Death of a Claimant for Reasons Unrelated to Their Claim

By Matthew W. Murphy, VBM Attorney

Article written April 17, 2023

It is unfortunate, but it happens…you find out a claimant has passed for reasons unrelated to their claim. While it is certainly not the most important issue for the claimant’s survivors, at some point, a determination needs to be made as to what, if any, benefits are owed to the claimant’s survivors and the process for disbursing those funds and getting an approved stipulation.

The threshold question that needs to be determined is: are any additional benefits owed?  Clearly, there is no further obligation with regard to any future or anticipated medical care pursuant to Section 287.140.  If the employee received authorized medical care which remains unpaid, the employer/insurer remain responsible for payment of those charges.  That debt cannot be shifted to the estate of the deceased employee. Furthermore, the employer/insurer are not responsible for any future or ongoing temporary benefits (TTD/TPD) pursuant to Sections 287.170 or 287.180.  Any past TTD / TPD benefits that had not been paid remain owed.

The question that most often comes up is the whether the employee is entitled to any unpaid PPD or PTD benefits.  The relevant statutory answer to that question is found at Section 287.230.1 which provides:

The death of the injured employee shall not affect the liability of the employer to furnish compensation as in this chapter provided, so far as the liability has accrued and become payable at the time of the death, and any accrued and unpaid compensation due the employee shall be paid to his dependents without administration, or if there are no dependents, to his personal representative or other persons entitled thereto, but the death shall be deemed to be the termination of the disability.

 This section has been interpreted as follows:

The dictionary definition of "accrued" has been defined as “to come into existence as a legally enforceable claim.” A “permanent partial disability” is “a disability that is permanent in nature and partial in degree.” Section 287.190 “The level of permanent partial disability associated with an injury cannot be determined until the injury `reaches a point where it will no longer improve with medical treatment' or, in other words, reaches maximum medical improvement.” Cardwell v. Treasurer of State of Mo., 249 S.W.3d 902, 910 (Mo.App.2008)).

In short, if the employee had not reached MMI for their injury(ies) at the time of the death, then there is likely no further liability for PPD or PTD benefits.  Until the employee reaches MMI the amount of disability cannot be determined.  How much was the employee going to improve due to further medical intervention? Was the employee going to have a bad result from further medical care?  Would the condition have improved over time?  The answers to these questions are unknowable and therefore, the amount of PPD or presence of PTD has not “accrued” or “come into existence.”

However, the notion of “no benefits until MMI” is not without some consideration.  For example, assume an employee suffers an injury to the hand resulting in traumatic amputation of the three fingers and injury to the thumb for which they are receiving therapy.  While the therapy might have restored some amount of function to the thumb, no amount of therapy would replace the fingers.  Section 287.190 provides scheduled benefits for amputation or total loss of use of fingers.  A successful argument could likely be made that benefits up to 110% of each amputated finger has accrued and are owed.  In contrast, the employer/insurer would argue that no compensation for the thumb or hand is owed.  One can be at MMI for some injuries but not others depending on whether the injuries can be separated from each other.

If the employee was at MMI, then the determination would be made as to the disability, whether PPD or PTD.  If PTD, then the compensation would be owed at the weekly rate from the date of MMI to date of death.  According to a recent case, if the claimant would have been owed PPD, then the entire amount of PPD is owed.  However, the court did not answer the question regarding whether the date of death affects the PPD owed.  As practitioners, we often forget that PPD is a weekly benefit like any other in workers compensation.  We pay as a lump sum as a convenience and at the option of the employee: “Notwithstanding the provisions of section 287.190, an employee shall be afforded the option of receiving a compromise settlement as a one-time lump sum payment.  A compromise settlement approved by an administrative law judge, or the commission shall indicate the manner of payment chosen by the employee.” Section 287.390.3.  Theoretically, 10% PPD of the knee could be paid in 16 weekly installments of the claimant’s PPD rate.  I have never come across an employee that has opted for the weekly payments and no insurer would push for that.  HOWEVER, if the PPD would have been 25% BAW and the employee dies two weeks after MMI (assuming the employee did not know he was going to pass), this “option” would not have been exercised.  The way Section 287.390.3 is written, it appears that weekly payments are the default unless the employee exercises the option to receive a lump sum.  Under this scenario, the employer/insurer’s obligation may be limited to 2 weeks of PPD payments rather than the entire 100 weeks that would apply to 25% BAW.

If the deceased employee is entitled to benefits, then they go to the employee’s “dependents.”  Of course, “dependent” has a specific denotation in workers’ compensation.  Dependent includes non-remarried surviving spouse and children (or stepchildren if claimed as dependent on tax returns) up to a certain age depending on certain circumstances.  The identification of “dependents” is beyond the scope of this article.  In such a case, an ALJ can determine who the dependents are for the purpose of settlement of the claim and disbursement of funds.  This can be done through a hearing or as part of a stipulation. If there are no “dependents” then the funds would go to the personal representative.  The personable representative is the administrator of the decedent’s estate.

Obviously, other issues can come up including, whether the death was a natural consequence of the original injury…who qualifies as a dependent…what disability had accrued, etc.  If you have any questions or would like to discuss a specific case, feel free to contact Vessell Bridges Murphy Law Offices.   |   (573) 777-4488  |