Division 5 - Table of Contents

Injury Manual

Division 5 – Table of Contents 1

Division 5 - Table of Contents

Division 5 5.0 Death Benefits 5.1 Summary Information

5.1.1 Introduction to Death Benefits Introduction Who may be entitled to a death benefit Benefit types Important terms and definitions 5.1.2 Summary of Division 5 Legislation

Summary of Section 144 – Death benefits

Calculation of death benefits for a surviving spouse (non-seasonal earners) Calculation of death benefits for a surviving spouse (seasonal earner) If seasonal employment not held until on or after July 1st of prior calendar year Benefit calculated using greater of IRB at time of accident or at date of death If customer dies within first seven days after the accident Minimum spousal death benefit Weekly death benefit ends when surviving spouse dies Calculation of dependant death benefits Minimum dependant benefits Payment of dependant death benefits

Summary of Section 145 – Death benefit – dependant If both parents die If the deceased was the sole parent of the dependant If surviving parent of the dependant is not entitled to a benefit Payment of a dependant death benefit Minimum dependant death benefit When there is more than one dependant

Summary of Section 146 – Capitalization of death benefits Summary of Section 147 – Lump sum death benefit

No surviving family Only surviving parents and non-dependant children Under 21 with no spouse or dependants, but surviving parents

Summary of Section 148 – Funeral benefit Summary of Section 149 – Education benefit for surviving spouse Summary of Section 150 – Vocational counselling Section 151 – Grief counselling – repealed Section 162 – Financial counselling – as it applies to death benefits Section 172 – Payment of benefits – as it applies to death benefits

Benefit levels in place as of the date of death must be used Death benefits paid on a bi-weekly basis pending lump sum election Surviving spouse and dependant(s) as of the date of death

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5.1.3 Summary of Part V Regulations Summary of Section 26 of the Regulations - Calculation of death benefit Summary of Section 27 of the Regulations - Dependant benefits Summary of Section 28 of the Regulations - Method of capitalization for surviving spouse’s benefit Summary of Section 29 of the Regulations - Educational Benefit for surviving spouse

5.2 Spousal Benefits

5.2.1 Spousal Death Benefits Important terms and definitions Who may be considered a surviving spouse Calculations performed according to Division 4 (Income Replacement Benefits) Calculation and payment of a spousal benefit Calculations for non-seasonal workers Calculations for seasonal workers with more experience Calculations for seasonal workers with less experience Greater of IRB at time of accident or at date of death Death within the first seven days Minimum spousal death benefits Weekly benefit ends when surviving spouse dies Determining eligibility of a surviving spouse Multiple surviving spouses Supporting documents

5.3 Dependant Benefits

5.3.1 Dependant Death Benefits Important terms and definitions Who may be considered a dependant Calculations performed according to Division 4 (IRB) Calculation and payment of dependant benefits Minimum weekly dependant benefits Payment of dependant benefits to a surviving spouse

Dependant benefits payable to surviving spouse Payment to the Public Guardian and Trustee Benefit payable until dependant reaches age 21 or dies Benefits for dependants with a physical or mental impairment

When Benefits are Payable to a Dependant – Additional Circumstances Both parents die Sole parent dies When the parent of the dependant is not entitled to the spousal benefit Multiple dependants

Payment of Benefits to a Dependant Benefit payable until age 21 or dependant dies Minimum dependant death benefit

When Benefits are Payable to Multiple Dependants When there is more than one dependant Paying benefits in the prescribed manner

Determining eligibility of a dependant

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Supporting documents identifying parents of a dependant Records that assist in identifying the biological parent of a dependant DNA testing to be used in limited circumstances Payment for DNA testing only when SGI relies on testing results to make a decision

Determining if the deceased stood in the place of a parent Non-biological parents source document checklist Legal adoption Foster home exclusion

Mentally or physically impaired dependant supporting documents 5.4 Lump Sum Benefits

5.4.1 Capitalization of Death Benefits for Spousal or Dependant Benefits Capitalization of death benefits Election within five years Capitalization in the prescribed manner

Discount based on standard mortality tables Compensation pursuant to WCB or other legislation

SGI may elect not to capitalize the benefit Surviving spouse or dependant may waive rights

Financial counselling Capitalization of Benefits for Multiple Dependants Calculating the lump sum payment

Establishing the lump sum conversion date Method of capitalization for benefits to the surviving spouse Issuing payment of lump sum death benefits

5.4.2 Lump Sum Death Benefits No survivors Surviving parent or non-dependant child

Declaration requirements Under age 21 with surviving parents

5.5 Other Benefits

5.5.1 Other Death Benefits Funeral benefit

Funeral benefit to be paid immediately Payment to the deceased’s estate Payment to the funeral home in exceptional circumstances

Education benefit for surviving spouse Eligibility requirements for an education benefit Eligible education expenses Education benefit limited to 25% per calendar year in most cases Future course enrollments only Dependant not entitled to education benefit

Education Benefit Expense Procedure Vocational counselling Financial counselling Grief counselling Examples of expenses not covered under a claim for death benefits

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5.6 Other related policies, procedures, and information

5.6.1 Adjudicating the claim for death benefits Initial Contact

Who can notify SGI of a claim Who can initiate the claim Confirming the authority of a representative PIR to initiate claim if no contact from deceased’s family Obtaining contact information from the RCMP or police

Initial Interview Types of information gathered at the time of the initial interview Employment Information

Application for Death Benefits Confirming Coverage Requesting Supporting Documents Procedures

Death Benefit Checklist Following the completion of the death benefit calculation

5.6.2 Death Claim Policies and Procedures

Concerns with Causation

Information contained in the Autopsy or Coroner’s Report Review by a medical consultant

When permanent impairment and death benefits are payable Repatriation on Death Claims

5.6.3 WCB or Other Compensation as it Relates to Death Benefits Other compensation means Summary of Section 202 as it relates to death benefits

Death benefits to a surviving spouse or dependant If no surviving spouse or dependant Death benefit calculated pursuant to Division 5

Where there is no other compensation or other compensation is less Benefits to be calculated pursuant to Division 5 – Death Benefits SGI to top-up death benefits pursuant to Division 5 – Death Benefits

Other death benefits not payable Information required to adjudicate the claim Information required by the IRB Unit Timing and payment of death benefits Lump sum option Related Policy Topics

5.7 Death Benefit Calculation Policies, Procedures, and Information 5.7.1 Death Benefits Source Documents and Information Collecting Information and Supporting Documents

Death occurs immediately following the motor vehicle accident Death occurs at a later date following the motor vehicle accident

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Surviving Spouse Source Documents If married If cohabitating as a spouse Ex-spouses Multiple family units

IRB source documents Death benefit source documents Supporting documents identifying parents of a dependant

Records that assist in indentifying the biological parent of a dependant Non-biological parents source documents Mentally or physically impaired dependant supporting documents 5.7.2 Death Benefit Calculation Policies and Procedures Calculations performed according to Division 4 (IRB)

Death benefits not an IRB No seven-day waiting period

Death benefit calculations based on greater of the date of death or the date of the accident If the customer dies within the first seven days Death benefits to be calculated using benefit amounts in place as of the date of death

Circumstances as of the date of death to be considered Calculation to be performed if deceased earned income Multiple family units 5.7.3 Death Benefit Payment Policies and Procedures Bi-weekly payments until lump sum election

Bi-weekly payments Capitalization of bi-weekly benefits Continuation of dependant benefits if surviving spouse dies Combination of bi-weekly and lump sum benefits Minimum spousal benefit cannot be capitalized

Death benefits not reduced if customer received benefits prior to death Payment to the Office of the Public Guardian and Trustee

Dependants not residing with the surviving spouse Dependants with a mental or physical impairment Concerns with neglect or abandonment Public Guardian and Trustee contact information Correspondence with the Public Guardian and Trustee Payment to the Public Guardian and Trustee for non-residents

Death Claims Garnishment If death benefits are not payable

5.8 Case Studies 5.8.1 Case Study Examples Case Study One – Surviving parents and non-dependant children Case Study Two – Applying WCB or other compensation when accident occurs on work duty Case Study Three – One surviving spouse and multiple family units Case Study Four – Education benefit for surviving spouse Case Study Five – Multiple family units Death Benefits Flow Chart

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5.1.1 – Introduction to Death Benefits 1

5.1.1 Introduction to Death Benefits (5.1.1-01/2017)

Effective January 1, 2017

Purpose Provides an introduction to the Act, the regulations, and SGI’s policies and procedures with respect to the administration of death benefits.

Act 144-151 Division 5

Regulations 26-29 Part V

Introduction No Fault benefits are provided in the case where a Saskatchewan resident is fatally injured as a result of

a motor vehicle accident.

Death benefits are provided to the family of a customer who is fatally injured as a result of a motor vehicle accident. Division 5 outlines who is entitled to a benefit and under what circumstances each type of benefit is paid.

In accordance with section 108 of the Act, the customer’s family or estate may be entitled to benefits if

the accident occurs in Canada or the United States, or on a vessel travelling between ports of those countries.

No Fault coverage may also be provided to non-residents under certain defined circumstances.

Note: Please see Division 2 of this manual for additional information with respect to who may be entitled to a benefit on the basis of residency.

Who may be entitled

Who may be entitled to receive a death benefit: Surviving spouse: ° Spouse ° Someone who is cohabitating as a spouse ° Former spouse Dependant(s) under the age of 21 Non- dependent children over the age of 21 Parents The estate Note: For detailed information with respect to the administration and payment of the above benefits, please click on the relevant bullet point to take you to more detailed sections of this division of the manual. Please also see the Death Benefit Flow Chart for additional information.

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Benefit types Types of benefits that may be available in the case of a death:

Spousal benefit (Act, s 144, Regulations, s 26) Dependant benefit (Act, sections 144 and 145, Regulations, s 27) Lump-sum death benefits for parents, non-dependent children, and the estate(Act, s 147) Funeral benefit (Act, s 148) Spousal education benefit (Act, s 149 and Regulations, s 29) Vocational counselling benefit (Act, s 150) Grief counseling (Act, s 162.1) Financial counselling (Act, s 162 and Regulations, s 72) Note: Effective as of January 1, 2017 section 151 of the Act (i.e., grief counselling) has been repealed and is now replaced by section 162.1, to apply to immediate family members of a customer who sustains bodily injury (i.e., injury or death) as a result of a motor vehicle accident. Please see 7.2.1 – Counselling for immediate family for additional information.

Important Terms and Definitions

Important terms and definitions: Spouse (Act, ss. 2(1)(rr)): The spouse of the customer who is, at the date of the accident, residing with the customer; or A person with whom, at the date of the accident, the customer is cohabiting and has cohabited as a

spouse: ° Continuously for a period of not less than two years; or ° Continuously for a period of not less than one year, if they are parents of a child.

(i.e., biological parents of a child, a legally adopted child, or a person standing in the place of a parent)

Note: Also note that many families have two residences due to employment or medical circumstances. This does not mean that they are separated. Please review the below examples for additional clarification.

Example – Health concerns: Due to health issues and requirement for extended care, one spouse is living in an extended care unit and the other spouse still resides in their primary residence. Example – Employment: The employment of one spouse requires them to reside in a different town or province to perform their job duties. The other spouse resides in the primary residence.

Surviving spouse (Act, ss. 2(1)(ss)): A surviving spouse means a spouse of a customer and includes a former spouse of a customer who, at

the date of the accident: ° Had been living separate and apart from the customer for one year or less; ° Was receiving spousal support from the customer; or ° Had a court order or agreement with the customer entitling that person to spousal support from the

customer.

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Equivalent to spouse: There are instances where SGI will consider the youngest dependant to be a spouse (i.e., equivalent to

spouse) when the deceased has no surviving spouse within the definitions of the Act.

Parent (Act, ss. 2(1)(ff)) means: The mother or the father of a child; A person to whom custody of a child has been granted by a court of competent jurisdiction or by a

custody agreement; or A person with whom a child resides and who stands in the place of a parent to the child. Child (Act, s. 2(1)(l)): A person to whom the customer stands in the place of a parent; and A person for whose support a customer was, at the date of the accident, liable pursuant to any Act or

Act of the parliament of Canada.

Dependant (Act, ss. 100(b)), with respect to a deceased customer, means: A child of the customer who is under 21 years of age at the date of the accident and includes a child of

the customer born after the date of the accident or the death of a customer; or

Any person who would qualify for a tax credit pursuant to section 118.3 of the Income Tax Act(Canada) for a mental or physical impairment and who is dependent on the customer for the necessities of life at the date of the accident.

Beneficiary (Act, ss. 2(1)(d)):

Means a person who applies for and is entitled to receive benefits.

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5.1.2 – Summary of Division 5 Legislation 1

5.1.2 Summary of Division 5 Legislation (5.1.2-01/2017)


Purpose Provides a detailed overview of the relevant sections of the Act pertaining to the administration of death benefits.

