Death Benefit

What is Employment Injury Death Benefit?

The Death Benefit is a payment or periodical payments made to specific survivors of a deceased insured person who died as a result of an accident or of a prescribed industrial disease arising out of or in the course of employment.

Employer’s Responsibility

The employer must certify that death occurred as a result of the accident/prescribed industrial disease.

Who Can Claim?

You can claim the Death Benefit if you are one of the following five types of dependants:-

  • Widow legal/common law
  • Widower legal/common law
  • Children
  • Orphans
  • Dependent parent(s)

In order to qualify the dependents must provide documentary evidence to prove their relationship to the deceased insured person.


The benefit is paid to the lawful spouse of the Insured person (the spouse is lawful even if separated from the Insured person).

Common-Law Spouse

As a Common-Law Spouse you will be paid the benefit if both you and the Insured person were legally single persons, living together as husband and wife up to the date of death of the insured person for a minimum of 3 years. A single person is one who was never married or, if married, was released from the marriage due to death of the Insured person or a decree of divorce absolute.  A Common Law spouse may be either nominated or not nominated as beneficiary by the insured prior to his or her death. The official Nomination of Beneficiary form is Form NI42.

Where you were not nominated as beneficiary you must provide alternative evidence of nomination and evidence of cohabitation for 3 years prior to the death of the insured person. 

Form To Be Completed

NI117 Employment Injury Death Benefit Claim Form

Supporting Documentation

  • Death Certificate of deceased insured person
  • Birth Certificate of widow and eligible children
  • Medical Certificate for mentally or physically disabled child
  • Medical Certificate for pregnant spouse, certifying pregnancy and expected date of confinement.
  • N.I. Registration Card of deceased and
  • Marriage Certificate for Legally Married Persons
  • Original and copy of a valid PICTURE ID of both the claimant and the person submitting the claim on behalf of the claimant (where applicable) is required for acceptance of the claim.

For Common Law (Nominated)

  • Evidence of single status of claimant and deceased
  • Decree Absolute or relevant Death Certificate if either party was previously married to another person. 

For Common-Law Situations (Not Nominated)

  • Evidence of single status of claimant and deceased
  • Evidence of common-law relationship, i.e. evidence of three years of cohabitation up to the time of death
  • Decree Absolute or relevant Death Certificate if either party was previously married to another person.

For Dependent Parents

  • Evidence of support of dependent parent
  • Birth certificate of the deceased

For Common Law (Spouse)

The following are some examples of documents you may use as alternative evidence of nomination.

  • Will - claimant is indicated as spouse/beneficiary.
  • Employer’s Pension Plan - claimant recorded as spouse/beneficiary.
  • Life Insurance Policy - claimant indicated as spouse/beneficiary.
  • Credit Union document - claimant indicated as spouse/beneficiary.
  • Deed - in both parties names.
  • Birth Certificate of child - both parties named.
  • Joint Account – Statement in both parties names
  • Statutory Declarations from 3 prominent people in the community to attest to knowledge of common law relationship

In addition, such claims will be advertised in the newspaper once per week for three consecutive weeks. If no objection is lodged by a spouse of either party and all other qualifying conditions are met, you will be paid the benefit as the widow/widower of the deceased insured.

Alternative Evidence of Paternity for Child Allowance

The following are some examples of documents you may use as alternative Evidence of Paternity when the father’s name is not inserted on the Birth Certificate of the child.

  • Marriage Certificate of Parents.
  • Paternity order given by a court.
  • Adoption Certificate where child is adopted.
  • Evidence of pregnancy at date of death of insured father and birth certificate when child is born.

When To Apply?

You must apply for the benefit within 12 months of the date of death of the insured person.

Late Applications

You must apply on time to ensure that you receive your benefit. Failure to submit your claim to the Board within 12 months from the date of death of the insured person may result in the benefit being paid from the date it was received by the Board, unless you can show there was good cause for the delay in submission. Your explanation must be submitted in writing.

How To Apply?

Submit your claim to the NIBTT Service Centre most convenient to you. There, one of our customer service representatives will accept your claim for processing.

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