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Notice of Discontinuance of Workers'. Compensation Dependency Benefits.Insurer must complete the following. Due to the employee's death, workers' compensation wage-loss benefits were discontinued on. (date). 1. This form is used for an employer to notify the dependent of a deceased worker that their benefits will be discontinued on a specific date. This notice is to advise you of the status of disability benefits for your workers' compensation injury on the date shown above. Signing a Suspension Agreement means that you agree to end weekly benefits payments. Certain injured civilian employees to receive full compensation. -37.5. Dependency Claim Petition To Convert Voluntary Tender to Formal Judgment. The insurer can stop benefits at any time.