By: Wesley Heim, Associate, Tampa

Amidst the seemingly constant barrage of fraudulent claims in the Florida’s Workers’ Compensation system, it is quite easy to find oneself jaded. Defending workers’ compensation claims for a living permits a rapid skill-set development of search and destroy for any Claimant who decides to test the waters of dishonesty. However, if you look just below this surface you will see there are plenty of perfectly legitimate claims finding their way to successful resolutions. Aside from causation disputes, there is no class of claims more legitimate than those which stem from a death at work.

As with any area of law, there are myriad exceptions, caveats, and pitfalls associated with the resolution of death benefits claims. These claims tend to carry a particularly heavy emotional weight for overt reasons; however, knowing where to start will assist processing the claims quickly.

Florida Statute § 440.16 provides the framework for compensation in death benefits claims. The statute provides any death causally related to an accident at work within one year of the date of an accident, or within five years of an initial finding of permanent disability, merits the award of death benefits. Benefits payable under Fla. Stat. § 440.16 include:

1. Funeral expenses – up to $7,500.00;
2. Up to $150,000.00 in compensation benefits;
3. Spousal postsecondary student fees.

Funeral expenses must be paid within 14 days of receipt of a bill. In death cases, these benefits are almost always paid, even when there are no dependents in the estate. Compensation benefits cannot be paid at a weekly rate exceeding 66.67 percent of the decedent’s Average Weekly Wage. Specific limitations regarding percentages of any indemnity benefits owed as payable to a spouse, child, parent, or other dependent, or any  combination therefrom are outlined in Fla. Stat. § 440.16. Educational expenses are payable to a surviving spouse; however, limitations exist including: credit-hour caps, limitations depending on the type of educational facility, a seven year post-death cut off, and continuous enrollment requirements of the beneficiary.

Dependents

Whether an individual is considered a dependent of the decedent is determined by a variety of factors. Natural children as part of a marriage are presumed to be dependent. Theis v. Miami, 564 So. 2d 117, 118-119 (Fla. 1990). Adoptive children and other children who are introduced into a valid marriage may also be considered dependents throughout the duration of the marriage. Id. Furthermore, if there is no valid marriage, dependency must be established.

The Florida Supreme Court in Macdon Lumbar Company v. Stevenson, 117 So. 2d 487, 489 (Fla. 1960), has provided a six factor test for use in determination of whether an individual seeking disbursement of death benefits is a valid recipient:

1. The individual is actually ‘dependent’ on the decedent;
2. Dependency existed at the time the decedent passed away;
3. The Decedent made substantial contributions to support them – a mere expectation of future support is not sufficient;
4. Any contributions were made regularly with reasonable expectation they would continue into the future;
5. If a Decedent living with his/her parents contributes to their room and board or similar expenses, the total amount paid by the Decedent must exceed the reasonable costs of his/her living expenses for the parents to be considered dependent;
6. A substantial contribution creating dependency is determined by how much the contribution allowed the receiving party to maintain their standard of living.

This multi-factor examination of dependency is further enhanced by the 1^st DCA’s simple test: Without continued support, would the receiving party’s life be materially altered? General Electric v. De Cubas, 504 So. 2d 1276 (Fla. 1^st DCA 1986). This test is used to decide whether a potential dependent relied “substantially” on the Decedent – a determination which is central to establishing dependency. Id. Dependents are limited to the following classes of individuals as related to the Decedent: spouse, children, parents, brothers, sisters, and grandchildren.  

Once dependency is determined, the disbursement of compensation becomes much clearer. Minor dependents are entitled to compensation benefits until they reach 18 years of age or until benefits have been exhausted (whichever comes first). Full-time students of an accredited educational institution can extend this entitlement until they are 22 years of age with minor exceptions. A thorough ongoing investigation is required as receipt of substantial life insurance proceeds may obviate dependency status. Carroll Steel Erectors v. Alderman, 599 So. 2d 181, 185 (Fla. 1^st DCA 1992).

Termination of Benefits:

Death benefits are payable until $150,000 in benefits have been provided for all modern dates of accident (2003 – present). This statutory cap does not include the $7,500 funeral expense allowance. In the event a spouse receiving death benefits is remarried, Florida Statute 440.16(1)(b)(2) directs a lump sum payment of 26 weeks of benefits subject to the overall $150,000 cap for death benefits. Remarriage and provision of this lump sum to the former spouse does not terminate other dependent’s entitlement to death benefits.

Familiarity with the rules concerning issuance of death benefits in the Florida Workers’ Compensation system is pivotal to an expeditious resolution of these somber claims – one of the few ways you can show compassion for the surviving beneficiaries in the time they need it most.

Wesley Heim | Attorney