Rule 622-1-.03(1)

Payment of Non-dependency Benefits into the Subsequent Injury Trust Fund

For accident dates prior to July 1, 1995, the employers’ payments to the Subsequent Injury Trust Fund in no-dependency death cases will be initiated through the use of a Subsequent Injury Trust Fund Form “F” referred to as a “No Dependency Agreement.” This agreement must be submitted to the State Board of Workers’ Compensation for approval and, upon approval, the employer will process the payment in accordance with Code Section 34-9-358.