If a worker dies: what the Fund pays

It is subsection (e) of Article 3 of Act 45-1935 and what goes with it: who may be a beneficiary when a worker dies because of work, how much is paid, for how long, how it is divided among the family, and what protections those payments have.

The right arises if the worker’s death occurs within three years of the accident and as its consequence, or — for funeral and care expenses — if the death comes from a compensable occupational illness occurring within three years from the date the resulting disability manifested itself. Beneficiaries may be the widow, the parents, the children including posthumous, adopted or foster, the grandparents, the foster father or mother, the grandchildren, the siblings including foster siblings, the concubine, and relatives within the fourth degree of consanguinity or second of affinity, provided they depended totally or partly for their subsistence on what the worker earned at the time of death.

• That the worker’s death occurs within three (3) years of the accident and as its consequence; or, for a compensable occupational illness, within three (3) years from the date the resulting disability manifested itself.Verified against the official source
• That the relative depended totally or partly for their subsistence on what the worker earned at the time of death: that is the general condition the Administrator applies in distributing the compensation.Verified against the official source
• For the concubine: having lived with the worker, during the last three years before the death, “honestly as husband and wife, in a state of public concubinage”.Verified against the official source

Information pending verification.

1. 1

   Step 1: The funeral: up to fifteen hundred dollars

   Article 3(e)(1) starts there. If as a result of the accident the worker dies within three years of it and as its consequence, “the Administrator shall pay the funeral expenses up to a maximum of one thousand five hundred (1,500) dollars in addition to the other medical care, hospitalisation and medicine expenses incurred by the Administrator’s order”. The same expenses are paid where the death comes from a compensable occupational illness, provided it occurs within three years from when the resulting disability manifested itself.

2. 2

   Step 2: And an exception that saves doubtful cases

   The same subsection adds something worth knowing when the cause of death is disputed: nothing above shall be construed as denying the Administrator authority “to pay burial expenses in cases where a worker hospitalised at the State Insurance Fund’s expense dies, or in cases where an autopsy is performed on a deceased worker after the Administrator has taken jurisdiction over the case to investigate the cause of the accident or of the death, regardless of what is finally determined about causation”.

3. 3

   Step 3: Who may be a beneficiary

   The list in subsection (e)(2) is long on purpose: widow; parents; children, including posthumous, adopted or foster; grandparents; foster father or mother; grandchildren; siblings, including foster siblings; concubine; and relatives within the fourth degree of consanguinity or second of affinity. All of them, “on qualifying under the rules established here”, receive a compensation equivalent to sixty-six and two thirds per cent of the wage the worker earned on the day of the accident, payable monthly in arrears, with a minimum monthly payment of a hundred and thirty dollars and a maximum of four hundred and thirty, for a period of five hundred and forty weeks. And there comes the big exception: save what the Act provides where the beneficiaries are the widow, the parents or the children.

4. 4

   Step 4: The widow or concubine alone: fifty per cent

   Paragraph (f) is the main ladder, and it starts like this: if the beneficiaries are the widow, the father, the mother, or children — including posthumous or adopted — or concubines, “the compensation shall be paid for an indefinite time”. Not five hundred and forty weeks: indefinite. And then the figure: if the beneficiaries are the widow or concubine only, they are entitled to “a total compensation amounting to fifty (50) per cent of the wage the worker received on the day of the accident, payable in monthly instalments in arrears, which shall not be less than one hundred thirty (130) dollars nor exceed the sum of four hundred thirty (430) dollars”.

5. 5

   Step 5: How it rises with each child

   The Act steps the increase. “Where the widow or concubine concurs with a single child, the total compensation to be distributed among the beneficiaries shall be increased by ten (10) per cent of the wage the worker received on the day of the accident. If several children, or other beneficiaries, concur with either of them, the total compensation shall be increased by five (5) per cent for each additional beneficiary.” And the two caps that close the ladder: “in no case shall the total payment exceed eighty-five (85) per cent of the worker’s salary on the day of the accident nor be greater than five hundred thirty (530) dollars monthly”. Where the only beneficiaries are the children, including posthumous or adopted, the total compensation shall not exceed sixty per cent of the salary, in monthly payments fluctuating between a hundred and thirty and four hundred and thirty dollars.

6. 6

   Step 6: Until when the children collect

   Paragraph (c) fixes it in one line that decides years of family income: “Where there are dependent minors, on their turning eighteen (18) years of age — unless those minors are persons permanently incapacitated for work by reason of their mental condition or physical impairments, or until the age of twenty-five (25) if they are pursuing studies — the payments in their favour shall be suspended.” Eighteen as the rule, twenty-five if studying, and no limit if permanently incapacitated for work.

7. 7

   Step 7: If the widow or concubine remarries

   The right is not unconditional. “The right to compensation of the surviving spouse or concubine, as a dependant of the deceased worker, shall cease if they marry or live in concubinage.” And the Act settles where that money goes: in that case, or if that person dies, “the monthly payments to the dependent minors shall be increased by distributing among those dependent minors the monthly amount the surviving spouse or concubine was receiving”. Absent dependent minors, the Administrator is obliged to redistribute the compensation among the remaining beneficiaries.

8. 8

   Step 8: The concubine: three years of public cohabitation

   Paragraph (b) defines who qualifies: “there shall be considered entitled to the corresponding share in the compensation the woman who at the time of the worker’s death had, during the last three years before the death, lived with the worker honestly as husband and wife, in a state of public concubinage”. Three years, and public. The Act uses those words, and they are what must be provable.

