Initial entitlement decision - fatality claims

Notification of a worker’s death may be received by any WCB staff member via telephone or correspondence from an employer, Occupational Health & Safety, a family member or another interested party.

Begin the discussion by acknowledging the loss and offering condolences to the caller. Be mindful that the person may be grieving. Approach the conversation with care recognizing that information discussed may be sensitive or difficult for them to talk about.

If the notification is received by a WCB staff member who is not the claim owner, transfer the call to:

• a fatality team member on E40, when there is no existing claim.
• the assigned claim owner when there is an existing claim.

The fatality team member or assigned claim owner completes the Fatal Accident Report and gathers the required information outlined in this step.

When the fatality team member or the assigned claim owner cannot be reached, the WCB staff member continues the discussion with the caller and completes the Fatal Accident report and gather the required information.

During the initial call, be sure to confirm the following details:

• The name of the caller and their relationship to the deceased
• Date of death
• Location of death (e.g., at home, name of hospital or other care facility)
• Cause of death or how the worker passed away, if known (e.g., fatal work accident, suicide, mesothelioma, cancer)
• Name of attending doctor
• Name and contact information (including the address) for the executor or designated person for the estate. If the caller is the executor, ask that they submit a copy of first and last page of the will that confirms the information.
• Name and contact information for the funeral home (if known)

Existing claims

Compare the worker information (e.g., spelling of the worker's name, address, etc.) with any existing open claims.

Confirm if benefits are being paid and review the deceased worker's claim history to determine if there are any other existing open claims with benefits being paid. End all benefits on the claim effective the date of death or month of death, if applicable.

Benefits may include but are not limited to:

Wage loss benefits:

• Temporary total disability (TTD) - end date of death
• Permanent partial disability (PPD) - end month of death
• Permanent total disability (PTD)- end month of death
• Economic loss payment (ELP) - end month of death
• Temporary economic loss payment (TEL) - end month of death
• Earnings loss supplement (ELS) - end month of death

Allowances benefits:

• Home maintenance allowance (HMA) - up to 30 days after date of death
• Housekeeping allowance (HKA) - up to 30 days after date of death
• Personal care allowance (PCA) - up to 30 days after date of death

Note: Returned cheques should be forwarded to the Payment Unit. 

Note: If the notification of the worker's passing is received long after it occurred, an overpayment may occur as the benefits are ended the date of death or month of death. Address and action the overpayment as appropriate. 

Assign the claim, if required

When the information is gathered by a WCB staff member who is not the claim owner:

• Notify the decision maker of the worker's passing for any existing claims where benefits are being paid.
• Assign the claim to the appropriate team desk, if required. The claim assignment may be:
  • The fatality team when the death may be related to a new accident (i.e., does not appear to be related to an established claim) or the worker ended their life.
  • The OD team when the cause of death may be related to an occupational disease or injury.
  • A physical injury team (includes secondary psychological injury claims) for claims with a compensable physical injury and the worker has passed away.
  • A psychological injury team for claims with a compensable psychological injury and the worker has passed away.

For newly established claims, continue to the next step.

For existing claims, continue to step 3.

This step may be completed by an adjudicator or case manager on a physical injury team, OD team or fatality team.

Call the employer to discuss the circumstances of the death. Begin by acknowledging their loss and offering condolences. Approach the conversation with care, recognizing that this may be a very difficult time for the employer and their employees.

Confirm the following information with the date-of-accident employer:

• The official company name including their WCB employer account number.
• The worker and employer information including the worker's name, address, occupation and if the worker was considered an employee, a director or partner in the company, or a proprietor (e.g., truck driver).
• The cause of death or how the fatal accident occurred (e.g., workplace‑related death at the scene of an accident, suicide, death resulting from a work-related medical condition such as an occupational illness/disease).
• The name of the worker's surviving dependent spouse or partner? If the worker was in an adult interdependent relationship, what was the length of the relationship and are there any dependants?
• Whether the worker had dependent children or was a guardian for dependants and how many are under age 18.
• Name of the executor of the will, if known.
• Next of kin contact information.
• A completed C-040 is submitted to the WCB.

Review the deceased worker's claim history to determine if there are any open claims. Compare the worker information (e.g., spelling of the worker's name, address, etc.) on the fatality claim with any existing open claims.  

If there are open claims for the deceased worker, notify the decision maker assigned and end all payments for pensions or allowances on any existing open claims, if required. For information on the type of benefits that end, refer to step 1.

