10.7 Entitlement To Medical Benefits Copy

An employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed. The employee is specifically entitled to health care that:

• Cures or relieves the effects naturally resulting from the compensable injury;
• Promotes recovery; or
• Enhances the ability of the employee to return to or retain employment.

Medical benefits are payable from the date of the compensable injury. Except in an emergency, all health care must be approved or recommended by the employee’s treating doctor. An insurance carrier’s liability for medical benefits may not be limited or terminated by agreement or settlement.

Distribution of Death Benefits

If there is an eligible child or grandchild and an eligible spouse, half of the death benefits shall be paid to the eligible spouse and half shall be paid in equal shares to the eligible children. If an eligible child has predeceased the employee, death benefits that would have been paid to that child shall be paid in equal shares per stripes to the children of the deceased child.

If there is an eligible spouse and no eligible child or grandchild, all the death benefits shall be paid to the eligible spouse.  If there is an eligible child or grandchild and no eligible spouse, the death benefits shall be paid to the eligible children or grandchildren.

If there is no eligible spouse, no eligible child, and no eligible grandchild, the death benefits shall be paid in equal shares to surviving dependents of the deceased employee who are parents, stepparents, siblings, or grandparents of the deceased.  If an employee is not survived by legal beneficiaries, the death benefits shall be paid to the subsequent injury fund.

In this section:

Eligible child means a child of a deceased employee if the child is:

• A minor;
• enrolled as a full-time student in an accredited educational institution and is less than 25 years of age; or
• a dependent of the deceased employee at the time of the employee’s death

Eligible grandchild – means a grandchild of a deceased employee who is a dependent of the deceased employee and whose parent is not an eligible child.

Eligible spouse – means the surviving spouse of a deceased employee unless the spouse abandoned the employee for longer than the year immediately preceding the death without good cause, as determined by the commission.

If the death of an employee results from a compensable injury, the insurance carrier shall pay to the person who incurred liability for the costs of burial the lesser of:

• The actual cost incurred for reasonable burial expenses; or
• $6,000

If the employee died away from the employee’s usual place of employment, the insurance carrier shall pay the reasonable cost of transporting the body, not to exceed the cost of transporting the body to the employee’s usual place of employment.