--- title: "WorkSafe claim for compensation following a work-related death: completion guide" url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-vic-worksafe-death-claim" type: "precedent" site: "AI Law Framework" id: "a21-form-vic-worksafe-death-claim" area_id: "A21" kind: "form" ai_level: "yellow" version: 1 task_ids: ["A21-T1-R5", "A21-T1-R4", "A21-T1-R15"] law_stated_as_at: "2026-10-23" --- # WorkSafe claim for compensation following a work-related death: completion guide > Link to the WorkSafe form used after the death of a worker from a work-related injury or illness, including dependency, grief and loss, and funeral expenses. Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-vic-worksafe-death-claim Law stated as at: 2026-10-23 Site index for agents: https://ailawframework.com/llms.txt ## Key facts - Kind: Form. A form to complete, or a guide to completing an official one. - Practice area: [Personal Injury & Compensation](https://ailawframework.com/precedents/personal-injury-and-compensation.md) - Jurisdictions: Victoria - AI level: Yellow. You and the tool draft together, with you directing. You check every statement you rely on. - Law stated as at: 2026-10-23 - Status: Maintained. Checked on 2026-10-23 against the official form at worksafe.vic.gov.au and the 3 authorities it cites, for Victoria. ## When to use it Use when a dependant or another person is claiming compensation after a worker has died from a work-related injury or illness. The person completes the current PDF in Adobe Reader. For a living worker, use the worker's injury claim form. ## Used for these tasks - [Draft the pre-action notice or statutory claim form from the instructions](https://ailawframework.com/practice/personal-injury-and-compensation/draft-the-pre-action-notice-or-statutory-claim-form-from-the-instruction.md) - [Map statutory entitlements under the applicable compensation scheme](https://ailawframework.com/practice/personal-injury-and-compensation/map-statutory-entitlements-under-the-applicable-compensation-scheme.md) - [Triage a new injury enquiry against scheme eligibility](https://ailawframework.com/practice/personal-injury-and-compensation/triage-a-new-injury-enquiry-against-scheme-eligibility.md) ## How AI may be used The tool may index the death certificate, funeral invoice and relationship documents the lawyer has collected; the family completes the current PDF and the lawyer checks every statement. **AI may:** - Index the death certificate, funeral invoice and documents showing relationship or dependency - List which of the manual's heads the instructions mention: dependency lump sum or pension, grief and loss, burial or cremation, and medical and like expenses **AI must not:** - Must not describe how the worker died or decide who is a dependant - Must not write answers into the PDF - Must not require a medical authority. The claims manual says a valid claim needs a signed medical authority except for a claim relating to the death of a worker **The lawyer checks:** - The PDF is downloaded and completed in Adobe Reader. The page says a browser may not save it - The claims manual says a dependant or another person may claim a dependency lump sum or pension, a grief and loss lump sum, and burial or cremation, including repatriation, and medical and like expenses - The manual says the form is not mandatory for a non-dependent family member seeking reimbursement of expenses - The manual ties the form to section 20. A signed medical authority is not required on a death claim - Health information stays in a firm-controlled tool. Check ASCR r 9, APP 11, and whether any disclosure would be a notifiable breach under the Privacy Act 1988 (Cth). ## Authorities - [WorkSafe Victoria, Claim form for compensation following a work-related death, published 17 November 2022 (opened 23 October 2026)](https://www.worksafe.vic.gov.au/resources/claim-form-compensation-following-work-related-death) - [WorkSafe claims manual, Claim for Compensation Following a Work-related Death, citing the Workplace Injury Rehabilitation and Compensation Act 2013 s 20](https://www1.worksafe.vic.gov.au/vwa/claimsmanual/Claims%20Manual/2-claims-management/2-2-make-claim/2-2-1-worker-completes-claim-form.htm) - [Workplace Injury Rehabilitation and Compensation Act 2013 (Vic), version 054, in force 2 October 2026](https://www.legislation.vic.gov.au/in-force/acts/workplace-injury-rehabilitation-and-compensation-act-2013/054) ## Official form [Official form](https://www.worksafe.vic.gov.au/resources/claim-form-compensation-following-work-related-death) ## Where this comes from The official form is published by worksafe.vic.gov.au; this page is a completion guide. Last checked on 2026-10-23. ## Full text and drafting notes The full text and the drafting notes are not part of this public page. Signed-in firm accounts can read them at https://ailawframework.com/precedents/personal-injury-and-compensation/form-vic-worksafe-death-claim and through the signed-in MCP connector https://ailawframework.com/mcp/firm. *Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*