Confirm if:

• Employer is covered under the WCA. Ensure the claim is charged to the employer's account so the claim decision for the fatality can be accepted or not accepted.
• Worker is covered under WCA. Refer to Section 1(1)z of the WCA and Section 7 of the WC Regulation. If not, the fatal claim is not accepted. Send the appropriate letter to offer condolences and explain that benefits being paid on the claim will end, if applicable. Process any outstanding benefits (e.g., Non-economic loss payment (NELP) for permanent clinical impairment (PCI)), if applicable and end this procedure.
• Accident occurred in the province of Alberta. Note: If the accident occurred outside of Alberta and the worker was employed to work outside of Alberta, Section 28 of the Alberta Workers' Compensation Act applies (i.e., the dependent spouse or partner is eligible to elect for compensation in the province of Alberta). Refer to the Alberta residents/employees injured while working outside Alberta section of the 1-1 Initial entitlement decision procedure.
• The claim involved third-party action. If yes, determine if there are any third-party action legal proceedings. Refer to the G-3 Third-Party Actions (wcb.ab.ca) and the Third-party claims section of the 1-1 Initial entitlement decision procedure.

This step may be completed by a case assistant, adjudicator or case manager on a physical or psychological injury team, OD team or fatality team. 

Review the information gathered from the initial call and the circumstances of the worker's passing. Ensure all benefits (e.g., wage loss benefits, allowances) have ended on the existing claim and on all other worker's claims, if applicable. If not, end the benefits on the claim(s) effective the date of death or month of death. Refer to step 1.

If the cause of death is clearly unrelated to the worker's compensable injury (i.e., claim is accepted for an elbow sprain and the worker died from cancer), send the appropriate letter to offer condolences and explain that benefits being paid on the claim will end, if applicable. Process any outstanding benefits (e.g., NELP for PCI), if applicable, and end this procedure.

If the cause of death may be due to the compensable accident or injury, continue with this step to request the required information outlined below.

Request medical death certificate and related medical reports

Request any missing reports or documents such as the medical death certificate, autopsy reports, hospital reports or medical reports from physicians or other treatment providers, police reports, etc. 

If the family was not able to provide information regarding a worker's relevant treatment, consider requesting a Statement of Benefits PaidA Statement of Benefits Paid is a document provided by Alberta Health Services that outlines the medical services and benefits paid on behalf of an individual under the Alberta Health Care Insurance Plan (AHCIP). The statement typically includes the dates and types of services received and the amount billed and paid by the AHCIP.. A copy of the will or a “grant of administrationA grant of administration is a court order that names someone to manage a deceased person's estate when there is no will or the named executor is unable or unwilling to act.” from the courts is needed to support who the executor is or who has the legal authority to act on behalf of the estate.

If there is no will and the family does not have a “grant of administrationA grant of administration is a court order that names someone to manage a deceased person's estate when there is no will or the named executor is unable or unwilling to act.” from the courts, request assistance from the Legal Services department to subpoena Alberta Health Services to obtain the Statement of Benefits Paid.

A medical death certificate is required for all fatal claims because it confirms the cause of death provided by the physician. To request the certificate, the Restricted Application for Vital statistics form must be completed for the province the worker passed away in. This form is not available online and there is no charge for the document in Alberta. A case assistant is able to assist with gathering this document.

For out-of-province medical death certificates, request a copy of the certificate from the executor or family member handling the estate. WCB is not able to request an out-of-province medical death certificates without a letter of authorization from the next of kin. 

When it is not possible to receive a copy of the certificate from the executor or family member, complete the Restricted Application for Vital statistics form, if applicable and submit the request to the Bureau of Vital Statistics for the province. A fee may be required before the out-of-province death certificate can be released.

If the claim is not assigned to a fatality case manager (for a fatality unrelated to an occupational disease) or occupational disease and illness case manager (for a fatality related to an occupational disease), continue to the next step.

If the claim is already being managed by a fatality or occupational disease and illness case manager and:

• Investigation into the cause of death is required, continue to step 5.
• Investigation into the cause of death is not required, continue to step 6. 

Assign the claim to the fatality team to determine if the cause of death is related to a work accident, injury or a compensable medical condition.

Before transferring the claim, ensure any medical reports and the medical death certificate have been requested. Note: These do not need to be on file before transferring the claim.

Complete the following before transferring the claim:   

• Process any outstanding PCI awards.
• Pay all outstanding benefits owing.  
• Update all eCO screens.
• Advise the next of kin that the claim will be transferred to a fatality case manager.