Act 144-151

162 172

Division 5 Financial counselling Payment of benefits

Summary of Section 144

Calculation of death benefits for a surviving spouse (non-seasonal earners), Act, ss. 144(1)): The surviving spouse(s) of a deceased customer is entitled to a weekly death benefit (DB) calculated

using the following formula: DB = (50% x IRB) Where IRB is the weekly income replacement benefit that the deceased customer would have received had they survived (other than a seasonal worker), on the basis of the greater of: ° The yearly employment income (YEI) the customer earned or would have earned from all

employments held at the date of the accident; and

° The YEI the customer earned in the year before the accident excluding employment insurance (EI) benefits if SGI is satisfied that the customer would have held a more remunerative employment at the date of the accident but for special circumstances.

Note: The above section deals with non-seasonal earners, which includes both salaried and self-employed earners. Also, please note that the surviving spouse is entitled to 50% of the IRB for his or her lifetime.

Calculation of death benefits for a surviving spouse (seasonal earner, Act, ss. 144(2)): If the deceased customer was a seasonal worker at the date of the accident, the surviving spouse(s) is

entitled to a weekly death benefit (DB) calculated using the following formula: DB = (50% x IRB) Where IRB is the weekly income replacement benefit that the deceased customer would have received had they survived, on the basis of the greater of:

° The YEI the customer earned in the year before the accident. This includes EI payments, employment

disability plans and WCB payments or similar provisions in any other Act, or any legislation of any other jurisdiction, that relate to the compensation of individuals injured in accidents; and

° The average YEI the customer earned in the two years prior to the accident. This includes EI payments, employment disability plans and WCB payments or similar provisions in any other Act, or any legislation of any other jurisdiction, that relate to the compensation of individuals injured in accidents.

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If seasonal employment was not held until on or after July 1st of prior calendar year (Act, ss. 144(3)): If the customer held or would have held seasonal employment at the date of the accident, the weekly

death benefit to the surviving spouse must be calculated according to subsection 144(3.1) of the Act if: ° The deceased customer did not hold the seasonal employment until on or after July 1 of the year

before the date of the accident; and

° The deceased customer did not otherwise hold the seasonal employment in the two years before the accident.

The weekly death benefit (DB) is calculated using the following formula (Act, ss. 144(3.1)):

DB = (50% x IRB) Where IRB is the weekly income replacement benefit that the deceased customer would have received had they survived, on the basis of the greater of:

° The YEI the customer earned in the year before the accident. This includes EI payments, employment

disability plans and WCB payments or similar provisions in any other Act, or any legislation of any other jurisdiction, that relate to the compensation of individuals injured in accidents;

° The average YEI the customer earned in the two years prior to the accident. This includes EI payments, employment disability plans and WCB payments or similar provisions in any other Act, or any legislation of any other jurisdiction, that relate to the compensation of individuals injured in accidents; and

° The YEI for the same class of employment (i.e., Appendix A) as the seasonal employment the insured

held or would have held but for the accident.

Benefit calculated using greater of IRB at time of accident or at date of death (Act, ss. 144(3.2)): If after a motor vehicle accident the customer is receiving a weekly IRB pursuant to Division 4 and later

dies as a result of the accident, the death benefit is the greater of: ° The weekly IRB the customer was entitled to at the date of his or her death; and ° The amount IRB as defined in subsections (1), (2) or (3) of section 144 of the Act (i.e., IRB as of the

date of the accident).

If customer dies within first seven days after the accident (Act, ss. 144(3.3)): If a customer dies within the first seven days after the accident, he or she is deemed to have died on the

date of the accident.

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Minimum spousal death benefit (Act, ss. 144(4) and (4.1)): The minimum death benefit a surviving spouse is entitled to receive pursuant to this section is

$69,322(2016). If a surviving spouse receives the minimum death benefit mentioned in subsection 144(4) of the Act, the

spouse is not entitled to additional death benefits pursuant to section 144, other than a death benefit payable pursuant to subsection (6) (i.e., dependant death benefit).

Weekly death benefit ends when surviving spouse dies (Act, ss. 144(5)): The weekly death benefit payable pursuant to this section ends when the surviving spouse dies.

Calculation of dependant death benefits (Act, ss. 144(6)): If at the date of the accident the deceased customer has a dependant, SGI shall pay a weekly death

benefit for care and maintenance of the deceased’s dependant in the amount (B), calculated using the following formula: B = (5% x IRB) x DC Where IRB is the income replacement benefit as calculated pursuant to subsections 144(1), (2), (3), (3.1) or (3.2); and DC is the number of the deceased’s dependants.

Minimum dependant benefits (Act, ss. 144(7)): The minimum weekly death benefit for a dependant must not be less than the weekly benefit set out in

section 27 of the regulations. ° The minimum weekly benefit payable to the surviving spouse for weekly dependant benefits is:

The following amounts are shown in 2016 dollars: $30 – For one dependant; $54 – For two dependants; $63 – For three dependants; or $72 – For four or more dependants.

http://claimdocs.sgi.sk.ca/Injury_Manual_v2/Content/Entries/27r.htm

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Payment of dependant death benefits (Act, ss. 144(8) – (11)): The death benefit for the dependant(s) is payable to the deceased’s surviving spouse.

SGI may pay the weekly death benefit for the dependant(s) to the Public Guardian and Trustee if:

° The dependant(s) does not reside with the surviving spouse; or ° In SGI’s opinion, the surviving spouse has neglected or abandoned the dependant.

The weekly dependant death benefit is payable until: ° The dependant reaches 21 years of age; or ° The dependant dies.

If the dependant meats the definition of subsection 100(b)(ii) of the Act, the dependant death benefit is payable until: ° The dependant dies; or ° They are no longer considered a dependant as defined by subsection 100(b)(ii) of the Act.


If both parents die (Act, ss 145(1)): If both of a dependant’s parents die in the same accident, the dependant is entitled to the death benefit

mention in section 144 for each parent as if the dependant were the surviving spouse (i.e., equivalent to spouse) of each parent.

If the deceased was the sole parent of the dependant (Act, ss 145(2)): If the deceased was the sole parent of the dependant and dies as a result of the accident, the dependant

is entitled to the death benefit mentioned in section 144 as if the dependant was the surviving spouse (i.e., equivalent to spouse).

If the surviving parent of the dependant is not entitled to a benefit (Act, ss 145(3)): If the surviving parent of the dependant is not entitled to a death benefit as set out in subsection 144(1),

the dependant is entitled to the death benefit as if they were the surviving spouse (i.e., equivalent to spouse). ° This provision is used only if there is one dependant; otherwise refer to subsection 145(6) of the Act.

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Payment of a dependant death benefit (Act, ss. 145(4)): The dependant death benefit mentioned in this section is payable until the earlier of the following:

° The dependant reaches 21 years of age; or ° The dependant dies.

Minimum dependant death benefit (Act, ss. 145(5) and (5.1)): The minimum death benefit a dependant is entitled to receive pursuant to subsections (1) to (4) is

$69,322 (2016).

A dependant who is entitled to a death benefit pursuant to subsections (1)to (4) is not entitled to a death benefit pursuant to subsection 145(6) (i.e., when there is more than one dependant).

When there is more than one dependant (Act, ss. 145(6)): If there is more than one dependant (i.e. multiple dependants), the death benefits mentioned in this

section are to be calculated and paid in the prescribed manner as outlined in subsection 26(4) of the regulations.

Paying benefits in the prescribed manner: ° The benefits must be calculated on the basis of the youngest dependant being equivalent to spouse.

° The benefits mentioned above (i.e., equivalent to spouse) are payable until the youngest dependant

reaches age 21 and each dependant is entitled to an equal share of the benefit until they reach age 21. ° The dependant benefit (i.e., 5% of IRB) is calculated not including the youngest dependant, and must

be paid until the second youngest dependant reaches age 21. ° A dependant is entitled to an equal share of the death benefits mentioned above (i.e., dependant

death benefits) until they reach age 21.


Capitalization of death benefits (Act, s 146): A surviving spouse or a dependant who is entitled to a death benefit may elect to have the benefit

capitalized and, subject to the regulations, paid out as a lump sum.

An election must be made within five years after the date of death of a customer and is not revocable.

SGI shall undertake capitalization in the prescribed manner (Regulations, s 28);

° Section 28 of the regulations states that SGI shall determine the capitalized value of the surviving spouse’s death benefit based on the standard mortality tables published by Statistics Canada using a discount rate of 3% per year.

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If SGI is required to pay a death benefit to a surviving spouse or a dependant pursuant to section 202 of the Act(i.e., compensation pursuant to WCB or other legislation), SGI may elect not to capitalize the benefit.

If a surviving spouse or a dependant waives his or her rights pursuant to section 202 of the Act, SGI shall pay that person a lump-sum benefit of $15,404 (2016) in lieu of any benefit that would otherwise be payable.


Lump-sum death benefit: No surviving family (Act, ss 147(1)): If a customer dies leaving no surviving spouse, dependant, parent or non-dependent child, the

customer’s estate is entitled to a lump-sum benefit of $15,404 (2016). Only surviving parents and non-dependant children (Act, ss 147(2)): If the customer dies leaving no surviving spouse or dependant, but leaves a parent or non-dependent

child, SGI shall pay $15,404 (2016) to each parent and non-dependant child.

Five or more persons entitled to benefit (Act, ss 147(3)): ° If five or more persons are entitled to a benefit described in subsection 147(2), the total sum payable

to all persons is $69,322 (2016) and that amount shall be divided equally among all persons entitled to that benefit.

Under 21 with no spouse or dependants, but surviving parents (Act, ss 147(4)): If on the day the customer dies, they are under 21 years of age and leave no surviving spouse or

dependants, but leave one or more surviving parents, SGI shall pay $30,809 (2016) to the customer’s estate.


Funeral benefit (Act, s 148): The customer’s estate is entitled to a lump sum benefit of $10,078 (2016) for funeral expenses. ° This payment is made automatically without respect to the actual cost of the funeral.


Education benefit for surviving spouse (Act, s 149): Subject to the regulations, SGI may pay an education benefit to a surviving spouse who, at the date of

the accident, was dependent on the deceased. An education benefit is to be used for the education of the surviving spouse. The maximum amount of an education benefit pursuant to this section is $46,215 (2016). Note: Section 29 of the regulations prescribes that the surviving spouse must apply within 5 years from the date of the accident in order to receive the benefit, which is designated for specific expenses (i.e., tuition, books, child care, and additional housing expenses). For additional information, please see 5.1.3 – Summary of Part V Regulations.

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Vocational counselling (Act, s 150): Subject to the regulations, SGI may pay a maximum benefit of $671 (2016) to a deceased customer’s

surviving spouse for vocational counselling.

Section 151 repealed

Grief counselling: Section 151 of the Act (grief counselling) has been repealed and is now replaced by section 162.1 to

apply to immediate family members of a customer who sustains bodily injury (i.e., injury or death) as a result of a motor vehicle accident. Please see 7.2.1 – Counselling for immediate family for additional information.

Section 162 as it applies to death benefits

Financial counselling (Act, s. 162): Subject to the regulations, SGI may reimburse a beneficiary for authorized financial counselling if the

beneficiary receives a lump-sum payment (e.g., a lump sum death benefit) in excess of the prescribed amount ( i.e., $69,322 (2016)).

° The maximum benefit for financial counselling is $1,343 (2016).

Note: Please see the section on financial counselling in section 7.2.1 – Benefits for Expenses of this manual.

Section 172 as it applies to death benefits

Section 172 of the Act as it applies to death benefits: Benefit levels in place as of the date of death must be used: Subsection 172(3.2) indicates that benefits payable pursuant to Division 5 must be calculated based on

the maximum benefit amount payable for that benefit on the date of death. ° This means that certain amounts must be considered as of the date of death, such as:

The maximum insurable earnings; or Minimum spousal and dependant death benefits.

Death benefits paid on a bi-weekly basis pending lump sum election: Subsection 172(5) directs SGI to pay a death benefit to a beneficiary every 14 days pending an election

to receive a lump sum benefit.

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Surviving spouse and dependant(s) as of the date of death: Subsection 172(7) indicates that SGI must only consider payment of death benefits to a surviving spouse

and/or dependant(s), if they are a surviving spouse or dependant as of the date of the customer’s death.

° This subsection applies in instances where the customer sustains injuries and at some later point in

time dies from accident-related injuries and a death benefit is payable as a result. For example, if a person is a surviving spouse or dependant at the date of the accident, but is no longer a surviving spouse or dependant as of the date of death, they would no longer be entitled to a death benefit. Note: In these instances, SGI must consider only the circumstances in place as of the date of death.

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5.1.3 – Summary of Part V Regulations 1

5.1.3 Summary of Part V Regulations (5.1.3-01/2017)


Purpose Provides a detailed overview of the relevant sections of the regulations pertaining to the administration of death benefits.

Regulations 26-29 Part V – Death Benefits

Summary of Section 26 of the Regulations

Calculation of death benefit (Regulations, s 26): In determining a deceased’s yearly employment income (YEI) for surviving spouse and dependant

benefit calculations (subsections 144(1), (2), (3.1) or (6) of the Act), SGI shall not add in any fixed costs (which relates to income replacement benefit (IRB) calculations for self-employed earners).

For the purpose of calculating the death benefit to a surviving spouse (subsection 144(3.1)), the classes

of employment and the corresponding YEI set out in Appendix A apply in calculating a deceased’s YEI.

