For all initial claims an M-3 Form (Notice of Qualifying Death or Disability/Initial Application for Benefits) must be completed by employer AND applicant then submitted to DPSST. Upon determination that the death/disability meets the statutory eligibility requirements, the Board will award the one-time, lump sum benefit ($25,000).
To assist with the Board's initial determination, the following information should be submitted as well:
- Copy of any incident reports or police reports showing date and manner of death
- Copy of death certificate, if available
HOW TO APPLY FOR DISCRETIONARY BENEFITS
The Board may award benefits to assist with mortgage payments, health and dental benefits and scholarships. To apply for those benefits, the applicant is required to complete the M-1 Form (Supplemental Application for Benefits) and submit the following information:
For a one-time mortgage benefit (up to 12 months), please submit the following:
- Copy of Homeowner's policy verifying there is no mortgage insurance on the applicant's home.
- Copy of Mortgage Statement showing monthly mortgage amount
HEALTH AND DENTAL BENEFIT REIMBURSEMENT
For health and dental benefits, please submit the following:
- Copy of policy in effect at time of applicant's death
- Copy of premium showing monthly benefit amount and individuals covered under policy at time of death (NOTE: Benefits only available for qualifying spouse up to five years or until spouse remarries, whichever occurs first; and until a child or dependent attains the age of 18, or if dependent attending school, age 23)
- For family members who qualify due to enrollment in school, submit verification of enrollment
- Duration of time benefits are requested (i.e., quarterly, annually, etc.).
For educational benefits, please submit the following:
Standard Benefit for a Graduate Program of Higher Education:
- Verification applicant has exhausted the available education benefits.
- Verification of enrollment
- Copy of tuition costs/fees from selected college
Duration of time benefits are requested (i.e., quarter, semester, etc.)