Note: If, at the time of transfer, there are any outstanding appeal issues or entitlement decisions (e.g., allowances, cost relief, etc), under review prior to the worker's fatality, these issues continue to be managed by the non-fatality case manager.

This step may be completed by the fatality case manager or an OD adjudicator or case manager.

Contact the next of kin and/or executor within five business days of learning of the fatality. Begin by acknowledging the loss and offering condolences. Approach the conversation with care, recognizing that this may be a very difficult time for the family.

Confirm if there is a will and obtain the name and contact information for the executor. If there is no will, ask if the family has a “grant of administrationA grant of administration is a court order that names someone to manage a deceased person's estate when there is no will or the named executor is unable or unwilling to act.” or applied to the courts for one to support who has the legal authority to act on behalf of the estate. 

Request one of the following documents to confirm who can act and provide information on behalf of the estate:

• A copy of the will, naming the executor.
• A grant of administrationA grant of administration is a court order that names someone to manage a deceased person's estate when there is no will or the named executor is unable or unwilling to act..
• A grant of probateA grant of probate is a court-issued document that “grants” authority to administer an estate in accordance with a deceased person’s will. Probate does not determine the contents of a will but serves as proof that there is a will and that the process of the will’s execution was valid. Probating is therefore the court process of validating a will..

Note: Only a copy of the first and last page of the will is required to confirm the name(s) of the executor (located on the first page) and the signature of the deceased (located on the last page). Details included within the will are not required for adjudication of the claim and should not be requested.

When there is an existing claim, determine whether the fatality will be adjudicated under that claim or if a new claim is required (e.g., the fatality resulted from a separate work incident). Explain that any benefits the worker was receiving will end effective the date or month of death. 

Confirm information about the worker's dependent family members, if applicable:

• Spouse or partner relationship
  • Name and age
  • Whether the worker had dependent childrenA dependent child is a child from a current or previous marriage, born out of wedlock, a grandchild or any other child to whom the worker stood in the place of a parent, or legally entitled to financial support from the worker, even if the worker was not paying the support and is under the age of 18, or between the ages of 18 to 25 and is a student. .
  • Whether any dependent children under the age of 18 lived with the dependent spouse/partner at the time of the worker's death or whether any student between the ages of 18 to 25 lived with the dependent spouse/partner at the time of the worker's death or at one time lived with the dependent spouse/partner but now lives independently.
  • Whether the worker had any dependent children who did not reside with the surviving dependent spouse/partner at the date of the worker's death.
• Dependent children or other dependants
  • Name of any dependent children and their age(s).
  • If the worker was a guardian for a dependant(s), obtain the name of the dependant(s) and their age.

Discuss the next steps required to determine entitlement for the cause of death and explain:

• That the process for determining if a worker's death can be accepted under WCB legislation may involve gathering sensitive information that may be difficult for them to discuss and may involve requesting reports such as medical reports, the medical death certificate, and autopsy results, if required to determine the cause of death.
• The possible entitlements that may be available if the claim is accepted (e.g., funeral-related expenses up to a maximum, survivor benefits if applicable for the dependent spouse/partner, and/or children,  bereavement counsellingThis counseling is authorized for a maximum of 10 sessions per family member within the 24 month period following the worker's death., etc.). Refer to Policy 04-08 Part II Addendum A - Funeral and Death Expenses and the Funeral and death related expenses section.
• That if the claim is being investigated by the Investigations Unit, the next of kin will be contacted directly by the investigator to provide information.
• If the accident occurred outside the province of Alberta and the worker was employed to work outside of Alberta and the criteria of Section 28 have been met, they have the right to elect in Alberta. If the worker resided outside of Alberta, they may also have the right to elect in the jurisdiction in which the worker resided. Explain that to elect to claim compensation in Alberta, the Right of Election to Claim under the Alberta Act or the Election to Claim Under the Act for Claimants Who Reside Outside Alberta form must be signed and returned to WCB before the claim can be accepted and benefits paid. For federal government claims, the Employer's Report of Injury must have a counter-signature before an entitlement decision can be made.
• A signed medical release form from the executor or the family member with the legal authority to act on behalf of the estate is required to obtain medical records. Note: A “grant of administrationA grant of administration is a court order that names someone to manage a deceased person's estate when there is no will or the named executor is unable or unwilling to act.” is required to confirm the name of the person who has the legal authority to act on behalf of the estate.
• That if there is no will and the family does not have a “grant of administrationA grant of administration is a court order that names someone to manage a deceased person's estate when there is no will or the named executor is unable or unwilling to act.” from the courts, assistance from the Legal Services department may be requested to subpoena Alberta Health Services to obtain the Statement of Benefits Paid.