If the deceased’s YEI is determined on the basis of classes of employment, and the deceased did not hold full-time employment at the date of the accident, the YEI must be reduced according to the formula outlined in subsection 21(4) of the regulations.

For the purpose of subsection 145(6) of the Act (i.e., death benefits for multiple dependants), SGI shall

calculate and pay the death benefits in accordance with the following rules: ° The benefits must be calculated on the basis of the youngest dependant being equivalent to spouse.

° The benefits payable pursuant to subsection 145(6) are payable until the youngest dependant reaches

age 21 and each dependant is entitled to an equal share of the benefit until they reach age 21. ° The dependant benefit mentioned in subsection 144(6) is calculated not including the youngest

dependant, and must be paid until the second youngest dependant reaches age 21. ° A dependant is entitled to an equal share of the death benefits mentioned above (i.e., dependant

death benefits) until they reach age 21.


Dependant benefits (Regulations, s 27): For the purposes of subsection 144(7) of the Act, the minimum weekly dependant benefit payable to

the surviving spouse pursuant subsection 144(6) of the Act is as follows: ° $30 – For one dependant ° $54 – For two dependants ° $63 – For three dependants ° $72 – For four or more dependants

Note: The above amounts are expressed in 2016 dollars.

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5.1.3 – Summary of Part V Regulations 2


Method of capitalization for surviving spouse’s benefit (Regulations, s 28): ° For the purposes of section 146 of the Act, SGI shall determine the capitalized value of the surviving

spouse’s death benefit based on the standard mortality tables published by Statistics Canada using a discount rate of 3% per year.


Educational benefit for surviving spouse (Regulations, s 29): To be eligible for an educational benefit, a surviving spouse must apply within five years of the date of

the accident (or the date of death).

An educational benefit must be used by the surviving spouse for the following types of expenses:

° tuition fees ° required books or other course materials ° child care ° housing expenses if the surviving spouse is required to maintain more than one residence in order to

attend an educational institution.

A surviving spouse is not eligible for more than 25% of the maximum educational benefit payable in one calendar year.

SGI may exempt a surviving spouse from those types of expenses specified above, or pay an educational benefit above 25% of the maximum benefit payable per calendar year, if SGI is satisfied that doing so is reasonably required by the surviving spouse.

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5.2.1 – Spousal Death Benefits 1

5.2.1 Spousal Death Benefits (5.2.1-01/2017)


Purpose Provides a detailed overview of the Act, the regulations, and SGI’s policies and procedures with respect to the administration of spousal death benefits.

Act 144 Death Benefits

Regulations 26 Calculation of death benefit

Important terms and definitions

Important terms and definitions: Please use the following terms and definitions to determine who may be entitled to a spousal benefit. Spouse (Act, ss 2(1)(rr)): The spouse of the customer who is, at the date of the accident, residing with the customer; or A person with whom, at the date of the accident, the customer is cohabiting and has cohabited as a

spouse: ° Continuously for a period of not less than two years; or ° Continuously for a period of not less than one year, if they are parents of a child.

(i.e., biological parents of a child, a legally adopted child, or a person who stands in place of a parent)

Note: Also note that many families have two residences due to employment or medical circumstances. This does not mean that they are separated. Please review the below examples for additional clarification.

Example – Health concerns: Due to health issues and requirement for extended care, one spouse is living in an extended care unit and the other spouse still resides in their primary residence. Example – Employment: The employment of one spouse requires them to reside in a different town or province to perform their job duties. The other spouse resides in the primary residence.

Surviving spouse (Act, ss 2(1)(ss)) means: A surviving spouse means a spouse of a customer and includes a former spouse of a customer who, at

the date of the accident: ° Had been living separate and apart from the customer for one year or less; ° Was receiving spousal support from the customer; or ° Had a court order or agreement with the customer entitling that person to spousal support from the

customer.

Injury Manual


Who may be considered a surviving spouse

Who may be considered a surviving spouse: Depending on the facts, the following types of beneficiaries may be considered a surviving spouse, and may be eligible for spousal death benefits: spouse someone who is cohabitating as a spouse a former spouse A spousal benefit may be payable to someone who: Was legally married to the deceased. Had been cohabitating with the deceased for at least two years. Had been cohabitating with the deceased for at least one year and had a child with the deceased. An ex-spouse who was eligible for spousal support from the deceased. Multiple surviving spouses: Using the definitions above, there are instances where there may be more than one surviving spouse

who is entitled to receive a benefit. ° For example, at the time of the customer’s death, he had remarried or was cohabitating for more than

two years with a spouse, but concurrently was required to pay spousal support to a former spouse. Each surviving spouse is entitled to receive a full spousal benefit and dependant benefit, as the case may

be, and the amount of these benefits is not divided amongst surviving spouses. A separate benefit calculation must be completed for each family unit based on the composition of that

family. A separate application for benefits must be completed with respect to each family unit.

Calculations performed according to Division 4 (IRB)

Calculations performed according to Division 4 (Income Replacement Benefits): Follow the procedures outlined in Division 4 to establish the Income Replacement Benefit (IRB) the

customer would have been entitled to receive, had they not been fatally injured in the motor vehicle accident.

Note: For additional information please refer to Division 4 – Income Replacement Benefits of this manual.

Death benefits not an IRB: A death benefit is not an IRB although the IRB is used to calculate death benefits. No seven-day waiting period: There is no seven-day waiting period. Section 172 (Payment of benefits) of the Act has no application to

death benefits.

Injury Manual


Calculation & payment of a spousal benefit

Calculation and payment of a spousal benefit (Act, s 144): The weekly spousal death benefit (DB) equates to 50% of the calculated income replacement benefit

(IRB) that the deceased would have been entitled to receive had they survived according to the following formula (Act, ss 144 (1), (2), (3), (3.1), (3.2)):

DB = (50%) x IRB

The spousal death benefit as outlined above is paid on a bi-weekly basis. The benefit is payable for the lifetime of the surviving spouse. Surviving spouse may elect to have spousal benefit paid as a lump sum: The spousal benefit may be paid out as a lump sum pursuant to section 146 of the Act.

The surviving spouse must elect to have the benefit paid out as a lump sum within 5 years of the date of

loss.

The minimum spousal benefit is $69,322 (2016) regardless of whether the deceased was a non-earner (Act, ss 144(4)).

Note: For additional information with respect to the capitalization of death benefits please refer to 5.4.1 – Capitalization of Death Benefits for Spousal and Dependant Benefits of this manual.

Calculations for non-seasonal workers

Calculations for non-seasonal workers (i.e., salaried or self-employed)(Act, ss 144(1)): The weekly death benefit (DB) is calculated using the following formula:

DB = (50% x IRB)

The IRB identified above is the greater of: ° The YEI the customer earned or would have earned from all employments held at the date of the

accident; or

° The YEI the customer earned in the year before the accident.

Note: For additional detail with respect to this calculation please reference subsection 144(1) of the Act.

Injury Manual


Calculations for seasonal workers with more experience

Calculations for seasonal workers with more experience (Act, ss 144(2)): For a deceased customer who held seasonal employment prior to July 1st of the prior calendar year, the

weekly death benefit (DB) is calculated using the following formula: DB = (50% x IRB) The IRB identified above is the greater of:

° The YEI the customer earned in the year before the accident; or ° The average YEI the customer earned in the two years prior to the accident.

Note: The YEI mentioned above is the YEI as set out in the regulations.

Calculations for seasonal workers with less experience

Calculations for seasonal workers with less experience (Act, ss 144(3) and (3.1)): For a deceased customer who held seasonal employment on or after July 1st of the prior calendar year,

the weekly death benefit (DB) is calculated using the following formula: DB = (50% x IRB)

If the deceased customer did not hold the seasonal employment until on or after July 1st of the year

before the accident, and did not otherwise hold seasonal employment in the two years before the accident, the IRB identified above is the greater of:

° The YEI the customer earned in the year before the accident; ° The average YEI the customer earned in the two years prior to the accident; or ° The YEI for the same class of employment (i.e., Appendix A) as the seasonal employment.

Note: The YEI mentioned above is the YEI as set out in the regulations.

Greater of IRB at time of accident or at date of death

Benefit calculated using greater of IRB at time of accident or at date of death (Act, ss. 144(3.2)): If after a motor vehicle accident the customer is receiving an IRB and later dies as a result of the

accident, the death benefit is the greater of: ° The IRB the customer would have been entitled to receive at the time of the accident; or ° The IRB the customer was entitled to at the date of his or her death.

Note: The purpose of calculating a death benefit in the above manner is to ensure that the customer’s family receives the best possible benefit under the circumstances, taking into consideration of the customer’s income and circumstances as of the date of death.

Death within the first seven days

Death within the first seven days after the accident (Act, ss. 144(3.3)): If a customer dies within the first seven days after the accident, he or she is deemed to have died on the

date of the accident.

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Minimum spousal death benefits

Minimum spousal death benefits (Act, ss 144(4) and (4.1)): The minimum death benefit a surviving spouse is entitled to receive is $69,322 (2016); If a surviving spouse receives the minimum death benefit, the spouse is not entitled to any additional

amount of death benefits, other than a dependant death benefit according to subsection 144(6) of the Act.

Weekly benefit ends when surviving spouse dies

Weekly death benefit ends when surviving spouse dies (Act, ss. 144(5)): The weekly death benefit payable pursuant to this section ends when the surviving spouse dies.

Determining eligibility of a surviving spouse

Determining eligibility of a surviving spouse: Obtain a completed Application for Death Benefits

Obtain a marriage certificate

Where a spousal relationship exists and a marriage certificate cannot be produced, it is important to

ensure that objective evidence substantiating that spousal relationship is obtained (e.g., a sworn affidavit)

If there is an ex-spouse, supporting information will need to be produced demonstrating receipt of, or

entitlement to, spousal support as of the date of the accident (e.g., copy of the judgment or agreement, or receipts documenting payments)

Note: For additional information, please see 5.6.1 – Adjudicating a Claim for Death Benefits and 5.7.1 – Death Benefit Source Documents & Information.

Multiple surviving spouses

Multiple surviving spouses: There may be more than one individual who is entitled to receive a death benefit as a surviving spouse.

Each surviving spouse is entitled to receive a full spousal benefit. The benefit is not divided among the

individuals entitled to receive this death benefit. If the deceased had an ex-spouse, from whom he or she was divorced or separated, whether via

execution of a separation agreement or otherwise, and to whom spousal support was being paid or was payable by contract or court order, that ex-spouse is considered a surviving spouse and qualifies for a spousal benefit.

This benefit is paid to the ex-spouse even if there is a spouse, whether through marriage or cohabitation,

who is also receiving a spousal benefit.

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Supporting Documents

Supporting documents to establish that an individual is a surviving spouse: Once the person(s) has been identified as spouse, one or more of the following supporting documents is

required to confirm eligibility for a surviving spouse:

If married: A copy of the marriage certificate.

If cohabitating as a spouse:

A sworn statutory declaration verifying cohabitation as a spouse; A sworn affidavit(s) from one or more objective third party(ies); or Any official document(s) that would support cohabitation as a spouse.

(e.g., including, but not limited to income tax returns, etc.) Examples of additional supporting documents that may assist with establishing cohabitation: ° copy of mortgage or rental agreement ° utility bills ° joint bank account information ° income tax returns If a statutory declaration is completed, at a minimum, it should include the following information with respect to the person completing the declaration: ° name ° address ° date of birth ° SGI Customer Number ° occupation ° relationship to deceased

Ex-spouses: A copy of the court documents outlining any spousal support payments (i.e., a copy of the court order or

agreement). Multiple family units: Each family unit must provide the required supporting documents.

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5.3.1 – Dependant Death Benefits 1

5.3.1 Dependant Death Benefits (5.3.1-01/2017)


Purpose Provides a detailed overview of the Act, the regulations, and SGI’s policies and procedures with respect to dependant death benefits.

Act 144

145 Death benefits Death benefit - dependant

Regulations 26 27

Calculation of death benefit Dependant benefits

Important terms and definitions

Important terms and definitions: Equivalent to spouse (Act, ss 145(2)): There are instances where SGI will consider the youngest dependant to be a spouse (i.e., equivalent to

spouse) when the deceased has no surviving spouse within the definitions of the Act.

Parent (Act, ss 2(1)(ff)) means: The mother or the father of a child; A person to whom custody of a child has been granted by a court of competent jurisdiction or by a

custody agreement; or A person with whom a child resides and who stands in the place of a parent to the child. Child (Act, s 2(1)(l)): A person to whom the customer stands in the place of a parent; and A person for whose support a customer was, at the date of the accident, liable pursuant to any Act or

Act of the Parliament of Canada.

Dependant (Act, ss 100(b)), with respect to a deceased customer, means: A child of the customer who is under 21 years of age at the date of the accident and includes a child of

the customer born after the date of the accident or the death of a customer; or

Any person who would qualify for a tax credit pursuant to section 118.3 of the Income Tax Act (Canada) for a mental or physical impairment and who is dependent on the customer for the necessities of life at the date of the accident.

