Handling of Death Claims—early Identification of Potential Issues and Key Questions to Ask

• Publication year: 2018
• Author: JESUS MENDOZA, ESQ.

Handling of Death Claims—Early Identification of Potential Issues and Key Questions to Ask

JESUS MENDOZA, ESQ.

San Francisco, California

Death claims are often complex and emotionally charged. They present complex issues of law and fact not at play in day-to-day workers' compensation cases. This article defines key terms, examines questions for both defense and applicant to consider in the case while the applicant is still living, and explores key factors to valuation and resolution. The article also discusses key steps to early identification and analysis of case value and exposure and focuses on the discovery questions and legal analysis practitioners must perform.

Key Definitions and Requirements

Death benefits are workers' compensation benefits paid to dependents for an employee's AOE/COE death. In a dependency death claim, the claimants allege that an employee's work either directly or indirectly caused the employee's death. The death is compensable when the decedent's work or a work-related injury is a contributing cause to the death, as reinforced by the seminal case of South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291. When the industrial event is a contributing proximate cause of the death of an employee, the employer is liable, for a date of injury after January 1, 2013, for payment of a death benefit and for burial expense up to $10,000.

Note: The applicant(s) in a dependency death claim are the decedent's surviving dependents. The remainder of this article uses applicant(s) interchangeably with surviving dependent(s). The applicants in a death claim allege that a dependency relationship entitles them to recover for the AOE/COE death.

For recovery, a claimant must fall under the statutory definition of dependent. Labor Code sections 3501 through 3503 define the various terms. Labor Code section 3503 requires that death benefits be paid to persons who are blood relatives and/ or good-faith members of the deceased employee's family or household. Dependency is a finding of fact a judge makes, and it is subject to presumptions.

The total dependency-conclusive presumptions are laid out in Labor Code section 3501 and apply to:

• Natural children born or adopted who either lived with or for whom the decedent was legally responsible for maintenance of, that are either
• under 18, or
• physically or mentally incapacitated from earning
• Spouses at the time of death who earned no more than $30,000 in the 12 months preceding the decedent's death

Labor Code section 3502 further provides that if dependency is not conclusively presumed, it can still be established in total or in part according to the facts.

Partial dependents include persons who can establish "an actual amount annually devoted to his or her support from earnings from the decedent." Atlantic Richfield Co. v. Workers' Comp. Appeals Bd. (Arvizu) (1982) 31 Cal.3d 715, 723. The partial dependent need not show they could not live...