Claim for Pension By Dependents

Claim for Pension By Dependents - (Forms/Publications)
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Title Claim for Pension By Dependents (A fillable form - 172 KB PDF)
Description Used by dependents of a deceased worker to file a claim for benefits.
Detail
Form number F242-062-000
Availability
Online only. See document above to download.
Keywords claim information, claims, coverage, deceased worker, disability pension benefits, disabled, espanol, industrial insurance, occupational death, pension disability benefits, social security offset, spanish, sso, surviving children, survivor benefits, survivors, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 11-2009
Contact information
Related information
Documents Verification of School Enrollment
Claim for Pension by Spouse or Children

Address Change Request for Pensioners


Declaration of Entitlement for Widow or Widower Benefits Under Industrial Insurance
Declaration of Entitlement for Guardian Benefits under Industrial Insurance
Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance
Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance

Authorization for Deposit of Payments


Web pages Workers' Comp Claims

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