Who may be considered a dependant

Who may be considered a dependant: A child of the insured who is under 21 years of age at the date of the accident; or A child of the insured born after the date of the accident or the death of an insured; or Any person who was dependant on the deceased at the date of the accident who would qualify for a tax

credit pursuant to section 118.3 of the Income Tax Act (Canada) for a mental or physical impairment.

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A child of the deceased includes: ° The biological child of the deceased; ° A legally adopted child of the deceased; ° A non-biological child to whom the deceased stood in the place of a parent; and ° A child for whose support an insured was, at the date of the collision, liable pursuant to any Act or Act

of the Parliament of Canada


Calculations performed according to Division 4 (Income Replacement Benefits): Follow the procedures outlined in Division 4 to establish the Income Replacement Benefit (IRB) the



Death benefits not an IRB: A death benefit is not an IRB although the IRB is used to calculate death benefits. No seven-day waiting period: There is no seven-day waiting period. Section 172 (Payment of benefits) of the Act has no application to

death benefits.

Calculation and payment of dependant benefits

Calculation and payment of dependant benefits (Act, ss 144(6)): A dependant benefit is based on 5% of the deceased’s calculated income benefit.

Benefit = (5% x IRB) x DC

Where: IRB is the income replacement benefit; and DC is the number of the deceased’s dependants.

The benefit cannot be less than the prescribed minimum weekly amount (Act, ss 144(7)).

Minimum weekly dependant benefits

Minimum weekly dependant benefits (Act, ss 144(7) and Regulations, s 27): The amount of the weekly dependant benefit payable to the surviving spouse cannot be less than the

following amounts: ° $30 – for one dependant ° $54 – for two dependants ° $63 – for three dependants ° $72 – for four or more dependants Note: The above amounts are expressed in 2016 dollars.

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Payment of Dependant Benefits to a Surviving Spouse

Payment of Dependant Benefits to a Surviving Spouse: Dependant benefits payable to surviving spouse (Act, ss. 144(8)): The death benefit for the dependant(s) is payable to the deceased’s surviving spouse. Payment to the Public Guardian and Trustee (Act, ss. 144(9)): SGI may pay the weekly death benefit for the dependant(s) to the Public Guardian and Trustee if:

° The dependant(s) does not reside with the surviving spouse; or ° In SGI’s opinion, the surviving spouse has neglected or abandoned the dependant.

Benefit payable until dependant reaches age 21 or dies (Act, ss. 144(10)): The weekly dependant death benefit is payable until:


Note: The dependant benefit can be paid directly to the dependant if they are older than 18 years of age. Benefits for dependants with a physical or mental impairment (Act, ss. 144(11)): If the dependant has a physical or mental impairment as defined in subsection 100(b)(ii) of the Act, the

dependant death benefit is payable until: ° The dependant dies; or ° They are no longer a dependant within the meaning of subsection 100(b)(ii) of the Act.

When Benefits are Payable to a Dependant

When Benefits are Payable to a Dependant – Additional Circumstances Both parents die (Act, ss 145(1)): If both parents die in the same accident, the dependant is entitled to the death benefit mentioned in

section 144 of the Act as if the dependant were surviving spouse (i.e., equivalent to spouse, 50% x IRB) of each parent.

Note: It is not necessary to determine which parent died first for the purpose of determining the amount of the death benefits that are payable.

Sole parent dies (Act, ss 145(2)): If the deceased was the sole parent of the dependant and died as a result of an accident, the dependant

is entitled to the death benefit mentioned in section 144 of the Act as if the dependant was the surviving spouse (i.e., equivalent to spouse, 50% x IRB).

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When the parent of the dependant is not entitled to the spousal benefit (Act, ss 145(3)): If the remaining parent of the deceased’s dependant is not entitled to a benefit set out in subsection

144(1), the dependant is entitled to the death benefit mentioned in section 144 as if the dependant was the surviving spouse (i.e., equivalent to spouse).

Multiple dependants: If there are multiple dependants, the benefits must be paid in the prescribed manner in accordance with

subsection 26(4) of the regulations. For additional information, please see the section below concerning When Benefits are Payable to Multiple Dependants.

Payment of Benefits to a Dependant

Payment of Benefits to a Dependant Benefits payable until age 21 or dependant dies (Act, ss 145(4)): The dependant benefit mentioned in this section is payable until whichever comes first:


Note: The dependant benefit can be paid directly to the dependant if they are older than 18 years of age. Minimum dependant death benefit (Act, ss. 145(5)): The minimum death benefit a dependant is entitled to receive is $69,322 for a death occurring in 2016.

When Benefits are Payable to Multiple Dependants

When Benefits are Payable to Multiple Dependants When there is more than one dependant (Act, ss. 145(5.1)-(6)): A dependant who is entitled to a death benefit under subsections 145(1)-(4) is not entitled to a death

benefit pursuant to subsection 144(6) (i.e., when there is more than one dependant). If there is more than one dependant, the death benefits mentioned in this section are to be calculated

and paid in the prescribed manner as outlined in subsection 26(4) of the regulations. Paying benefits in the prescribed manner (Regulations, s 26(4)): The youngest dependant is considered to be the surviving spouse (i.e., equivalent to spouse) for the

purpose of the death benefit calculation. The spousal benefit (i.e., equivalent to spouse, 50% x IRB) is payable until the youngest dependant

reaches age 21 and each dependant is entitled to an equal share of the benefit until he or she reaches age 21.

The dependant benefit (i.e., 5% x IRB) is calculated not including the youngest dependant, and must be

paid until the second youngest dependant reaches age 21.

A dependant is entitled to an equal share of the death benefits mentioned above (i.e., dependant benefits) until he or she reaches age 21.

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Determining eligibility of a dependant

Determining eligibility of a dependant: Obtain an Application for Death Benefits.

Obtain a copy of the birth certificate or other legal documentation to determine the child’s age and

establish the deceased as the parent.

Note: A birth certificate is preferred in almost all circumstances. If a birth certificate is not available, depending on the circumstances, alternate documentation may be acceptable for these purposes.

If the deceased stood in the place of a parent – Conduct a thorough investigation including interviews of

relevant parties, to ascertain whether the deceased stood in the place of a parent and whether any other third party stood in the place of a parent to the dependants.

Conduct interviews and obtain information that establishes the details of:

° the identity of the dependants ° whether the deceased stood in the place of a parent to a dependant ° whether there is surviving spouse and whether he or she stood in the place of a parent ° whether there is a surviving parent (i.e., either biologically or standing in the place of parent)

Note: For additional information, please see 5.6.1 – Adjudicating a Claim for Death Benefits and 5.7.1 – Death Benefit Source Documents & Information.

Supporting documents identifying parents of a dependant

Supporting documents identifying parents of a dependant: The following source documents may be required to demonstrate that the deceased was the parent of a

dependant. This should be used with other required information provided by the beneficiaries to ensure only eligible dependants are provided benefits.

Records that assist in identifying the biological parent of a dependant include: Birth certificate of the dependant which identifies the deceased parent or identifies the dependant as

having the same last name as the deceased parent. Live birth record of the dependant issued by the hospital identifying the deceased parent. Baptism records identifying the deceased parent. Other official documents such as government records, band records, etc. DNA test results confirming the deceased as the biological parent (DNA testing should be used as a last

resort). Payment for DNA testing only when SGI relies on testing results to make a decision: DNA testing may be an option where there is a disagreement as to biological parentage that cannot be

resolved via existing documentation. The onus of proof rests with the beneficiary to establish entitlement to death benefits. If DNA testing is

provided to SGI, SGI will reimburse the costs associated with the DNA testing where SGI relies on the DNA testing to either confirm or deny coverage.

Injury Manual


Determining if the deceased stood in the place of a parent

Determining if the deceased stood in the place of a parent: It is important to conduct a thorough investigation to establish the facts of the situation to determine if

the deceased stood in the place of a parent.

Note: The following analysis also applies to a surviving spouse or surviving parent and whether he or she stood in the place of a parent.

The following questions may form part of the analysis:

° Is the child involved with the extended family in the same way as a biological child? ° Did the deceased provide financial support for the child? ° Did the deceased discipline the child? ° Did the deceased demonstrate to others that he or she was responsible as a parent of the child? ° What was the nature of the child’s relationship with the biological parent? ° Did the child call the deceased Mom or Dad? ° Has the child’s surname changed to the deceased’s? ° Has there been any prior discussion about adoption? ° Did the deceased take part in the child’s activities? ° Was there some degree of affection? ° Did the deceased engage in decisions about education? ° Did the deceased attend parent-teacher meetings? ° Did the deceased give the child gifts? ° Did they carry a picture of the child in their wallet? ° Did the child view the deceased as a father or mother figure? ° What is the age of the child? ° What was the duration of the child’s relationship with the deceased? ° Was there any intention to terminate the relationship? ° Was any other person obligated to support the child?

Note: The above questions may be used as a guide. However, every situation is different and is based on its own unique facts.

Non-biological parents source document checklist: Adoption papers identifying the deceased parent. Objective evidence that the deceased stood in the place of a parent. Affidavits from objective third parties who have knowledge as to whether the deceased customer stood

in the place of a parent to a dependant. Example - Standing in place of a parent:

A customer who was in a spousal relationship dies as a result of a motor vehicle accident. This

relationship was not more than two years in duration and no children were born of the relationship. The spouse who was living with the deceased has a child from a previous relationship and the deceased was standing in the place of a parent. ° SGI would consider the spouse to be a surviving spouse even though the relationship was less than

two years in duration because the deceased stood in the place of a parent at time of the accident.

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Legal adoption: Children who have been adopted pursuant to provincial adoption legislation (e.g., Saskatchewan’s

Adoption Act) are no longer considered to be the children of their biological parents, and are considered the children of their adoptive parents for the purposes of Division 5 of the Act.

Adopted children (i.e., dependants) are entitled to the same benefits as other children pursuant to

Division 5 of the Act. If the parent of a legally adopted child dies as a result of a motor vehicle accident, the child (i.e., dependant) is entitled to receive benefits in the usual manner. Legally adopted children are treated in the same manner as the biological children of the deceased.

With respect to the entitlement of adopted children, children that have been adopted by a third party

prior to the death of a biological parent are not entitled to receive death benefits for the death of the biological parent.

With respect to the entitlement of adopted children who are adults, adult children are not entitled to

death benefits where their biological parent passed away and they had already been adopted by a third party at the time of the death of the biological parent.

Note: Only the circumstances in place as of the date of death are to be considered with respect to adoption. Any adoption that occurs following the date of death will have no impact on benefit entitlement.

Foster home exclusion: Foster homes have an agreement with the Government of Saskatchewan to provide care for minors

when there is no parent or adult able to care for the minor. ° The foster home receives payment for the service provided, to care for the dependant and the foster

parents would not be entitled to the payment of death benefits under the Act.

Mentally or physically impaired dependant

Mentally or physically impaired dependant supporting documents: The prior year’s income tax return is required to confirm that tax credits are being applied in accordance

with section 118.3 of the Income Tax Act (Canada) for a dependant who is mentally or physically impaired, and who was dependent on the deceased for necessities of life at the date of the accident.

Injury Manual

5.4.1 – Capitalization of Spousal and Dependant Benefits 1

5.4.1 Capitalization of Spousal and Dependant Benefits (5.4.1-01/2017)


Purpose Provides a detailed overview of the Act, the regulations, and SGI’s policies and procedures with respect to the capitalization of spousal and dependant death benefits.

Act 146 Capitalization of death benefits

Regulations 28 Method of capitalization for surviving spouse’s benefit

Capitalization of death benefits

Capitalization of death benefits (Act, ss 146(1)): A surviving spouse or a dependant who is entitled to a death benefit may elect to have the benefit

capitalized and, subject to the regulations, paid out as a lump sum.

Election within five years

Election within five years (Act, ss 146(2)): Subject to the regulations (section 28 of the regulations), a lump-sum election must be made within five

years of the date of death of the deceased and is not revocable. ° This means that the surviving spouse may elect to capitalize the bi-weekly benefits payable and

receive a lump-sum benefit payment.

Capitalization in the prescribed manner

Capitalization in the prescribed manner (Act, ss 146(3)): SGI shall undertake capitalization in the prescribed manner. Discount based on standard mortality tables (Regulations, s 28): ° Section 28 of the regulations states that SGI shall determine the capitalized value of the surviving

spouse’s death benefit based on the standard mortality tables published by Statistics Canada using a discount rate of 3% per year.

Compensation pursuant to WCB or other legislation

Compensation pursuant to WCB or other legislation SGI may elect not to capitalize the benefit (Act, ss 146(4)): If SGI is required to pay a death benefit to a surviving spouse or a dependant pursuant to section 202 of

the Act, SGI may elect not to capitalize the benefit. Surviving spouse or dependant may waive rights (Act, ss 146(5)): If a surviving spouse or a dependant waives his or her rights pursuant to section 202 of the Act, SGI shall

pay that person a lump-sum benefit of $15,404 (2016) in lieu of any benefit that would otherwise be payable pursuant to section 202 of the Act.

