Agreement For Compensation For Death

FORM 18 - AGREEMENT FOR COMPENSATION FOR DEATH. This form is used as an agreement within the context of workers' compensation in the State of Delaware. It involves the dependents of a deceased worker who sustained a fatal injury during employment. The purpose of the form is to outline the terms and details of compensation to be paid to the dependents due to the worker's death resulting from a work-related accident. Key information included in the form: • Identification of the deceased worker and the employer. • Date, place, cause, and nature of the injury that led to the worker's death. • Date of the worker's death. • Agreement on the compensation amount and rate, calculated based on the worker's average weekly wage at the time of injury. • The specified weekly compensation amounts for each dependent. • Signatures of all dependent beneficiaries as well as the signature of the employer or their attorney. • The date when the agreement was made. The completed form serves as a legal record of the agreement reached between the dependents and the employer regarding compensation payments following the worker's death due to a work-related injury. www.FormsWorkflow.com