Case Conclusion Date: 10.03.2013
Practice Area: Workers Compensation
Outcome: Beneficiary is entitled to the Death Benefits
Description: Security Guard for Dallas apartment complex was killed while on duty. Deceased worker had no children or siblings as beneficiary, leaving only a mother entitled to Death Benefits for two years. Carrier recieved notice of the claim and did not dispute the same timely, instead filing a notice saying there were no known beneficiaries. Mother filed claim for death benefits which Carrier began paying. Carrier then obtain autopsy which had been completed several months prior. Based upon the autopsy drug test and a peer review report, Carrier then denied Death Benefit payment to mother. Claimant hired Mr. Rodriguez who pursued the matter to Contested Case Hearing on the theory the deceased employee was not intoxicated at the time and the Carrier had waived their abilty to dispute the Death Benefits as they had not filed a Plain Language Notice disputing the claim within 60 days of having received notice of the death. Hearing Officer found, Claimant (who had died as a result of a gunshot wound to the back of the head) sustained a compensable injury. The Carrier recieved notice of the injury on October 16, 2012 and notice of the death benefits claim on January 5, 2013. Carrier did not dispute the compensability until March 21, 2013 when they did so claiming there was newly discovered evidence (autopsy report). Despite the autopsy report, Mr. Rodriguez was able to demonstrate, through use of letters from family members who took deceased employee to work on the date of the accident, the deceased employee did possess the normal use of his faculties at the time of the injury (deceased employee worked alone and there were no other witnesses); therefore he was not in a state of intoxication. Moreover, Attorney demonstrated, the Carrier did not contest compensability in a timely manner as the Insurance Carrier could have discovered the evidence at an earlier date.