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Financial Counselling

Financial counselling (Act, s 162 and Regulations, s 72) The financial counselling benefit is available to the surviving spouse to assist with making a decision to:

° Receive a bi-weekly spousal death benefit; or ° Elect to have the bi-weekly death benefit capitalized and paid out as a lump sum.

Capitalization of benefits for multiple dependants

Capitalization of benefits for multiple dependants: In instances where the youngest dependant is deemed to be a surviving spouse (i.e., equivalent to

spouse) and dependant death benefits are payable to multiple dependants within a family unit, all benefits must be paid on a bi-weekly basis or as a lump sum as follows.

Each family unit must decide to either: ° Continue to receive bi-weekly death benefit payments; or ° Elect to capitalize the benefit and have all amounts paid-out as lump sums for each dependant. For example, if there are four dependants in one family unit, they along with a parent or guardian must make a selection for the entire family unit to continue to receive bi-weekly payments or lump-sum payments. Note: In instances where there is no surviving spouse, all benefits paid (i.e., either bi-weekly or lump sum) to dependants under 18 years of age must be paid to the Public Guardian and Trustee (Act, ss 144(9)).

Calculating the lump sum payment

Calculating the lump sum payment: Establishing the lump sum conversion date: The election for lump sum must be provided to SGI in writing with a conversion date. The conversion date selected must allow a minimum of 7-10 business days to allow the IRB Unit to

calculate the lump-sum benefit. If a lump-sum election is made, a revised Life Beneficiary form is required showing the conversion date. Method of capitalization for benefits to the surviving spouse: The IRB Unit will determine the capitalized value of the surviving spouse’s death benefit based on the

standard mortality tables published by Statistics Canada using a discount rate of 3% per year (i.e., per annum) in accordance with section 28 of the regulations.

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Issuing payment of lump-sum death benefits: A new death benefit calculation version will be created based on the lump-sum conversion date.

The IRB Unit will: ° Review the lump-sum calculation request; ° Review the claim file; ° Process the lump-sum death benefit payment for approval; and ° Return the lump-sum death benefit cheque(s) to the branch once approved.

Note: For additional information please see 5.6.1 – Adjudicating a Claim for Death Benefits.

Injury Manual

5.4.2 – Lump Sum Death Benefits 1

5.4.2 Lump Sum Death Benefits (5.4.2-01/2017)


Purpose Provides a detailed overview of the Act, the regulations, and SGI’s policies and procedures with respect to lump-sum death benefits.

Act 147 Lump sum death benefit

No survivors No Survivors (Act, ss 147(1)):

If the deceased has no surviving spouse, dependants, parents or non-dependent children, the estate

will receive a lump sum of $15,404 (2016).

Surviving parent or non-dependent child

Surviving parent or non-dependent child (Act, ss 147(2)-(3)): If the deceased has no surviving spouse or dependants, but leaves a parent or non-dependent child,

each parent or non-dependent child receives $15,404 (2016). ° If the parents and non-dependent children total five or more persons, they share equally a lump sum

of $69,322 (2016).

Declaration requirements:

When a death claim involves non-dependent children over 21 years old and/or parents, ensure that all individuals that are entitled to a portion of the lump-sum benefit receive their share of the benefit.

A declaration must be completed when a death claim involves non-dependent children or parents. The declaration will help to determine the number of non-dependent children and/or parents who are entitled to a death benefit and ensure the appropriate benefits are paid.

The declaration should identify all non-dependent children or parents who may be entitled to the

benefit. This is completed to make certain that all non-dependent children and parents are identified prior to paying a death benefit pursuant to subsection 147(3) of the Act, so as to ensure that all those individuals who are entitled to a share of the benefit receive their respective shares.

Under age 21 with surviving parents

Under age 21 with surviving parents(Act, ss 147(4)): If the deceased is under age 21 and has no spouse or dependants, but leaves one or more surviving

parents, a lump sum of $30,809 (2016) is paid to the estate.

Injury Manual

5.5.1 – Other Death Benefits 1

5.5.1 Other Death Benefits (5.5.1-01/2017)


Purpose Provides a detailed overview of the Act, the regulations, and SGI’s policies and procedures with respect to other types of death benefits available to beneficiaries.

Act 148

149 150 162 162.1

Funeral benefit Education benefit for surviving spouse Vocational counselling Financial counselling Grief counselling

Funeral benefit

Funeral benefit (Act, s 148): The funeral benefit is indexed each year and is payable to the estate in the amount of $10,078 (2016).

Funeral benefit to be paid immediately:

The funeral benefit should be paid promptly, as soon as the following information is obtained on file: ° An Application for Death Benefits; and ° A physician’s report of death or funeral director’s certificate of death.

Note: If it is clear that the death was caused by a motor vehicle accident, the benefit can be paid immediately upon the receipt of the above information. If there is information or evidence to suggest that the motor vehicle accident is not the cause of death, the funeral benefit should be withheld until additional information is obtained and the cause of death is determined.

Payment to the deceased’s estate: The payee for any funeral benefit payment is “The Estate of [insert name of deceased customer here].” The funeral benefit amount is paid based on the funeral benefit amount in place as at the date of the

customer’s death.

For example, if a customer dies 2 years after the motor vehicle accident and the death is related to the accident, then SGI pays the death benefit and funeral benefit as per the date of the death, not the date of the accident.

The amount of the funeral benefit is $10,078 (2016). It is not affected by the actual cost of the funeral and associated expenses (e.g., lunch, headstones, memorials).

Injury Manual


Payment to the funeral home or a family member in exceptional circumstances: Payments are to be made directly to the funeral home or a family member only in exceptional

circumstances. Examples of exceptional circumstances may include: ° The family is in the process of establishing the deceased’s estate and does not have money available

to pay the funeral costs to the funeral home.

° The family is in the process of establishing the deceased’s estate and a family member has already paid the funeral costs to the funeral home.

In exceptional cases, if the deceased’s family signs a funeral benefit release, the funeral benefit can be

paid directly to the funeral home. If the amount of the funeral expenses is less than the funeral benefit limit, any remaining amount is to

be paid to the deceased’s estate.

If the funeral invoice has been paid in full by a family member and there is confirmation from the funeral home that the account has been paid in full, SGI may reimburse the person who paid the expense and the remaining amount of the benefit to the deceased’s estate (i.e., “The Estate of”).

Education benefit

Education benefit for surviving spouse (Act, s 149 and Regulations, s 29): SGI may pay an education benefit to a surviving spouse who, at the date of the accident (or the date of

death), was dependent on the deceased. An education benefit is to be used for the education of the surviving spouse and is paid to a maximum amount of $46,215 (2016).

Eligibility requirements for an education benefit: To be eligible for an education benefit, a surviving spouse must apply within five years from the date of

the accident or the date of death. The surviving spouse can take classes for as long as necessary within the benefit limit, so long as SGI is advised of the intention to take classes within five years of the accident or the date of death.

Eligible education expenses: An education benefit must be used by the dependant surviving spouse for the following types of

expenses:

° tuition fees ° required books or other course materials ° child care ° housing expenses if the surviving spouse is required to maintain more than one residence in order to

attend an educational institution (e.g., room and board costs)

Note: If the surviving spouse is not required to maintain a second residence to attend school (e.g., the course of study is available locally), the housing expense benefit is not payable.

Injury Manual


Education benefit limited to 25% per calendar year in most cases: A surviving spouse is not eligible for more than 25% of the maximum education benefit payable in one

calendar year.

SGI may pay expenses outside of those specified in subsection 29(4) of the regulations, or pay an education benefit above the maximum amount of 25% per calendar year, if SGI is satisfied that doing so is reasonably required by the surviving spouse.

Dependant not entitled to education benefit: A dependant entitled to an "equivalent to spouse" death benefit pursuant to section 145 of the Act, is

not entitled to an education benefit.

Education Benefit Expense Procedure

Education benefit expense procedure: 1. Establish eligibility of the customer as a surviving spouse: ° This is established by the source documents collected on the file including:

A marriage certificate; or Evidence of cohabitation as a spouse.

Note: For additional information please see 5.7.1 – Death Benefit Source Documents and Information.

2. Verify acceptance into a program of study at an educational institution:

° Obtain the following information from the surviving spouse or the educational institution:

The name of the institution and course of studies; and Proof of enrollment or registration in the course of study.

3. Pay eligible expenses up to the yearly limit upon submission of receipts: ° Eligible expenses may be reimbursed based on receipts for: tuition books and course materials child care additional housing expenses

° Prepare the cheque for reimbursement of eligible expenses. ° Prepare a decision letter with an explanation to accompany the cheque.

Vocational counselling

Vocational counselling (Act, s 150): Vocational counselling is available to a spouse (i.e., surviving spouse) of the deceased up to $671 (2016).

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Financial counselling

Financial counselling (Act, s 162 and Regulations, s 72): Reimbursement for authorized financial counselling to a maximum amount of $1,343 (2016) is available

to a beneficiary. This benefit reimburses a beneficiary for authorized financial counselling and may be used by the

surviving spouse to assist in making a decision regarding bi-weekly or lump-sum payment options.

Grief counselling

Grief counselling (Act, s 162.1): Section 151 of the Act (Grief counselling) has been repealed and is now replaced by section 162.1 to

apply to immediate family members of a customer who sustains bodily injury (i.e., injury or death) as a result of a motor vehicle accident. Please see 7.2.1 – Counselling for immediate family for additional information.

Examples of expenses not covered

Examples of expenses not covered under a claim for death benefits: Family members of the deceased customer are not eligible to claim for expenses including, but not

limited to, the following: ° their income loss ° phone bills ° travel costs ° child care costs ° costs associated with administering the estate

(e.g., court probate fees or costs to appoint an administrator)

Injury Manual

5.6.1 – Adjudicating a Claim for Death Benefits 1

5.6.1 Adjudicating a Claim for Death Benefits (5.6.1-01/2017)


Purpose Provides information on SGI’s policies and procedures with respect to the adjudication of a claim for death benefits.


Regulations 26-29 Death Benefits

Initial Contact Initial Contact

Who can notify SGI of a claim: Any person with knowledge that a fatality occurred as a result of a motor vehicle accident. Depending on the circumstances, any of the following may initiate a claim for death benefits: a surviving spouse of the deceased a family member of the deceased a guardian or co-decision maker of the deceased a guardian or co-decision maker acting on behalf of the dependants the executor or administrator of the deceased’s estate a power of attorney a lawyer a Personal Injury Representative (PIR) Confirming the authority of a representative: The following types of information may be requested:

° A copy of the order appointing a guardian or co-decision-maker. ° A copy of the power of attorney document. ° A signed authorization from the beneficiary that the lawyer is authorized to act on their behalf. ° For an executor or administrator, a copy of the Letters Probate or the Letters of Administration.

If the deceased was an Indian pursuant to the provisions of the Indian Act, who died intestate (i.e., dies

without having made a will), the spouse and/or dependants may seek the appointment of an administrator via the Indian Act.

PIR to initiate claim if no contact from deceased’s family: If a claim has not been initiated by the customer’s family, contact the deceased customer’s family to

initiate the claim in instances where notification has been received by SGI about the fatality.

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SGI may have received notification of the fatality from a number of sources, such as:

° the auto adjuster or auto claim information ° an RCMP or police report ° a newspaper article ° a news release ° an ambulance invoice

Obtaining contact information from the RCMP or police: If contact information for the deceased’s family is unclear, contact the RCMP or police department who

may be able to provide contact information for the deceased’s next of kin and family members.

Initial Interview

Initial Interview: Complete the initial interview with the deceased’s family members using the form entitled Initial

Interview Template (Fatality). The initial interview form contains important questions and a list of supporting documents required

from the potential beneficiaries to adjudicate the claim. The initial interview form will also help to document the family circumstances and will guide the payment of benefits going forward.

The initial interview may be completed at any time before or after the Application for Death Benefits

has been completed.

Types of information gathered at the time of the initial interview: Information gathered at the time of the initial interview may include: date and time of the accident accident circumstances (if known) date of the death (if the date of death occurs after the accident date) name of person initiating claim and relationship to deceased auto claim information (if known) extension policy information (Note: additional benefits may be payable to the beneficiary under other

policies of insurance) contact information for all potential beneficiaries marital status (i.e., not married, married, common law, or divorced) dependants (i.e., names and date of birth confirming age) the family dynamic and circumstances (i.e., to determine if there are multiple family units); surviving parents (names and contact information) non-dependent children (names and date of birth confirming age) employment status at the time of the motor vehicle accident employment information (i.e., employer name, job title, nature of the employment etc.) Note: The above information is a general list of information typically gathered at the time of the initial interview. For further reference, please see the form entitled Initial Interview Template (Fatality).

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Employment Information: For additional information concerning what information should be gathered with respect to the

deceased’s employment, please see 4.10.1 –IRB Source Documents & Information.

Application for Death Benefits

Application for Death Benefits: The Application for Death Benefits authorizes SGI to gather medical and employment information to

assist in determining benefit entitlement for the purpose of adjudicating the claim. The application may be completed by: ° a surviving spouse of the deceased; ° a family member of the deceased; ° a guardian or co-decision maker of the deceased; ° a guardian or co-decision maker acting on behalf of the dependants; ° the executor or administrator of the deceased’s estate; ° a power of attorney; or ° a lawyer.

