Alabama Association of Volunteer Fire Departments

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Prepared by Alabama Association Of Volunteer Fire Departments

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Table of Contents

What To Do First
Preparing Claims - General
Preparing Federal Claims
Preparing State Claims
Brief Summary of Federal Law/Rules
Brief Summary of State Law/Rules
Samples of Statements
Helpful Information


We gratefully acknowledge the cooperation of:

Mr. Richard J. Condon, Bureau of Justice
Assistance, Washington, DC
Mr. Clay Crenshaw, Attorney, State of Alabama Board of Adjustment

First Printing July 1989
Third Printing August 1992
(Revised pages 7, 12, and 16)
Fourth Printing October 2002

Copies may to ordered from:
Alabama Association of Volunteer Fire Departments, Inc.
660 Adams Avenue, Suite 345
Montgomery, Alabama 36104-4373


This book concerns Federal and state benefits that may be available in the event of the death in the line of duty of a firefighter/EMT, and has been prepared by the Alabama Association of Volunteer Fire Departments.

The words in this book are ours and do not necessarily reflect the opinion or policies of either the Bureau of Justice Assistance or the Alabama State Board of Adjustment. In preparing claims, if there is any conflict between this book and instructions received from either the Federal or State agency named, their instructions must be followed.

We hope that you will never have to use the information in this book for that would mean that a firefighter has been lost in the line of duty. But this tragedy has happened before and may happen again. Each fire department should be prepared to deal with the possibility and to fully assist the survivor(s) of the firefighter in the submission of claims. See Sample Form A for your use now. Sample Forms B and C may assist later.

Federal and State laws on the subject are not precisely the same. A separate claim must be submitted to each and on their forms. Too, the benefits are not like an insurance policy; they are not paid on an automatic basis. Each benefit is separate, the burden of proof of eligibility is on the claimant, and each claim is decided on the basis of evidence that is submitted as part of the claim.

In this book, we suggest what to do first, give you some information that will help in filing a claim, and have furnished a brief summary of both the Federal law and the Alabama law.


If death is obvious, immediately notify law enforcement officials. They will notify the medical examiner/coroner. These personnel must be notified if the individual dies en route to or at a medical facility.

Fire departments are responsible for ensuring that the medical examiner/coroner and the State Forensic Lab are IMMEDIATELY informed of the first paragraph, page 6, which begins “Toxicological examinations:”

Coordinate with law enforcement officials and/or the medical examiner/coroner concerning immediate notification of the family. This should be done as soon as possible to avoid a casual, though well-meant, word reaching the family through others. Each department should have one or more “Chaplains” who could help to notify the immediate family of a death.

Immediately notify the Alabama Association of Volunteer Fire Departments through one of our officers, or have your county association do so.

If the injury, which caused death, was associated with a fire, notify the State Fire Marshal’s office; they will determine whether circumstances cause the case to fall within their jurisdiction. Coordinate before calling; some law enforcement jurisdictions prefer to make that call.

Have someone begin at once writing down the name, address, and phone number of anyone who may have to be contacted later for information or to make a statement. That includes witnesses, law enforcement officers, rescue squad members, and ambulance personnel.



Claims must be submitted within one year of the death of the individual.

The burden of proof for establishing eligibility for the award of a benefit rests with the claimant.

An individual cannot name beneficiaries.

All official documents which have to be submitted as part of a claim (e.g., marriage certificate, birth certificate, death certificate) must be signed by the custodian of those records and a raised seal of that office must be placed upon the paper.

Photocopies of documents where signatures and seal are copies, even if certified as a true copy by a notary public, are not acceptable.

Statements by individuals, investigative reports, and other documents must be notarized and the notary’s raised seal placed upon the paper.

