When they must send it
• For change to rate, amount or schedule: before or with the changed payment, but not later than 14 days after the last payment made before the change. • For payment ending: with the last payment or, if the decision to end benefits was made after the date of the last payment, within 14 days of the payment.
The deadline this notice puts on you
This notice does not itself start a clock against you.
Rule text
8 CCR § 9812 · 14 unspecified
Trigger: after the claims administrator's date of knowledge both of the death and of the identity and address of the dependent
Notice is required within 14 days after the claims administrator's date of knowledge both of the death and of the identity and address of the dependent
Quoted from the statute, marked computed. The deadline table is a draft extraction — read the official code if the two disagree.
The rule behind it
8 CCR §9812(f)(2)
The official model notice
BENEFIT NOTICE INSTRUCTION MANUAL City_State_Zip Telephone Number [include if available] Website address Date [Option] SENT VIA E-MAIL TO employee’s e- mail address Employee Employer: Address Date of Injury: City_State_Zip Claim Number: NOTICE REGARDING DEPENDENCY BENEFITS CHANGE IN PAYMENT OR BENEFIT ENDING CLAIMS ADMINISTRATOR NAME is handling the workers' compensation claim of EMPLOYEE NAME on behalf of EMPLOYER NAME. This notice is to advise of the status of dependency benefit payments for the workers' compensation injury on the date shown above. A copy of this notice will be sent to all dependents. [Include one or more of the following]: (1) We are changing the benefit rate for INSERT BENEFIT TYPE. The rate is being changed to $ INSERT WEEKLY RATE beginning with the payment on DATE because INSERT REASON FOR CHANGE IN RATE. (2) We are changing the payment amount for INSERT BENEFIT TYPE. The amount is being changed to $ INSERT WEEKLY AMOUNT beginning with the payment on DATE because INSERT REASON FOR CHANGE IN AMOUNT. …
Published by the Division of Workers’ Compensation in the Benefit Notice Instruction Manual. Excerpt — read the full manual at the source. p.77.
Source · dir.ca.gov →When this went wrong
Decisions of the Workers’ Compensation Appeals Board on this subject. Each quotes the passage it turned on and links to the official PDF.
- ADJ19102087 · 2026-08-25 · Anaheim District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.3This matter involves a claim for death benefits by the widow of an injured worker who sustained a sudden cardiac arrest and died on November 10, 2023 while at the place and during the period of his employment. (F&O, Opinion on Decision, p. 1.) While the QME in this case states that stress from decedent’s employment contributed to the cause of his sudden cardiac arrest and death, there is no claim for psychiatric injury. (See Applications for Adjudication of Claim- Death, April 8, 2024 and April 29, 2024.) “Stress is not a diagnosis, disease, or syndrome. It is a nonspecific set of emotions or physical symptoms that may or may not be associated with a disease or syndrome. Whether or not stress contributes to a disease or syndrome depends on the vulnerability of the individual, the intensity, duration, and meaning of the stress; and the nature and availability of modifying resources.” (American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, 2nd Edition at p. 1055.) However, stress may cause a physical injury or a psychiatric injury or both.
The WCJ and Board found substantial medical evidence from QME Dr. Fischer that stress from decedent’s employment contributed to his sudden cardiac arrest and death, meeting the standard that employment need only be a contributing cause of death for compensability under Labor Code and case law. Defendant’s challenges to the medical evidence and applicant’s credibility were rejected.
Official decision · page 3 → - ADJ17262790 · 2026-05-11 · Redding District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.12Accordingly, as in the Franco case, we decline to impose such unstated restrictions on section 3501, and we conclude that Jovie Fischer must be conclusively presumed to be a total dependent of the decedent under section 3501(a).
The Appeals Board amended the WCJ's findings to find Jovie Fischer was a presumptive total dependent based on statutory interpretation and evidence that the decedent was acting as a parent to her.
Official decision · page 12 → - ADJ16925192 · 2024-05-10 · Van Nuys District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.6conclude that the applicant was legally liable for her support at the time of injury causing death
The evidence established that Martin the applicant was legally liable for the support of Melanie the applicant at the time of injury, satisfying the conclusive presumption of total dependency under Labor Code section 3501(a).
Official decision · page 6 → - ADJ11808374 · 2023-09-14 · Pomona District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.10Los Angeles, California by Custom Fresh Cuts, whose workers' compensation carrier at the time of injury was The Hartford, sustained injury arising out of and occurring in the course of employment to his digestive and body systems due to gunshots to his abdomen, resulting in his death. 2. The employer had knowledge of the injury to trigger the provision of the notice of potential eligibility to the decedent's dependents, which notice was not provided, thereby tolling the Statute of Limitations and making the claim timely. 3. The claim is not barred by the going and coming rule. 4. The issue of dependency benefits is deferred pending further proceedings and determination by the WCJ, jurisdiction reserved.
The Appeals Board found a strong and reasonable inference that the shooting was connected to the applicant's employment, and that the special risk exception to the going and coming rule applied, making the death compensable.
Official decision · page 10 →