A separate Application for Death Benefits must be completed by a potential beneficiary of the death

benefits (i.e., for each family unit). The Application for Death Benefits may be completed at any time before or after the initial interview has

been completed.

Confirming coverage

Confirming coverage: For information with respect to confirmation of coverage for Saskatchewan residents and non-residents,

please refer to Division 2 of Part VIII of the Act and Division 2 of this manual. The following sections of the Act will assist you in confirming coverage: ° 108 – Benefits for Saskatchewan residents and, if in a reciprocity agreement, for non-Saskatchewan

residents; ° 109 – Benefits for non-residents; and ° 110 – Accidents outside Saskatchewan.

Requesting supporting documents

Requesting supporting documents: The letter entitled Death – Request Supporting Documents should be sent to the customer after the

initial interview or Application for Death Benefits has been received and reviewed. This letter provides a summary of the discussion with the beneficiary and provides a list of the

supporting documents that SGI requires to adjudicate the claim and to determine the benefits payable.

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Procedures Death Benefit Checklist 1. Initial interview is complete: Complete the initial interview. 2. Application for Death Benefits is complete: Receive the Application for Death Benefits from one of the following: ° A surviving spouse of the deceased; ° A family member of the deceased; ° A guardian or co-decision maker of the deceased; ° A guardian or co-decision maker acting on behalf of the dependants; ° The executor or administrator of the deceased’s estate; ° A power of attorney; or ° A lawyer.

3. Employment information has been obtained: Document the nature of the customer’s employment:

° Was the deceased a salaried or self-employed earner? ° Was the deceased’s employment seasonal in nature?

Ensure the following income information has been obtained:

Salaried Earner Seasonal Earner Self-Employed Earner Paystubs

(3 prior pay-cycles) EVOE (prior 52 weeks) Income Tax Return

(prior year) Notice of Assessment

Paystubs (3 prior pay-cycles)

EVOE (prior 52 weeks) Income Tax Returns

(2 prior years) Notice of Assessment

Personal and/or Corporate Income Tax Returns

Notice of Assessment Statement of Business

Activities

(All for the 3 prior years) 4. All relevant source documents have been obtained and attached to file: Application for Death Benefits; Physician’s report of death or funeral director’s certificate of death; Marriage certificate or affidavit supporting cohabitation as a spouse; Spouse’s birth certificate, if applicable; Birth certificate for each dependant under 21 years old, if applicable; Prior year’s income tax return to establish spousal and dependant tax credits; and Prior year’s Notice of Assessment (NOA) or tax summary provided by Canada Revenue Agency (CRA).

Note: There will be circumstances where additional documentation is required to support the payment of death benefits. The above list is the minimum required information in order to request approval for the completion of a death benefit calculation.

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5. The appropriate IRB forms have been filled out and are complete: ° Complete the salaried earner or self-employed earner YEI form with supporting documents; and ° Complete the Beneficiary Life form listing death benefit source documents.

Note: A Beneficiary Life form must be completed for each family unit when there are multiple family units claiming death benefits.

6. The PIR III or Adjuster III has placed their approval note on file: ° An approval note must be placed on file indicating that the file has been reviewed and that all relevant

source documents and information have been collected and are attached to file.

° An approval note must be placed on file in order for the death benefit calculation to proceed to the IRB unit.

7. A death benefit calculation request has been sent to the IRB unit: Once the IRB unit has received the request, the IRB unit will:

° Provide death benefit summary version(s) for each surviving spouse and each dependant; ° Establish the bi-weekly death benefit payment effective as of the date of the accident; and ° Establish the lump-sum benefit option as of the date of the accident.

Summary of the above checklist: 1. Initial interview is complete. 2. Application for Death Benefits is complete. 3. Employment information has been obtained. 4. All relevant source documents have been obtained and attached to file. 5. The appropriate IRB forms have been filled out and are complete. 6. The PIR III or Adjuster III has placed their approval note on file. 7. A death benefit calculation request has been sent to the IRB unit.

Following the completion of the death benefit calculation: 1. Commence the payment of the bi-weekly death benefit as of the accident date: ° Payments should commence as of the date of the accident with no seven-day waiting period.

2. Provide a written decision letter detailing the beneficiary’s entitlement:

Provide a written decision letter to the beneficiary outlining the death benefit detailing the following where applicable: ° The bi-weekly spousal benefit; ° The bi-weekly dependant benefit; ° The option to have these benefits paid out as a lump sum; ° The date by which a lump sum election must be made (i.e., five years from the date of death); and ° The amount of the lump sum benefit if this option is elected.

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3. Explain the death benefit entitlement to the beneficiary(ies):

Contact the beneficiary to discuss the information outlined in the written decision letter, as well as the following information if applicable:

° How indexation is applied to the bi-weekly payment on an annual basis. ° The requirement of a written request at the time of a lump-sum election.

4. If a lump sum election is made, request a lump sum calculation from the IRB unit: When the beneficiary elects to receive a lump sum, the conversion date from bi-weekly payments to the

lump sum must be a minimum 10 business days from the date that the election is made. This allows time for the calculation to be completed and a lump-sum payment to be prepared by the IRB unit.

If the beneficiary(ies) elect in writing to receive a lump-sum death benefit, a revised Life Beneficiary form

is required. Once the file has been reviewed and the lump sum settlement cheque has been prepared, the cheque

will be returned to the PIR. 5. Draft informational letter to accompany the payment of the lump-sum death benefit: The death benefit payment (i.e., cheque) must be issued to the appropriate beneficiary. The payment must be accompanied with written correspondence. The letter entitled Death-Advise Acceptance of Lump Sum Death Benefit may be used to detail the

amount of the lump-sum payment. 6. Contact the beneficiary(ies) to explain the payment of the lump-sum benefit: Advise the customer of the lump-sum death benefit payment as of the conversion date that was

selected.

Note: A payment made to a surviving spouse should never be less than the minimum spousal benefit of $69,322(2016) as outlined in subsection 144(4) of the Act. If required the IRB unit can also provide calculations for minimum dependant benefits in accordance with section 27 of the regulations.

Summary of the above procedure: 1. Commence the payment of the bi-weekly death benefit as of the accident date. 2. Provide a written decision letter detailing the beneficiary’s entitlement. 3. Explain the death benefit entitlement to the beneficiary(ies). 4. If a lump-sum election is made, request a lump-sum calculation from the IRB unit. 5. Draft informational letter to accompany the payment of the lump-sum death benefit. 6. Contact the beneficiary(ies) to explain the payment of the lump-sum benefit.

Injury Manual

5.6.2 – Death Claim Policies and Procedures 1

5.6.2 Death Claim Policies and Procedures (5.6.2-01/2017)


Purpose Provides a detailed overview SGI’s policies and procedures with respect to the administration of death claims.


Regulations 26-29 Part V

Concerns with Causation

Concerns with Causation: If it is unclear as to whether the death is motor vehicle accident-related, obtain: ° An Autopsy Report or the Report of Coroner; and ° Medical information from the deceased’s practitioners documenting prior medical history.

Information contained in the autopsy or coroner’s report: Coroners are authorized to conduct investigations into all sudden, unexpected and unnatural deaths

occurring in the province of Saskatchewan. The investigation is conducted in order to determine the identity of the deceased, and how, when, where and by what means the person died.

In some circumstances, the coroner may require a post-mortem examination, which is most often completed to assist in determining the cause or manner of death, assist in identification or to document injuries.

At the conclusion of the investigation, the coroner will issue a report summarizing the investigative

findings. Review by a medical consultant: Upon the receipt of the autopsy or coroner’s report and any relevant medical information from the

deceased’s practitioners, forward this information to SGI’s medical consultants for review and consideration of the cause of death to determine if it is accident-related.

When permanent impairment & death benefits are payable

When permanent impairment and death benefits are payable (Act, s 153): Section 153 of the Act addresses the interaction between permanent impairment benefits and death

benefits, when a customer dies from accident-related injuries at a later date. Note: For information concerning the proper administration of both a permanent impairment and death benefit, please see 6.2.6 – When Beneficiary Dies.

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5.6.2 – Death Claim Policies and Procedures 2

Repatriation Repatriation on death claims: Repatriation is the process of returning a person to his or her place of origin or citizenship (i.e., the

process of returning to one’s home).

If a customer is fatally injured in a motor vehicle accident occurring in Canada or the United States, SGI covers the costs to return the body or ashes back to Saskatchewan, presuming Saskatchewan is their home province.

This cost is sometimes shown on the funeral bill. Payment of this expense is not paid out of the funeral

benefit and is funded separately. Examples: Example 1 – Non-residents fatally injured in a Saskatchewan registered vehicle, in Saskatchewan: A non-resident is fatally injured in a Saskatchewan registered vehicle and the accident occurs in Saskatchewan. Will SGI fund the return of the body (i.e., repatriation) to their home province or country? SGI will fund repatriation in these circumstances if no other coverage exists for the costs associated with

repatriation. No Fault Coverage applies as the deceased is deemed to a Saskatchewan resident in accordance with section 108 of the Act. Note: In the above example, section 108 of the Act allows the deceased to be deemed a Saskatchewan resident unless there is an agreement between SGI and the non-resident’s jurisdiction (e.g., knock-for-knock agreements with Alberta and Manitoba).

Example 2 – New Saskatchewan residents:

A new Saskatchewan resident is fatally injured after having moved to the province and meets the definition of a Saskatchewan resident. Will SGI fund repatriation? SGI will not fund repatriation in these circumstances. The deceased is considered to be a Saskatchewan

resident as they have made Saskatchewan their home.

Example 3 – Foreign students studying in Canada:

A foreign student is fatally injured in a motor vehicle accident while studying in Canada on a temporary basis (i.e., does not permanently reside in Canada) and is deemed to be a Saskatchewan resident. Will SGI fund repatriation?

SGI will fund repatriation in these circumstances, returning the body to the student’s home country.

Note: If the student has become a resident of Saskatchewan and has made Saskatchewan their home, SGI will not fund repatriation.

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5.6.3 – WCB or Other Compensation as it Relates to Death Benefits 1

5.6.3 WCB or Other Compensation as it Relates to Death Benefits (5.6.3-01/2017)


Purpose Provides an overview of how the Worker’s Compensation Board (WCB) or other compensation interacts with death benefit payments pursuant to Division 5.

Act 144-150

202 Division 5 Compensation pursuant to The Worker’s Compensation Act, 2013, or other legislation

Regulations Part V Death Benefits

Other compensation means

Other compensation means (Act, ss 202(1)): Compensation pursuant to The Workers’ Compensation Act, 2013 or any other Act, or any legislation of

any other jurisdiction, that provides for compensation of individuals injured in accidents.

Compensation pursuant to the National Defence Act (Canada); or

Compensation pursuant to the Royal Canadian Mounted Police Act (Canada) to a member of the Royal Canadian Mounted Police who was on work duty at the time of the accident and is injured in the accident.

Summary of Section 202 as it relates to death benefits

Summary of section 202 as it relates to death benefits: Death benefits to a surviving spouse or dependant (Act, ss 202(5)): If the deceased’s surviving spouse or dependant is receiving other compensation, they are entitled to

receive a death benefit for an employment the deceased held at the date of the accident if they: ° Are not entitled to other compensation for any employment held by the deceased; or ° The other compensation and the benefits paid are less than the death benefits the deceased’s

surviving spouse or dependant would have been entitled to receive pursuant to Division 5. If there is no surviving spouse or dependant (Act, ss 202(5.1)-(5.2)): If an individual dies in an accident leaving no spouse or dependant, the insurer shall pay to the

deceased’s estate, parents or non-dependent children, as the circumstances require, the benefits they would be entitled to receive pursuant to section 147 if: ° No other compensation is provided for the accident; or ° The other compensation provided is less than the benefits that otherwise would be payable pursuant

to section 147. SGI is required to provide benefits in an amount that will compensate the deceased’s estate, parents and

non-dependent children, as the circumstances require, for any loss not compensated by the other compensation and only to the maximum amount prescribed in section 147.

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Death benefits calculated pursuant to Division 5 (Act, ss 202(6)): A death benefit provided to a surviving spouse or dependant: ° Must be calculated in the manner set out in Division 5 and the regulations; and ° Must only compensate a surviving spouse or dependant for any income loss not compensated for by

that other compensation up to the maximum benefits allowable pursuant to Division 5.

Where there is no other compensation or other compensation is less

Where there is no other compensation or other compensation is less: In circumstances where the deceased was involved in a motor vehicle accident while on work duty (i.e.,

WCB coverage) or in instances where they may be entitled to other compensation, SGI will not consider potential death benefit payments unless: ° The beneficiary is denied coverage (i.e., they are not entitled to other compensation); or ° The beneficiary receives death benefits that are less than those pursuant to Division 5 of the Act.

Benefits to be calculated pursuant to Division 5 – Death Benefits: In the instance that it is determined that the beneficiary is not entitled to other compensation, SGI will

assess the full amount of benefits payable to the beneficiary under Division 5 of the Act. SGI to top-up death benefits pursuant to Division 5 – Death Benefits: In the instance that the beneficiary is receiving other compensation that is less than the death benefits

the beneficiary would have been entitled to under Division 5 of the Act:

° The death benefit is calculated in the usual manner given the circumstances of the claim; and ° SGI pays the difference between the other compensation and death benefits calculated pursuant to

Division 5 of the Act.

