Oregon Workers’ Compensation: What Happens if Claimant Passes Away?
In Oregon, when a claimant passes away that may not mean immediate claim resolution. Sometimes additional work up of the claim may be necessary before the claim can close. When a claimant dies the date of death is substituted for the medically stationary date, if claimant’s attending physician has not already established such date. OAR 436-030-0035(8).
Additionally, depending on where the claim is, when claimant dies, surviving beneficiaries may be entitled to benefits as well as have the ability to continue to process the claim.
Death Benefits
If claimant dies while receiving permanent total disability, from any cause, payments will continue to the surviving spouse or children/dependent. ORS 656.208. The surviving beneficiaries of an injured worker are normally entitled to benefits, known as death benefits under ORS 656.204. In Oregon Workers’ Compensation, a beneficiary means an injured worker, and the spouse in a marriage, child or dependent of a worker, who is entitled to receive payments under ORS 656. See ORS 656.005(2)(a). However, under ORS 656.005(2)(b)(A), a beneficiary does not include: a spouse of an injured worker living in a state of abandonment for more than one year at the time of the injury or subsequently. A spouse who has lived separate and apart from the worker for a period of two years and who has not during that time received or attempted by process of law to collect funds for support or maintenance is considered living in a state of abandonment.
These benefits surviving beneficiaries are entitled to include the cost of final disposition of the body and funeral expenses as well as monthly payments. ORS 656.204(1), (2), and (3). Generally, a spouse is entitled to monthly benefits for life but are terminated with a 3-year lump sum payment upon remarriage or cohabitation under certain circumstances. ORS 656.204(2). Children, under the age of 19, are also entitled to monthly benefits. ORS 656.204(4). Benefits to children are extended if they are attending a program of higher education, such as college or vocational training. ORS 656.204(6).
If surviving beneficiaries are receiving benefits, then at least once every two years, the insurer is required to verify all beneficiaries receiving death benefits are alive and remain eligible for benefits. OAR 436-075-0020(3).
Request for Hearing/Notice of Closure
If claimant dies before or after filing a request for hearing or a request for reconsideration, surviving beneficiaries are entitled to pursue the matter to final determination as to all issues presented by the request. ORS 656.218 and ORS 656.268(5)(e). However, in those cases where claimant dies and there are no surviving beneficiaries to receive death benefits, a worker’s estate may request reconsideration of a Notice of Closure. See OAR 436-030-0115(2) and ORS 656.218(4). If a surviving beneficiary or the worker’s estate requests reconsideration of the Notice of Closure, it must be made within 60 days of the date of Notice of Closure. ORS 656.268(5).
As you can see, when a claimant passes away, this does not always mean we can move forward with a simple claim closure. Surviving beneficiaries are entitled to death benefits and are entitled to pursue matters to final determination.
If you had a claimant pass away with an open claim and you have questions regarding how to close the claim while limiting the employer’s exposure, feel free to contact me at or 503-776-5421.
Posted by Daisha Barnes.