Explain that regular contact will occur every six weeks throughout the process to keep them informed of the status of the claim. Following the discussion, send a condolence letter and request any outstanding reports that have not already been requested. Monitor for their receipt.

When all of the required information has been received, continue to step 7.

If the required information has not been received and/or assistance is needed to obtain it, continue to the next step.

This step is completed by a fatality case manager.

Submit a referral to the Investigations Unit for assistance in obtaining relevant information about the cause of death such as:

• Activities 48 hours prior to death.
• Details about the circumstance of the death.
• Information on worker’s most recent employment as well as a work history.
• Witness statements about worker’s mental state and activities prior to death.
• Was the worker under the direct care of a physician or psychologist for treatment of depression or other related psychological condition? Any past history of these types of conditions or treatment sought? Medications worker may have been taking? Any suicidal ideations in past? Any problems with gambling, drugs or alcohol?
• Any issues of importance or focus the worker had prior to their death (e.g., increase or decrease in weight, pain tolerances, relationships, mood changes, environmental changes or non-compensable conditions (e.g., cancer, etc.).
• Name of hospital the worker may have been taken to after the incident to obtain admission/discharge reporting.
• Records from police involvement at the scene of the death, copy of suicide note (if applicable) and confirmation of any previous criminal history relating to drugs/alcohol.
• Confirm if there was any drug or alcohol involvement in the accident/death.
• Confirm marital status and any dependant information as well as any documentation to support dependency (e.g., court orders, maintenance enforcement/account information to support payments, letters from immediate family members of deceased worker to support circumstances surrounding dependency, etc.).
• Was there a will? If so, request a copy of the page that confirms the name of the executor and the signed last page.
• A completed Alberta Health Services Consent to the Disclosure of Individually Identifying Health Information form (AHC2099).
• A completed Release of Medical Information form.

This step is completed by a fatality case manager.

Review the information received (e.g., any medical reports, medical death certificate, autopsy report, police reports, information obtained from the Investigations Unit and other relevant information) to confirm the cause of death and relationship to the compensable injury, illness or accident.

If a fatality entitlement decision can be made, proceed to the next step.

If a fatality entitlement decision cannot be determined, identify and initiate the appropriate referral to support decision-making.

Consider if a referral is required for a:

• Medical opinion if there are questions about the worker's injury or the relationship of the injury to the work accident. When the cause of death is suicide, notify the clinical consultant supervisor who will designate a medical consultant for the review.
• Documentary forensic psychiatry review. This independent medical examination (IME) is used for complex suicide cases after all pre‑ and post‑investigations are completed and an initial medical consultant review has occurred.

For the referral, confirm the following information:

• If a worker ended their life:
  • Is there sufficient information to provide a psychiatric diagnosis?
  • If so, is the psychiatric condition(s) related to the date-of-accident injury?
  • Based on the circumstances leading up to the worker's death, what factors were primarily responsible for the suicide?
• Identify any occupational or non-occupational factor(s) contributing to the worker's actions and subsequent death.
• Provide an opinion on whether it is more likely than not that the compensable injury and/or its sequelaeRefers to complications or conditions that resulted from the compensable injury or illness. significantly contributed significantly to the worker's death and include rationale for the opinion.

Review all available information on the file to thoughtfully assess whether any work-related or occupational factors may have contributed to the worker’s passing.

Call the next of kin and/or executor and begin by checking in on how they are doing and acknowledging the difficulty of the situation. Once appropriate, explain the decision with sensitivity and discuss the rationale considered. Allow space for questions and concerns.

If the claim or death is not accepted, offer a referral to Community Support Services if the spouse/partner or dependent children are interested in available supports (e.g., grief or bereavement counselling, financial support). Send the appropriate letter with a copy to the employer. 

If the claim or death is accepted, discuss the following entitlements:

• For dates of accident on or after January 1, 2018, a one-time lump sum payment equivalent to the maximum Non-economic loss payment (NELP) payable for the year of the worker's death less the cumulative permanent clinical impairment percentage assessed on any of the worker's claims with a date of accident on or after January 1, 1995. Refer to Policy 04-04, Part II, Addendum A - Maximum Non-Economic Loss Payments.