Federal claims are submitted in one (1) copy; State claims are submitted in three (3) copies. The documents accompanying each of those copies must adhere to the requirement for signatures, notarized, and raised seals. One (1) additional copy should be retained permanently by the fire department assisting with the claim. Thus, a minimum of five (5) copies are required; a sixth if you intend to furnish an “original copy” to the claimant. Otherwise, any additional copies could be photocopies without the need for original signatures or raised seal.

Documents furnished with a claim should not be originals that the family may have. You must assume that no documents will be returned.

Toxicological examinations: The report of results is furnished by the Alabama Department of Forensic Science as soon as possible. It needs to be emphasized that the levels of carbon monoxide and of alcohol, as well as any other finding of substance(s), must be shown in a precise percentage. For example, Blood alcohol level of .089%; Carbon Monoxide level .06%. Toxicology reports which state vague or generalized levels, such as “positive for alcohol”, “Carbon Monoxide normal”, or “Carbon Monoxide less than 10%” could result in claim denial. A precise carbon monoxide level is particularly important to claim eligibility in a heart or stroke related death. It is recommended in such deaths that the medical examiner/coroner be reminded that a precise percentage of carbon monoxide is needed for benefits purposes even though that percentage may fall below “non-injury level”. If the medical examiner/coroner is confused by this request, suggest he or she call the Bureau of Justice Assistance and ask for the PSOB Office to receive further advice.

Clearly identify any opinion stated as an opinion. If certain facts are not known, say so. If it is necessary to include circumstantial evidence, do not attempt to draw any conclusions from it in your statement.

Stress, physical exertion, and/or strain, by themselves, are NOT traumatic injuries.

All documents requested by either the Federal or the State agency must be furnished with the claim.

The brief summary of Federal and State Law/Rules found in this book are not verbatim or precise. If such accuracy is needed, one should consult the applicable law.


On the first business day, during business hours (Eastern Time), call the Bureau of Justice Assistance (BJA) at 888-744-6513 and report the death. Be prepared to give: name of the deceased, name of fire department, brief circumstances of death, date of injury, date of death, name and address of widow, children’s ages, type of children (natural, adopted, step, illegitimate), whether children 19 or older are full time students or physically or mentally handicapped, and where there is no widow or child, the names and addresses of surviving parents. The fire department should appoint a member to handle the Federal claim and that member should make the notification of death to BJA. Forms and filing instructions are not provided by BJA until a death occurs.

The BJA will send copies of two different forms: one, Form 3650/5, which is the survivors’ claim; and Form 3650/6, which is completed by the fire department. Both forms, together with all supporting papers, should be submitted in one package to:

Bureau of Justice Assistance
Public Safety Officers Benefit Program
810 Seventh Street NW
Washington, DC 20531

Carefully read “Preparing Claims – General” earlier in this book.

The following pages consider parts of the two forms. The documentation identified on pages 8 through 11 may vary from claim to claim depending on circumstances of death and the makeup of a deceased’s family; it is described only to give an idea of what MAY be required. DO NOT try to document a Federal claim without first notifying the BJA of the death and seeking their advice as to specific documentation requirements.

DETAILS ABOUT FORM 3650/6 "Report of Public Safety Officer's Death":

Form is completed by the fire department where the deceased was a member and is certified in Item 17 by that department's Fire Chief.

Form reports the death, and together with documents submitted with it, should establish:

  1. That the deceased was a firefighter in a legally organized fire department.
  2. That the deceased was obligated by law, regulation, rule or condition of employment to be involved in the activity where traumatic injury led to the death.
  3. That an occurrence resulted in injury to the deceased and that the injury resulted in the death of the individual.
  4. The names of possible claimants.

Part II of the form asks for copies of reports. Include a copy of the police report signed by the investigating officer(s) and notarized to include raised seal of the notary.

Part IV of the form asks the same questions about claims for benefits as does Part IV-A of Form 3650/5; the answer to both questions, for a volunteer firefighter is “no”.

