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In addition to the Cal/OSHA required notice of serious injury or illness or death and required Form 5020 - Employer’s Report of Occupational Injury or Illness, every employer shall notify the Administrative Director of the Department of Industrial Relations of the death of any employee regardless of the cause of death by use of DIA 510 - Notice of Employee Death.1
This form is required to be filed with the Administrative Director within 60 days of your knowledge of the death of any employee, unless you have actual knowledge that the employee left a surviving minor child under the age of 18, in which case you are not required to file the form. An insured employer is entitled to forward the completed DIA 510 - Notice of Employee Death to its insurance carrier for subsequent submission to the Administrative Director.
The purpose of DIA 510 - Notice of Employee Death is to notify the state, specifically the Death Without Dependents Unit (DWD), that it may need to step in to recover any death benefits payable, due to the possibility of no existing legal dependents. Death benefits in cases of employees who leave no dependents are paid by the employer directly to the state.
1. Title 8, California Code of Regulations sec. 9900