Other death benefits not payable

Other death benefits not payable: Section 202 only speaks to death benefits payable to a surviving spouse or dependant relating to

employment the deceased held at the date of the motor vehicle accident, and lump-sum benefits pursuant to section 147 of the Act. If a beneficiary is entitled to other compensation, they are not entitled to receive the following death benefits even if the other compensation they receive is less than the benefits available under Division 5 of the Act: ° a funeral benefit ° an education benefit ° vocational counselling ° counselling

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Information required to adjudicate the claim

Information required to adjudicate the claim: Where a deceased customer was on work duty at the time of the motor vehicle accident, prior to directing a potential beneficiary to WCB (or provider of compensation pursuant to any other applicable Act or any legislation of any other jurisdiction), obtain the following information: 1. Was the deceased on work duty and involved in a motor vehicle accident?

Confirm that the deceased was on work duty and involved in a motor vehicle accident that caused their

death.

2. What was the nature of the deceased’s employment and earnings in their employment? Determine whether the deceased held one or more employments other than the one in which he or she

was working at the time of the accident. If the deceased held only one employment and the potential beneficiary(ies) is entitled to WCB benefits,

the deceased’s earnings in their employment must be determined.

All income replacement benefit (IRB) source documents normally collected, should be collected so that the deceased’s yearly employment income (YEI) can be determined and an IRB calculation completed for the purpose of calculating death benefits.

If there is a difference between what WCB pays and what SGI pays, the difference between those two

benefit levels may be owing to the beneficiary(ies). 3. Is there an extension insurance policy that might apply and provide additional coverage? Determine if the deceased had an extension policy that will pay an additional 10% of the deceased’s net

income and may provide excess income coverage, subject to other collateral benefits.

Information required by the IRB unit

Information Required by IRB Unit: 1. Death benefit source documents: ° All death benefit source documents normally collected on file in accordance with Division 5 (Death

Benefits) of this manual. 2. IRB source documents: ° All income replacement benefit (IRB) source documents normally collected on file in accordance with

Division 4 (IRB) of this manual. 3. Verification of WCB death benefits paid: ° Copies of all WCB documents regarding what payments the beneficiary(ies) will receive and the

payment schedule, provided on an annual basis. Important: All of the above noted information and supporting documents must be collected immediately following the motor vehicle accident. Do not wait to collect all relevant information until WCB has concluded benefits. SGI’s death benefit calculations should be complete at the onset regardless of when WCB concludes benefits.

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Timing and payment of death benefits

Timing and payment of death benefits: SGI calculations must be completed at the outset of the motor vehicle accident, but calculations cannot

be finalized until WCB has concluded payments.

Typically, WCB will provide payment of death benefits for up to 5 years – however, each circumstance is different resulting in different payment terms and length, depending on the age and number of dependants.

For example, if dependants are young in age, then payments from WCB may be extended for several years.

No benefits will be payable if the payments from WCB exceed SGI’s limits of coverage.

The IRB unit will produce a calculation from the information collected on file.

Lump sum option

Compensation pursuant to WCB or other legislation SGI may elect not to capitalize the benefit (Act, ss 146(4)): If SGI is required to pay a death benefit to a surviving spouse or a dependant pursuant to section 202 of

the Act, SGI may elect not to capitalize the benefit. Surviving spouse or dependant may waive rights (Act, ss 146(5)): If a surviving spouse or a dependant waives his or her rights pursuant to section 202 of the Act, SGI shall

pay that person a lump-sum benefit of $15,404 (2016) in lieu of any benefit that would otherwise be payable pursuant to section 202 of the Act.

Important: A final release is required to be signed by the surviving spouse and/or dependants who are waiving their rights to No Fault Coverage if electing the option pursuant to subsection 146(5) as described above. Contact the legal department for assistance with respect to the final release.

Related Policy Topics

Related Policy Topics WCB and SGI combined death benefits: What combined WCB and SGI minimum payment can the beneficiaries be assured of? The beneficiaries can expect to receive no less than the lump-sum value of the No Fault death benefit as

calculated as of the date of the accident.

For example, if the No Fault lump-sum death benefit was $100,000 and WCB paid $120,000, there would be no additional No Fault benefits paid. However, if WCB paid $75,000 there would be an additional No Fault benefit of equal to $25,000.

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No interest on death benefits if SGI elects not to capitalize the benefit: Will SGI’s No Fault death benefits pay interest if SGI elects not to capitalize the benefit pursuant to subsection 146(4) and later provides the option to capitalize the benefit once WCB death benefits are known? Interest is not paid on the remaining portion of the death benefit if an option to capitalize the benefit is

provided. The Act does not mandate the payment of interest in this circumstance. Extension insurance policy to provide additional coverage: Will an extension policy provide additional coverage with respect to 10% of the customer’s net wage not provided by No Fault Coverage when WCB or other compensation is being topped-up pursuant to section 202 of the Act?

Extension policies typically cover 10% of the customer’s net wage that is not provided by No Fault

Coverage. For example, if WCB’s maximum yearly insurable earnings (MYIE) is $70,000 and the No Fault MYIE is $100,000 – assuming the deceased was earning $100,000, No Fault Coverage would provide additional benefits up to SGI’s MYIE based on 90% of the customer’s net income. The extension policy would then respond and provide coverage for the additional 10% of the customer’s net income.

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5.7.1 – Death Benefit Source Documents & Information 1

5.7.1 Death Benefit Source Documents and Information (5.7.1-01/2017)


Purpose Provides a detailed overview of source documents and information required to complete death benefit calculations for the purpose of Division 5 of the Act.



Collecting Information & Supporting Documents

Collection of Information and Supporting Documents Death occurs immediately following the motor vehicle accident: The following types of information may be collected to confirm death occurred as a result of a motor

vehicle accident: ° Funeral director’s certificate of death confirming date of death ° An accident report from the RCMP or police confirming the circumstances of the accident ° Any of the following confirming the cause of death: A coroner’s report; or An autopsy report; or A physician’s report of death

An autopsy or coroner’s report will most likely be completed if the customer passed away at the scene

of the accident. If, the customer was transported to hospital, the cause of death will likely be documented in the physician’s report of death.

Note: If the autopsy report does not clarify the cause of death, or if doubt still exists with respect to the cause of death, further medical information may be required. For direction in these circumstances, please consult with the PIR III or Adjuster III.

Death occurs at a later date following the motor vehicle accident: In all instances, particularly where death occurs at a date sometime subsequent to the motor vehicle

accident, it is important to establish the cause of death, whether accident-related or otherwise.

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Surviving Spouse Source Documents

Supporting documents to establish that an individual is a surviving spouse: Once the person(s) has been identified as spouse, one or more of the following supporting documents is required to confirm eligibility for a surviving spouse: If married: A copy of the marriage certificate.

If cohabitating as a spouse:

a sworn statutory declaration of verifying cohabitation as a spouse a sworn affidavit(s) from one or more objective third party(ies) any official document(s) that would support cohabitation as a spouse

(e.g., including, but not limited to income tax returns, etc.) Examples of additional supporting documents that may assist with establishing cohabitation: ° copy of mortgage or rental agreement ° utility bills ° joint bank account information ° income tax returns If a statutory declaration is completed, at a minimum, it should include the following information with respect to the person completing the declaration: ° name ° address ° date of birth ° SGI Customer Number ° occupation ° relationship to deceased

Ex-spouses: A copy of the court documents outlining any spousal support payments (i.e., a copy of the court order or

agreement). Multiple family units: Each family unit must provide the required supporting documents.

IRB source documents

IRB source documents: Follow the procedures outlined in Division 4 to establish the Income Replacement Benefit (IRB) the


If a calculation is required with respect to spousal or dependant benefits based on the deceased’s income, the same documentation is required for a death benefit calculation as is required for an IRB calculation.

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IRB source documents required for death benefit calculations:

Salaried Earner Seasonal Earner Self-Employed Earner Paystubs

(3 prior pay-cycles) EVOE (prior 52 weeks) Income Tax Return

(prior year) Notice of Assessment

Paystubs (3 prior pay-cycles)

EVOE (prior 52 weeks) Income Tax Returns

(2 prior years) Notice of Assessment

Personal and/or Corporate Income Tax Returns

Notice of Assessment Statement of Business

Activities

(All for the 3 prior years) Note: For a detailed list of IRB source documents that are required for death benefit calculations please refer to 4.10.1 – IRB Source Documents and Information.

Death benefit source documents

Death benefit source documents:

The following source documents must be identified on the Beneficiary Life form and attached to file: Application for Death Benefits physician’s report of death or funeral director’s certificate of death marriage certificate or sworn statutory declaration supporting cohabitation as a spouse spouse’s birth certificate, if applicable birth certificate for each dependant under 21 years old, if applicable prior year’s income tax return to establish spousal and dependant tax credits prior year’s Notice of Assessment (NOA) or tax summary provided by Canada Revenue Agency (CRA) Note: There will be circumstances where additional documentation is required to support the payment of death benefits. The above list is the minimum required information in order to request approval for the completion of a death benefit calculation.

Supporting documents identifying parents of a dependant

Supporting documents identifying parents of a dependant: The following source documents may be required to demonstrate that the deceased was the parent of a

dependant. This should be used with other required information provide by the beneficiaries to ensure only eligible dependants are provided benefits.

Records that assist in identifying the biological parent of a dependant include: Birth certificate – Identifies the deceased parent or identifies the dependant as having the same last

name as the deceased parent. Live birth record – Issued by the hospital identifying the deceased parent. Baptism records – Identifying the deceased parent. Other official documents (e.g., government records, band records, etc.) DNA test results – Confirming the deceased as the biological parent (DNA testing should be used at a last

resort when other documentation is unavailable).

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Non-Biological Parents Source Documents

Non-biological parents source document checklist: Adoption papers identifying the deceased parent. Objective evidence that the deceased stood in the place of a parent. Affidavits from objective third parties who have knowledge as to whether the deceased customer stood

in the place of a parent to a dependant.

Mentally or physically impaired dependant

Mentally or physically impaired dependant supporting documents: The prior year’s income tax return is required to confirm that tax credits are being applied in accordance

with section 118.3 of the Income Tax Act (Canada) for a dependant who is mentally or physically impaired, and who was dependent on the deceased for necessities of life at the date of the accident.

Injury Manual

5.7.2 – Death Benefit Calculation Policies & Procedures 1

5.7.2 Death Benefit Calculation Policies and Procedures (5.7.2-01/2017)


Purpose Provides a detailed explanation of SGI’s policies and procedures with respect to death benefit calculations.

Act 144-150

172 Division 5 Payment of benefits



Calculations performed according to Division 4 (IRB): Follow the procedures outlined in Division 4 to establish the Income Replacement Benefit (IRB) the



Death benefit is not an IRB: A death benefit is not an IRB, although the IRB is used to calculate death benefits. No seven-day waiting period: There is no seven-day waiting period. Section 172 (Payment of benefits) of the Act has no application to

death benefits.

Greater of date of death or date of accident

Death benefit calculations based on greater of the date of death or the date of the accident: In accordance with subsections 144(3.2) of the Act, if a customer later dies from accident-related

injuries, death benefits are calculated on the basis of the greater of: ° the weekly IRB as of the date of death; or ° the amount of the IRB as of the date of the accident

Death within the first seven days

If the customer dies within the first seven days: In accordance with subsections 144(3.3) of the Act, if the customer dies within the first seven days

following the accident, he or she is deemed to have died on the date of the accident for the purpose of the calculation of death benefits.

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5.7.2 – Death Benefit Calculation Policies & Procedures 2

Benefit amounts in place as of date of death

Death benefits to be calculated using benefit amounts in place as of the date of death: In accordance with subsection 172(3.2) of the Act, if a customer later dies from accident-related injuries,

death benefits are calculated using the maximum benefit amounts payable as of the date of death. This means that certain amounts must be considered as of the date of death, such as: ° the maximum insurable earnings ° lump sum death benefits ° minimum spousal and dependant death benefits ° the funeral benefit ° an education benefit for a dependent spouse ° vocational counselling

Circumstances as of the date of death to be considered: In accordance with subsection 172(7) of the Act, if a customer later dies from accident-related injuries,

SGI must only consider payment of death benefits to a surviving spouse and/or dependant(s), if they are a surviving spouse or dependant as of the date of the customer’s death.

Calculation to be performed if deceased earned income

Calculation to be performed if deceased earned income: The surviving spouse may be entitled to receive the minimum spousal death benefit of $69,322 (2016).

The minimum spousal benefit is paid regardless of whether the deceased was a non-earner. The minimum spousal death benefit is indexed each year and applies as of the date of death.

A calculation of the spousal death benefit should always be completed based on the deceased’s income.

The deceased’s income in relation to the life expectancy of the surviving spouse will determine the amount of the calculated spousal death benefit, which could result in a benefit payment that is higher than the amount of the minimum spousal death benefit.