As a minimum, several documents must be submitted with Form 3650/6:

  1. Statement by the Fire Chief clearly but concisely stating what happened, including events leading up to, or following, the injury to the deceased, signed and notarized.
  2. A copy of the Fire Report (“Run Report”) or other document, which clearly shows the activity in which the deceased was injured was an official activity; signed by the Fire Chief and notarized.
  3. Copy of the toxicology report (which will include blood and urine analysis), signed by the toxicologist or by the medical examiner’s custodian of records with the medical examiner’s raised seal or notarized to include notary’s raised seal. If such a report was not made, submit a statement to that effect signed by the medical examiner or by the Fire Chief; statement must be notarized.
  4. Copy of death certificate with raised seal of the Health Department or the medical examiner.
  5. If deceased received more than first aid medical treatment, a statement by the medical personnel/ambulance attendants must be submitted, to include anything administered (e.g., oxygen) and the amount(s); statement must be notarized. A copy of hospital records or the physician’s report must be submitted also, signed by the custodian of hospital records or by the physician, as applicable; statements must be notarized.
  6. A notarized statement by the head of local government clearly stating that the fire department is legally organized and is authorized by that governmental body to act on its behalf by providing fire service to the (community) (area) of (name).
  7. Certified copy of department’s non-profit corporation charter or a copy of the minutes of a local government meeting which show that the local government established the department or encouraged citizens to establish it and function as that area’s fire department.

DETAILS ON FORM 3650/5 “Claim for Death Benefits”:

(Form is completed for the spouse and/or child(ren); if no spouse or child, complete the form for the parent(s).)

Item 5 is the name and address of the fire department that filed the Form 3650/6.

Part IV-A of form asks, “Has claim been filed for benefits under: (1) Federal Employees Compensation Act..? and (2) D.C. Retirement and Disability Act..?” The answer to both, for a volunteer firefighter, is “no”.

Part IV-B asks for statement of financial need. If found to be critical enough, an advance of up to $3,000 may be made while the remainder of the processing of the claim is done. Should any advance be made, the amount would be subtracted from the total benefit due before final payment is made. If claim is denied, claimant could expect to return any sum advanced.

Documents have to be submitted showing the relationship of the claimant to the deceased:

  1. 1. For a spouse: copy of marriage certificate must include raised seal of office issuing the copy. If either the deceased or the spouse making the claim was married previously, copy of the divorce decree(s) or copy of the death certificate of the previous spouse must be submitted; each document bearing raised seal of issuing office.
  2. For any child(ren): copy of birth certificate(s) showing the deceased as a parent, or if applicable, adoption papers with the deceased’s name as adoptive parent; each copy with raised seal of issuing office.
  3. For parent(s): a copy of deceased’s birth certificate or, if applicable, adoption papers showing the claimant(s) as natural or adoptive parent(s), together with documents that clearly show they are qualified individuals to make a claim; must bear raised seal of issuing office. (NOTE: If either a spouse and/or child(ren) files a claim, a parent may not receive any benefit.)

The Form 3650/5 is signed by the individual making the claim; should be notarized to include notary’s raised seal.


On the first business day, during business hours, call the Board of Adjustment at 334-242-7175, in Montgomery, and they will send you copies of their forms.

Carefully read “Preparing Claims – General” earlier in this book.

The claim must be submitted in triplicate, all three copies identical.

Claim must be signed by the claimant and must be notarized.

You will find that, excepting the actual claim form, which is sent to you, the documents sent to the Board of adjustment could be exactly those sent in support of the Federal claim. Read the form and any accompanying instructions carefully to ensure you do include all items they require.



The Federal law, the Public Safety Officer’s Benefit (PSOB) Act, is contained in the Public Safety Officer’s Act of 1976, 42 U.S.C. 3796, as amended, and is administered by the Bureau of Justice Assistance, US Department of Justice, Washington, DC.

Federal law provides a $250,000 benefit to the eligible survivor(s) of a public safety officer whose death is the direct and proximate result of a traumatic injury sustained in line of duty. A cost of living allowance is added each year.

