Investigating Dependency: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

When a fatality claim is filed, the claims administrator’s best practice is to immediately investigate the circumstances of both death and dependency. Often, the only dependent of the decedent is the spouse. For the sake of this blog let us presume that a deceased worker is survived only by a fully dependent wife.

The decedent is generally not represented by counsel in the first few weeks following death. This window of time allows the administrator the opportunity for their field investigator to meet with the widow, conduct an interview, and obtain either a written or recorded statement without attorney involvement. When interviewing the widow, it should be explained that following a death, estranged relatives often come out of the woodwork to file claims. It should be further explained that only those financially dependent on the deceased are entitled to death benefits. Therefore, we require the widow’s assistance to identify those individuals who truly are dependents, as opposed to those who are just opportunists. A widow will often cooperate with an investigator, especially if she is appalled at the thought of others seeking to profit from her spouse’s death.

To protect against false claims, it is imperative for the widow to identify all full or partial dependents or to unequivocally state there are no other dependents, other than herself. An itemized list of all immediate family members should be developed and identified by name and relationship. Then, one-by-one, everyone on that list, including parents, adult children, grandchildren, and siblings should be addressed by the widow. She is to comment on the dependency or non-dependency status of each. In addition, cash gifts should be fully explained to rebut any future attempt to reclassify the money as dependency payments. The administrator generally has only one chance at interviewing the widow. Therefore, the investigator needs to be thorough, detailed, and willing to spend the time necessary to do the job right.

In most death cases a widow will eventually retain legal representation, and the very first thing the attorney will do is attempt to increase the value of the claim. An application for death benefits will be filed at the WCAB naming the spouse, along with adult children, grandchildren, parents, and other relatives as full or partial dependents. Once the Application is served, the administrator can respond by providing counsel with a copy of the widow’s statement along with a benefit notice denying dependency status to everyone other than the surviving spouse, based on the widow’s own statement asserting she is the sole dependent.

Let’s stop for a moment and look at what has just happened. By timely obtaining the widow’s statement and by asking the right questions the value of the death claim was determined. Dependency claims filed by opposing counsel on behalf of other family members was rebutted by the attorney’s own client. Little did the widow realize that her statement to the field investigator would be used in the future to rebut dependency claims filed by her own attorney! Employers simply want the truth about dependency, and this is one method of how it is obtained. Trust us when we say, you will not be sorry to add this simple but effective investigation tactic to your claims procedural manual.