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Their dependency is total partial. 11. Petitioner was was not living with the deceased employee at the time of his or her death. 12.Fatal Claim Petition For Compensation By Dependents Of Deceased Employees Form. This is a Pennsylvania form and can be use in Workers Comp. View on Westlaw or start a FREE TRIAL today, § 17. A. Reports of Death and Claim for Compensation. Minimize effort for the surviving family to access this workers' compensation insurance benefit. 030 Dependent of injured employee barred from filing claim for compensation if untimely or previously denied. A widow, widower and a minor child of a deceased employee are considered "wholly dependent" as a matter of law. Seeking benefits for herself and her two children with Decedent.