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Eligible beneficiaries must complete DWC Form-042, Beneficiary Claim for Death Benefits and send it to DWC within one year from the date the employee died. Yes. Giving the completed form to your employer opens your workers' compensation case.CSU Workers' Compensation and the adjuster assigned will complete an investigation and determine if this is a covered Workers' Compensation claim. Provides benefits due to a work-related injury or illness. Who can receive Workers Compensation (WC) benefits? DESCRIPTION: You can become a self-insurer. Employees may not collect temporary total disability and unemployment benefits for the same weeks. Temporary Partial Disability. Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers' compensation claim. How can I contact the Georgia Workers' Compensation Assigned Risk Plan?