Multiple family units

Multiple family units: Whenever multiple family units may be entitled to death benefits, each family unit must have a separate

calculation based on the number of dependants in that family unit. ° A separate Beneficiary Life form must be completed for each family unit when there are multiple

family units claiming death benefits.

Injury Manual

5.7.3 – Death Benefit Payment Policies and Procedures 1

5.7.3 Death Benefit Payment Policies and Procedures (5.7.3-01/2017)


Purpose Provides a detailed explanation of SGI’s policies and procedures with respect to death benefit payments.



Bi-weekly payments until lump sum election

Bi-weekly payments until lump sum election Bi-weekly payments: Benefits are to be issued as soon as the calculation of the spousal and dependant benefit has been

completed.

Any benefits payable to the surviving spouse (i.e., spousal or dependant benefits) are paid on a bi-weekly basis (Act, ss 172(5)).

A recurring payment should be established to issue bi-weekly payments until such time as a lump sum

election is made. If the surviving spouse elects the lump sum payment option (i.e., capitalization), then the bi-weekly

payments ceases effective the lump sum conversion date (i.e., conversion from a bi-weekly to lump sum benefit).

Capitalization of bi-weekly benefits: A beneficiary may elect a lump sum payment rather then receiving bi-weekly payments.

With respect to bi-weekly payments: ° Spousal benefits are payable for the life of the surviving spouse; ° Dependant benefits are payable until the dependant reaches age 21; and ° Dependant benefits for dependants with a mental or physical impairment are payable for life or until

such time as they are no longer meet the definition of dependant pursuant to subsection 100(b)(ii) of the Act.

Anytime a death benefit is paid on a bi-weekly basis prior to a lump sum election, the payment of that

benefit is concluded upon the death of the surviving spouse or dependant, as the case may be. ° The surviving spouse and, depending on the circumstances, the dependant(s) must be informed of the

right to elect to have the death benefits capitalized, and paid out as a lump sum. This explanation will include advice to the effect that if the customer decides to continue with bi-weekly payment of death benefits instead, the benefit will conclude upon his or her death.

Note: The above explanation should also be provided to the Public Guardian and Trustee in circumstances where they are handling the affairs of the surviving spouse and/or dependant(s).

Injury Manual


Continuation of dependant benefits if surviving spouse dies: Bi-weekly dependant payments do not stop if the surviving spouse dies – payments would be redirected

to the Public Trustee for dependants under 18 years of age. Combination of bi-weekly and lump sum benefits: The surviving spouse, if receiving both spousal and dependant benefits, may elect to capitalize one

benefit and continue to receive bi-weekly payments for the other benefit. For example, the surviving spouse may elect to capitalize the payment of the spousal benefit, and continue to receive bi-weekly payments for the dependant benefit.

Minimum spousal benefit cannot be capitalized: The minimum death benefit cannot be capitalized – the maximum payment is paid as a lump sum.

Death benefits not reduced

Death benefits not reduced if customer received benefits prior to death: If the customer received No Fault benefits and later dies from accident-related injuries, these payments

are not recoverable and will not reduce the death benefits payable to beneficiaries.

Payment to the Office of the Public Guardian & Trustee

Payment to the Office of the Public Guardian and Trustee: Subsection 144(9) of the Act states that SGI shall pay the weekly death benefit for the dependant to the

Public Guardian and Trustee if: ° The dependant does not reside with the surviving spouse; or ° In SGI’s opinion, the surviving spouse has neglected or abandoned the dependant.

Note: The above also applies to dependants with a mental or physical impairment pursuant to subsection 100(b)(ii) of the Act.

Dependants not residing with the surviving spouse: If the dependant does not reside with the surviving spouse, the benefit must be paid to the Public

Guardian and Trustee or to the child's legal guardian until the dependent is 18 years of age. Dependants with a mental or physical impairment: Payments to dependants with a mental or physical impairment pursuant to subsection 100(b)(ii) of the

Act must be paid to the Public Guardian and Trustee. If an individual lacks capacity, a payment may be made through their legal guardian or the Public

Guardian and Trustee.

Injury Manual


The following legislation may be referenced for purposes of addressing those lacking capacity: Appointment of a guardian or co-decision-maker pursuant to The Adult Guardianship and Co-decision-

making Act.

Certificates of incapacity issued pursuant to section 28.2 or section 28.3 of The Public Guardian and Trustee Act.

Certificates of incapacity issued pursuant to section 24 of The Mental Health Services Act, or a long-term

detention order issued pursuant to section 24.1 of The Mental Health Services Act. A declaration of incapacity pursuant to The Powers of Attorney Act, 2002; or Similar legislation in other provinces or jurisdictions. Concerns with neglect or abandonment: Pursuant to subsection 144(9) of the Act, if an opinion has been reached that the surviving spouse has

neglected or abandoned one or more of the dependants for whom the surviving spouse would otherwise be receiving dependant death benefits, document these concerns and the basis for the concerns and proceed to pay the weekly death benefit for the dependant(s) to the Public Trustee and Guardian.

Note: Any concerns regarding neglect or abandonment must be identified and noted in the file. If there any concerns with paying a death benefit in this manner, consult with your PIR III or Adjuster III for direction.

Public Guardian and Trustee contact information:

Public Guardian and Trustee of Saskatchewan 1871 Smith Street Regina SK S4P 4W4 Phone: (306) 787-5424 Note: The Public Guardian and Trustee's Office is legally able to receive money on behalf of minors (i.e., under 18 years of age) or individuals who lack capacity where there is an acknowledgement making the Public Guardian and Trustee’s Office the individual’s property guardian.

Correspondence with the Public Guardian and Trustee: When issuing death benefit payments to the Public Guardian and Trustee, use the letter entitled Death-

Explain Benefits to Public Trustee when paying benefits to a dependant in trust.

If the Public Guardian and Trustee is providing instruction concerning the payment of death benefits, SGI will require a letter from that office detailing those payment instructions.

Issuing a payment in trust with cover letter: Include the following information in correspondence to the Public Guardian and Trustee: ° What the payment is for; ° The name, address, and date of birth of the dependant; ° The name of the parent or legal guardian of the dependant; and ° The contact person’s name, address, and telephone number where the minor is currently residing.

Injury Manual


Payment to the Public Guardian and Trustee for non-residents: All funds are paid to the Public Guardian and Trustee of Saskatchewan, regardless of where the

dependant resides. Funds are payable to the Public Guardian and Trustee where the accident (i.e., cause of action) took place.

Garnishment Death Claims Garnishment:

Whenever you receive a garnishee order, please review with your PIR III or Adjuster III prior to

redirecting payments to ensure the proper procedures followed. When SGI is served with a garnishing order from Canada Revenue Agency (CRA), SGI must remit the

payment to CRA. If SGI fails to provide CRA with payments to satisfy the garnishing order, this may result in SGI becoming

liable to pay CRA. The customer or a beneficiary should be advised of any garnishing orders that their claim may be subject

to, advising them of SGI’s legal obligation to pay amounts to satisfy the order.

If death benefits are not payable

If death benefits are not payable: If for some reason death benefits are not payable after an assessment of the claim, apply the following

steps: ° Contact the customer or arrange to meet with them to explain the rationale behind SGI’s decision. ° Document this discussion in your file notes. ° Send the customer a detailed decision letter outlining SGI’s decision. The decision letter must include:

° The reason(s) for SGI’s decision. ° Reference to the appropriate sections of the Act and regulations where necessary. ° The appeal option.

Injury Manual

5.8.1 – Case Study Examples 1

5.8.1 Case Study Examples (5.8.1-01/2017)


Purpose Provides case studies which illustrate how to apply of the Act, the regulations, and SGI’s policies and procedures with respect to death claims.



Case Study One

Surviving parents and non-dependant children: A 58 year-old customer is involved in a single-vehicle motor vehicle accident. She was pronounced dead

at the scene and, according to the RCMP investigation, alcohol was not suspected to have played any role. The customer has no spouse and divorced many years ago. She is the mother of two non-dependent children ages 28 and 29 who are the executors of her estate. She also has surviving parents who are ages 81 and 84. Based on this information, is there any entitlement to benefits? To whom? If so, what are the amounts payable?

° Entitlement to benefits is payable in this case under section 147(2) of the Act.

° The deceased leaves no surviving spouse or dependants, but has surviving parents, and two adult

children over the age of 21 that are not considered dependants.

° Each surviving parent and non-dependant child would receive $15,404 (2016) for a total of $61,616.

Case Study Two

Applying WCB or other compensation when accident occurs on work duty: A single 55 year-old woman with no dependants is killed in a motor vehicle accident while on work duty.

She is not at fault for the accident. Her yearly employment income is $50,000. WCB accepts a claim on her behalf and provides funding for funeral benefits only and no death benefits. She has no surviving parents or non-dependent children. Would a No Fault injury claim provide death benefits? If not, why? If so, to what extent? ° Section 202(5.1) provides that a death benefit will only be paid if no other compensation (Act, ss

202(1)) is provided for the accident or the other compensation is less than the benefits that are otherwise payable under section 147 of the Act.

° SGI will provide limited No Fault coverage for death in accordance with section 147 of the Act, which indicates that for a deceased with no spouse, dependants, parents, or non-dependant children – the estate will receive a lump sum payment of $15,404(2016).

Injury Manual


Case Study Three

One surviving spouse and multiple family units: A 38 year-old man was involved in a single-vehicle accident. He was employed at an underground mine

earning a yearly employment income of $64,000. An investigation yields the following information: He has four children, each with a different mother. The children are ages 16, 12, 5, and 18 months. Court orders confirm that he paid child maintenance with respect to each child, but no spousal maintenance was payable to any of their mothers. He had been living with the mother of the 18-month old child for the 20 month period immediately prior to the accident. All other children were residing with their biological mothers.

Who, if anyone, is entitled to benefits?

° Entitlement to death benefits exists for all four dependent children and the spouse that he had been

cohabitating with at the time of the accident.

° The surviving spouse is entitled to a death benefit calculated on the basis of 50% of the deceased's IRB as per subsection 144(1) of the Act as a bi-weekly lifetime benefit or she can elect to receive a lump sum within five years of the date of accident. She is also entitled to a 5% dependant benefit for the 18-month old until the child reaches age 21.

° The remaining three children are also entitled to death benefits and are deemed to be a surviving

spouse for each other family unit receiving 50% of the deceased’s IRB until each dependant reaches age 21.

Note: All of the above mentioned spousal and dependant benefits are paid on a bi-weekly basis until such time as a lump sum election has been made.

Case Study Four

Education benefit for the surviving spouse:

The customer is deceased as a result of a single vehicle motor vehicle accident in 2012. The deceased was survived by his spouse and four adult children. The deceased earned a yearly employment income of $54,000. His spouse was not working outside the home at the time and was dependent on him for the necessities of life. Death and funeral benefits were provided and the spouse elected to receive a lump sum spousal benefit. The spouse contacted SGI in 2014 to inquire about the education benefit as there is a one-year administration course at the Academy of Learning she wished to attend. Is the spouse entitled to an education benefit? If not, why? If so, how much funding is available?

The spouse is entitled to the education benefit as provided for in section 149 of the Act and section 29 of the regulations.

The maximum amount payable is $42,991(2012) for education and training and is to be disbursed at a

rate of no more than 25% per calendar year. A customer may be exempted from the application of the 25% annual cap where SGI is satisfied that doing so is reasonably required by the surviving spouse.

The education benefit must be applied for within five years of the date of the accident, but, the surviving spouse is not required to exhaust the benefit within that five year period. The educational program must be delivered by an educational institution as defined in clause 2(1)(d) of the regulations and can also be used for tuition, books, childcare, and additional housing costs where the surviving spouse is required to maintain more than one residence to attend the educational institution.

Injury Manual


The education benefit applies to a surviving spouse who at the date of the accident was dependent on the deceased.

Case Study Five

Multiple Family Units: The deceased was an employed 59 year-old man who was fatally injured in a motor vehicle accident. At

the time of his death he lived alone and there is no surviving spouse according to this definition. He was in a spousal relationship about 28 years prior to his death and had seven children with that spouse. At the time of his death the children were all over the age of 21.

The deceased was also married to another woman after this first relationship which ended 10 years prior

to his death. He had three children from this relationship who at the time of his death were 21, 17 and 15 years of age.

Would this be considered one or two separate family units?

Two Family Units:

The youngest child (i.e., dependant) from the deceased’s marriage would be considered the surviving

spouse. The dependant benefit would be paid until the second youngest child (i.e., age 17) reaches age 21 and the spousal benefit would be payable until the youngest child (i.e., age 15) reaches the age of 21. Each child receives an equal share of the benefit while they are under age 21. The oldest child who is 21 would not be entitled to a benefit. The death benefit calculation would be based on the deceased’s income at the time of the accident for the spousal benefit (i.e., 50% x IRB) and the dependent benefit (i.e., 5% x IRB).

The second family unit consists of seven adult children from the deceased’s first relationship. Under subsection 147(3) of the Act each non-dependent child would be entitled to receive an equal share of the maximum benefit of $69,322(2016).

Injury Manual


Death Benefits Flow Chart