When a worker has died as a result of a work related injury, a claim for compensation can be made by the worker’s dependant(s).
We understand it is a difficult time after losing a family member in a workplace accident. We encourage you to contact WorkCover WA’s Advice and Assistance Line on 1300 794 744.
Workplace fatality entitlementsThe following entitlements may be claimed by dependants:
- a lump sum entitlement;
- a periodic child’s allowance for dependent children;
- funeral expenses up to a statutory maximum amount (also available to non-dependants); and
- the worker’s reasonable medical expenses resulting from the workplace injury prior to the worker’s death (also available to non-dependants)
For more information on workplace fatalities see Workplace Fatalities: Information for dependents of workers – fact sheet.
The Workplace Fatality Compensation Claim Form must be completed to make a claim. A fillable version of the form can be found here.
There are a number of documents that insurers need to be provided with to enable them to assess liability for the claim. The required documents are described in the Workplace Fatality Compensation Claim Form – Guidelines for Claimants and assist to determine:
- the cause of death;
- the relationship to the deceased worker; and
- the dependence on the deceased worker’s earnings.
The employer’s insurer will assess your claim and notify you of the outcome as quickly as possible.
Claims relating to the lump sum entitlement and child’s allowance must also be lodged with WorkCover WA to be expedited to an Arbitrator for determination.
If your claim is accepted or disputed the insurer will notify you and provide you with a copy of the Form 150A – Application for Arbitration – Workplace Fatality.
For information on the amount of compensation for workplace fatality claims see Indexation of Workers’ Compensation Payments.
The following forms, notices and resources support the workplace fatality claim process:
Claimants
- Workplace Fatality Compensation Claim Form (PDF) (Fillable)
- Workplace Fatality Compensation Claim Form – Guidelines for Claimants
- WF04 – Notice to WorkCover WA about common law action by dependant(s)
- Child allowance proof of participation in full time study
- Form 150A – Application for Arbitration – Workplace Fatality
Insurers and self-insurers
- Compensation for Workplace Fatality – Guidelines for Insurers/Self-Insurers
- WF01 – Insurer/self-insurer notice liability is accepted
- WF02 – Insurer/self-insurer notice additional information required
- WF03 – Insurer/self-insurer notice liability is disputed
- Form 150A – Application for Arbitration – Workplace Fatality.
