New York State
Workers' Compensation Board
OFFICE OF THE CHAIRMAN
20 Park Street   Albany, New York 12207

Subject No. 146-115

Change in the Processing of Death Cases
New Forms AFF-1, AFF-2 and AFF-3, Affidavits for Death Benefits

Date:  June 30, 2003

As part of the Workers' Compensation Board's ongoing effort to enhance service and expedite claims processing, we have instituted a new policy with regard to the handling of death cases. Effective immediately, the Board will attempt, in non-controverted cases, to process the surviving dependent's claim for death benefits without requiring the personal appearance of the dependent before a WC Law Judge. Instead, a WC Law Judge will review the documents in the case file and, if warranted, issue a decision based on the information and evidence therein.

As part of this new process, in addition to the existing claim form that is filed in a death case (C-62, VF-62 or VAW-62), the Board will now also require the claimant to file a notarized affidavit in which he or she will swear to the basic facts regarding the decedent, the claimant's relationship to the decedent, dependency, etc. We also ask that copies of other necessary legal evidence, such as a death certificate, marriage certificate, funeral expense documentation, be enclosed with the affidavit.

There are three types of affidavits that are to be used by those who are filing for benefits as the result of a work related death of a family member:

• This affidavit is to be used by a surviving spouse or the dependent child(ren) of the deceased. It can also be used by the non-dependent parents or the estate of the deceased where there is no surviving spouse or other dependents.
• This affidavit is to be used by the brother(s) or sister(s) or grandchildren of the deceased who claim that they were dependent upon the deceased and where there is no surviving spouse or dependent children.
• This affidavit is to be used by the parent(s) or grandparent(s) of the deceased who claim that they were dependent upon the deceased and where there is no surviving spouse or dependent children.

This process and these affidavits are to be used in those cases where the employer has not controverted or contested the claim for benefits.

The affidavits are available on the Board's web site (www.wcb.ny.gov) and may be found under Common Forms. They may also be obtained at any office of the Workers' Compensation Board.

We ask the help and cooperation of all parties in making this new process a success.

 

Robert R. Snashall
Chairman