviving Dependents to Receive Death Benefits).
(f) If the carrier believes the claimant is
				eligible to receive death benefits, the carrier shall begin payment of death
				benefits. If the carrier believes that the claimant is not eligible to receive
				death benefits, the carrier shall file the notice of dispute of eligibility
				(notice of dispute) in the form and manner required by §
									124.2
				of this title (relating to Carrier Reporting and Notification Requirements).
(1) The carrier shall either begin the
				payment of death benefits or file the notice of dispute not later than the 15th
				day after the latest of:
(A) receiving the
				claim for death benefits;
(B) final
				adjudication of the carrier's denial of compensability or liability under
				§124.2 and subsection (b) of this section; or
(C) the expiration of the carrier's right to
				deny compensability/liability under subsection (a) of this section.