9. 9

   Step 9: Siblings, grandparents and distant relatives

   The more distant the relationship, the tighter the requirement and the lower the cap. Siblings and foster siblings over eighteen count as beneficiaries only if the Administrator determines “that they are persons permanently incapacitated for work by reason of their mental condition or physical impairments and that they depended principally on what the deceased worker earned”. Relatives in the third or fourth degree of consanguinity, or first or second of affinity, only if they are permanently incapacitated by mental condition, physical impairments “or advanced old age” and depended totally on what the worker earned.

10. 10

    Step 10: The three dollar caps: 18,500, 9,500 and 6,000

    Where there is no widow, concubine or children, the Act stops paying indefinitely and sets absolute ceilings. If the beneficiaries are the father or mother only, alone or concurring with lower-category beneficiaries, the total compensation shall not exceed eighteen thousand five hundred dollars — and the Administrator may advance a parent, or both, fifty per cent of their share for a profitable investment. If none of those beneficiaries exists, it is enough that one be a grandparent, foster parent, foster child, grandchild or sibling for the total not to exceed nine thousand five hundred dollars. And if none of those exists either, it is enough that one be a foster sibling or a relative in the third or fourth degree of consanguinity or first or second of affinity for the total not to exceed six thousand dollars.

11. 11

    Step 11: The advance for the first month’s needs

    Paragraph (i) is the one that solves the immediate problem, and it must be requested. At an interested party’s request, and to help meet pressing needs arising from the worker’s death, or relating to paying debts they previously contracted, to repairing and maintaining the widow’s home, or to school, medical, medicine or special food expenses for the widow or the other beneficiaries, the Administrator may make as an advance an initial payment of seven hundred and sixty dollars to the widow, two hundred and thirty dollars to each parent and seventy-five dollars to each of the remaining beneficiaries, up to a total maximum of fifteen hundred dollars. Where the widow is not among the beneficiaries, the Administrator may double those amounts, but the total advance may still not exceed fifteen hundred dollars.

12. 12

    Step 12: If the beneficiaries are minors

    Subsection (f) of the article sets a concrete safeguard. Where the beneficiaries in death cases are minors or incapacitated, the compensation is made effective through the father, mother or guardian. “However, such payments shall not be made through the father or mother who abandoned or neglected their obligations to the child before the worker’s death; and in that case, the payments shall be made through the person who had the minor beneficiary in their care and attention before the worker’s death.” And if the beneficiaries are minors or incapacitated, the Administrator submits the case for the Industrial Commission to appoint a guardian under Article 13, which we did not read.

13. 13

    Step 13: If the worker was a minor illegally employed: double

    Subsection (g) of Article 3 is short and forceful. For workers under eighteen employed in contravention of the laws in force at the date of employment who suffer injuries or occupational illnesses, the compensation due them for disability, “or their beneficiaries in death cases, shall be double the amount corresponding to an eighteen-year-old worker legally employed”. That additional compensation is paid by the employer, not the Fund: its amount constitutes a lien on all the employer’s property and is collected as compensation is collected from uninsured employers. Before collecting it, the Administrator gives the file to the Industrial Commission so both employer and worker have an opportunity to be heard and defend themselves.

14. 14

    Step 14: These payments cannot be sold or attached

    Subsection (h) closes the block by protecting the money. “The assignment, sale or transfer of the rights of workers, employees or their beneficiaries to receive the compensation payments, or any contract concerning them, shall be void, and the compensations granted by this Act to such workers, employees or beneficiaries may not be attached, nor may any worker, employee or beneficiary be deprived of their possession by any judicial process.” Void contract, unattachable payment.

Death compensation is determined and distributed by the State Insurance Fund Administrator. The advance for pressing needs is made “at an interested party’s request”: you must ask for it, it does not come on its own. If the beneficiaries are minors or incapacitated, the Administrator submits the case for the Industrial Commission to appoint a guardian. The Administrator’s decisions are appealed to the Industrial Commission. The Act publishes no addresses, phone numbers or forms in Article 3, and we read none here, so we do not invent them.

• Letting the three years pass: the right arises if the death occurs within three years of the accident and as its consequence, or within three years of the disability manifesting if it was an occupational illness.
• Not requesting the advance for pressing needs: the Act conditions it on “an interested party’s request”, so it must be asked for.
• Believing the death compensation lasts five hundred and forty weeks for everyone: if the beneficiaries are the widow, the parents or the children, it is paid for an indefinite time.
• Assuming the widow collects sixty-six and two thirds per cent: alone she collects fifty per cent of the wage, and it rises from there with each beneficiary.
• Forgetting the five-hundred-and-thirty-dollar monthly cap and the eighty-five per cent of salary cap where several beneficiaries concur.
• Giving up a child’s pension at eighteen: it extends to twenty-five if they are pursuing studies, and is not suspended if they are permanently incapacitated for work.
• Not documenting the three years of public cohabitation the Act requires for a concubine to qualify.
• Not knowing the spouse’s or concubine’s right ceases if they marry or live in concubinage, and that the monthly amount passes to the dependent minors.
• Assuming siblings or distant relatives collect the same: they have stricter requirements and caps of nine thousand five hundred or six thousand dollars.
• Signing an assignment or sale of the right to collect: the Act declares that contract void and makes the compensations unattachable.
• Ignoring that if the worker was under eighteen and illegally employed, the compensation to the beneficiaries is double, and the employer pays it.

These are the government pages this guide is based on.

• Corporación del Fondo del Seguro del Estado (CFSE)

  Fondo del Seguro del Estado

  bvirtualogp.pr.gov