CHECKLIST FOR DEATH/DEPENDENCY CLAIMS Thomas P. Kieselbach COUSINEAU MCGUIRE CHARTERED Suite 600 1550 Utica Avenue South Minneapolis, MN 55416 Telephone: (952) 546-8400 Fax: (952) 546-0628 Basic information needed. Dependents. Statute of limitations. Computation of benefits. Legislative changes (effective for dates of death on or after April 28, 2000). I. Basic information needed. Date of injury. Date of death. Wage information from employer. Specifics of the injury/death, i.e., causation. Obtain medical records, autopsy report, employment records, and medical bills. Obtain detailed burial expenses information (maximum $15,000.00). Obtain Social Security survivor or other government survivor benefit information. II. Dependents. Single households versus multiple households. Identify dependents, i.e., spouse, children, parents, grandparents, etc. Obtain birth certificates of children. Obtain marriage certificate. Living arrangement of spouse and deceased, i.e., voluntarily living apart. Children. Under the age of 18. Student between 18 and 25 years of age. Child who is physically or mentally incapacitated. Appointment of guardian or conservator for children or incapacitated dependents (Minn. Stat. §176.092). A guardian or conservator is required to be appointed by the attorney representing the dependent. If the attorney does not seek a probate court order appointing a guardian or conservator within 30 days, then it is incumbent upon insurer to notify the attorney representing the dependent of this requirement. If the dependent has no attorney or the attorney fails to seek appointment of a guardian or conservator within 30 days of being notified, the insurer shall seek the appointment in probate court. Persons wholly or partially supported. III. Statute of limitations. Minn. Stat. §176.151(2) 3 years versus 6 years. IV. Computation of benefits. Wage issues. Date of injury controls the wage. Please note that dependency benefits are based upon the weekly wage and daily wage which is determined by the hours normally worked in the employment or industry. Also, pay attention to seasonal, construction and irregularly paid workers (see Minn. Stat. §176.011(3) and (18). Identify appropriate compensation rate. Spouse with no dependent children: 50% of the wage. Spouse with one dependent child: 60% of the wage. Spouse with two or more dependent children: 66-2/3% of the wage. Two or more orphans: 66-2/3% of the wage. One orphan: 55% of the wage. Allocation of benefits. Minn. Stat. §176.111(10) and Rule 5220.2930. Regulatory guidelines for allocation: spouse/one child (84%/16%); spouse/two or more children (75%/25%). Any party may petition for an allocation of benefits pursuant to Minn. Stat. §176.111(10). The petition must be served and filed no later than one year from and after the date of the death. Offset/coordination with government survivor benefits. Minn. Stat. §176.111(21) and Rule 5220.2930(5). Single households versus multiple households. Consult Deskbook for methodology for calculating offset. Wage must be adjusted in connection with the offset. In single households, the offset will be computed only once taking the spouse and dependent children together as one group. V. Legislative changes (effective for dates of death on or after April 28, 2000). The minimum amount of dependency compensation that must be paid is $60,000.00 (Minn. Stat. §176.111(5)). Where there are no persons entitled to monetary benefits of dependency compensation, the estate shall be paid $60,000.00 (Minn. Stat. §176.111(22)). The $25,000.00 payment to the Special Fund has been repealed (Minn. Stat. §176.129(2). Burial expenses are capped at $15,000.00 (Minn. Stat. §176.111(18).