Fatal Claim Benefits in PA Workers’ Comp Not Automatic to Spouse
Among the benefits available under the Pennsylvania Workers’ Compensation Act (Act), are “fatal claim” benefits. Since these are only relevant for work accidents which involve the death of a worker, these are not things we like to often see. Unfortunately, sometimes these things do happen, and they are cases which need attention.
In addition to modest “burial expenses,” fatal claim benefits also include benefits for any surviving minor children, and, potentially, a spouse (among other categories of possible recipients beyond this topic). We say “potentially” since benefits to a spouse are not automatic.
Recently, the Commonwealth Court of Pennsylvania dealt with this issue in Grimm v. Workers’ Compensation Appeal Board (Federal Express Corporation). Here, the worker who died (Decedent) was employed by Federal Express. She suffered a fatal heart attack while delivering packages in her normal course of work.
Decedent was married to her husband (Claimant) in 1988. The couple had three children, before separating in 2010. The fatal heart attack took place in 2012. The workers’ compensation insurance carrier accepted responsibility for burial expenses, and for benefits for the three children, but denied liability for any benefits to Claimant.
Arguing that he was substantially dependent on Decedent, Claimant filed a Fatal Claim Petition, seeking widow’s benefits. Before the Workers’ Compensation Judge (WCJ), Claimant testified that, though he lived on his own (and not in the family home), he depended on Decedent for support. Claimant did admit that he was solely responsible for his food, rent and utilities. In fact, Claimant contributed money for the family expenses, rather than vice versa. Though Decedent did not give Claimant any monetary support or help with his daily living expenses, she did provide health insurance for him through her job.
Finding that Claimant and Decedent were not living together at the time of her death (the fact they remained married could not change the fact they lived in separate residences and led separate lives), and that Claimant was not financially dependent on Decedent (receiving only health insurance from her), the WCJ denied the Fatal Claim Petition.
This decision was affirmed by the Workers’ Compensation Appeal Board (WCAB). Without a showing that Claimant was (1) “actually dependent upon the decedent, and (2) that he received a substantial portion of support from the decedent,” Claimant could not overcome the fact that the two were not living together at the time of the death. While receiving the health insurance benefits was certainly of great value to Claimant, the WCAB observed that Claimant did not testify that he could not otherwise get health insurance.
Upon further appeal, the Commonwealth Court of PA also affirmed. First, the Court rejected the argument that, despite the separation and the living in different places, the “marital relationship” continued. The Court noted that the Act, in Section 307, specifically states the “living with” requirement (to have support presumed). Based on these facts, said the Court, the Claimant was not “living with” Decedent.
As to whether the providing of health insurance constituted sufficient financial support, the Court was also unmoved. “On review, we see no error or abuse of discretion in the WCJ’s determination that Decedent’s payment for health care coverage for her family, including Claimant, did not establish that Decedent provided a substantial portion of Claimant’s support.”
Once the Court resolved the issue that Claimant was not “living with” Decedent at the time of her death, then the only remaining question was whether he was substantially dependent upon her. The facts establish that this was not the case, since the payment of the health insurance, by itself, was not sufficient to show that he was “substantially dependent” on her. Therefore, the Court concluded that the Fatal Claim Petition was properly denied.