  Note: The one-time fatality payment is issued to the dependent spouse or adult interdependent partner (partner). When there is no surviving dependent spouse/partner, it is issued to the dependent children. When there are no surviving children, it is issued to the estate.

• Funeral expenses can be direct billed or WCB may reimburse for funeral expenses up to a maximum amount. Inform them of the maximum. If direct billing is not applicable, request that receipts for funeral expenses be submitted. A receipt is required for reimbursement of funeral expenses; however the receipt does not need to be an original. Refer to Policy 04-08 Part II Addendum A - Funeral and Death Expenses and the Funeral and death- related expenses section.
• A pre-burial allowance, which is a lump sum payment for incidentals payable to the executor of the estate or the person authorized by the grant of administration who is responsible for the funeral expenses. This payment does not require receipts before payment.
• Transportation expenses may be direct billed to WCB for transporting the deceased worker from the accident site to the hospital, mortuary, funeral home or other required locations, including transportation for burial to a location of choice within or outside.
• Eligibility for a lump sum payment for heroes if the deceased worker was a first responder or correctional officer as defined under WCA Section 24.2 (1). Refer to the Lump sum payment for heroes section.
• Bereavement counselling for a dependent spouse/partner and for eligible family membersSection 1(1)(q) of the WCA: "member of a family" means a spouse or adult interdependent partner, parent, grandparent, stepparent, child, stepchild, brother, sister, half-brother and half-sister of a worker. . Refer to the Bereavement counselling section
• Entitlements to survivor benefits available to dependent spouse/partner and/or dependent children. For more information, refer the appropriate internal procedures. 

Send the appropriate decision letter and attach the appropriate application of benefits form based on the next of kin's relationship to the deceased and whether the accident occurred in Alberta. Refer to the Fatality forms section for more information.

Funeral-related expenses

If the claim is accepted, issue the pre-burial expenseA preburial expense is an immediate lump sum for incidental expenses for costs resulting from a compensable death. Receipts are not required for this payment. payment. Review the receipts for funeral expenses and issue payment up to the maximum allowable amount.  

Pay for transportation costs related to transporting the deceased worker from the accident site to the hospital, mortuary, funeral home or other required locations, including transportation for burial to a location of choice within or outside of Alberta. For transportation expenses, there is no limit on the amount for reasonable and actual expenses to transport the body to a location of choice within or outside of Alberta. Refer to Policy 04-08 Part II Addendum A - Funeral and Death Expenses and the Funeral and death-related expenses section.

Funeral expenses and/or transportation of the deceased from the mortuary to the cemetery may be billed directly to WCB. 

One-time fatality payment for accidents on or after January 1, 2018

The one-time fatality payment is calculated based on the maximum NELP payable for the year of the worker's death less the cumulative percentage of all of assessed PCI on or after January 1, 1995. For example, if a worker's cumulative PCI on all their claims combined was assessed at 40%, the one-time fatality payment would be 60% of the maximum NELP payable for the year of the worker's death. 

Review the worker's claims to determine if NELPs have been issued on any of the worker's claims. 

When a NELP:

• was paid on this claim or any of the worker's previous claims and the cumulative PCI is 100%, a lump sum fatality payment is not payable.
• was paid on this claim or any of the worker's previous claims and the cumulative PCI is less than 100%, request calculations from the Payment Unit less the cumulative percentage of any PCI previously paid. Once the calculations are received, issue the one-time fatality benefit.
• was not paid on this claim or any of the worker's previous claims, issue the one-time fatality payment equivalent to the maximum NELP payable for the year of the worker's death. Refer to Policy 04-04, Part II, Addendum A - Maximum Non-Economic Loss Payments.

Review the file to assess eligibility for a lump sum payment for heroes. Refer to the Lump sum payment for heroes section. 

Determine if cost relief is applicable. Cost relief may apply when the worker's death resulted from specific occupational diseases, a cardiac (heart) condition, a third-party accident or negligence of another employer. Refer to Policy 05-02, Part II, Application 1: General and Policy 05-02, Part II, Application 2: Occupational Disease.

If there are no dependentsA dependent is a person who relied on the worker for financial support at the time of their death and meets the criteria set out in the applicable legislation and policy. For example, a dependent spouse, adult interdependent partner, or dependent children.,  A dependent is a person who relied on the worker for financial support at the time of their death and meets the criteria set out in the applicable legislation and policy. For example, a dependent spouse, adult interdependent partner, or dependent children.end this procedure.

If there are dependents, refer to the appropriate procedure to determine pension benefit entitlement.