Further, the amended law provides that parents do not have to be financially dependent upon the deceased.

Coverage includes firefighters serving a public agency, with or without compensation, as officially recognized or designated members of a legally organized fire department. A volunteer fire department must be acting on behalf of a public agency providing fire service to all citizens within its jurisdiction without regard to membership or require fee for services. Departments, which are not formed by local government as a unit of that government, are required to provide proof that they are legally organized (e.g., certified copy of their state issued non-profit corporation charter or a copy of the minutes of a local government meeting where that local government took official action to encourage citizens to organize a volunteer fire department.) Volunteer departments and fire brigades formed by a private entity are not covered. Federal civilian firefighters are covered; military are not. However, off-duty military personnel who are volunteer firefighters in a community are eligible if the injury causing death happens during activity with a volunteer fire department and otherwise meets eligibility.

If an off-duty firefighter comes upon an emergency and acts on his own, to be covered, he must be within his own jurisdiction or in a jurisdiction where his department has a mutual aid agreement. In addition, his death must result from an emergency action that would normally be required of him while on duty.

Death must result from injury sustained in the line of duty. “Line of Duty” means any action that the firefighter is authorized or obligated to perform by law, rules, regulation, or condition of employment or service.

Act does not cover death resulting from stress and strain, occupational illness, or chronic, progressive, or congenital disease, such as heart or pulmonary disease, unless there is a traumatic injury, which is the substantial factor in the death. Medical proof of the traumatic injury, such as a blood test of carbon monoxide, may be essential for coverage in such cases. To be a substantial factor, the traumatic injury has to be an equal contributing factor to the death, as is the disease.

“Traumatic injury” means a wound or condition of the body caused by external force, including injuries inflicted by bullets, explosives, sharp instruments, blunt objects, or other physical blows, chemicals, electricity, climatic conditions, infectious diseases, radiation, and bacteria, but excluding stress and strain. Smoke inhalation is considered a traumatic injury and a substantial factor in a heart related death, if the firefighter’s blood carbon monoxide level is 10% or greater at the onset of his attack; 15% or greater if the individual was a smoker.

“Spouse” means the husband or wife of the deceased at the time of death, and includes a spouse living apart from the deceased at time of death for any reason.

“Child” means any natural, illegitimate, adopted, or posthumous child or stepchild of the deceased who, at the time of death, is: 18 years of age or under; over 18 years and a student; over 18 years and incapable of self-support because of physical or mental disability.

No benefit shall be paid:

  1. If death was caused by intentional misconduct of the individual or by the individual’s intent to bring about his/her own death.
  2. If the individual was voluntarily intoxicated at time of death. Benefits will be denied if post-mortem blood alcohol level is .20% or greater.
  3. If individual was performing his/her duties in a grossly negligent manner at time of death (that is, wanton disregard for one’s own life.)
  4. To any individual who would otherwise be entitled to a benefit under the Act if that individual’s actions were a substantial contributing factor in the death.
  5. To any individual employed in a capacity other than a civilian capacity.
  6. If no one qualifies as a survivor entitled to receive such benefits.

"Intoxication" means a disturbance of mental or physical faculties (1) as evidenced by a post-mortem blood alcohol level of .20% or greater OR a post-mortem blood alcohol level of at least .10%, unless convincing evidence is furnished that the individual was not acting in an intoxicated manner immediately prior to death, or (2) resulting from drugs or other substances in the body.

The Federal benefit is not reduced by any benefit that may be received at the State or local level. Conversely, as a result of a US Supreme Court ruling, compensation of State or local agencies may not be reduced because Federal benefits are paid.

No benefit paid under this Act shall be subject to execution or attachment by creditors.

Federal benefits are not subject to Federal income tax (IRS Ruling No. 77-235, IRB 1977-288). And, since the benefits are not estate payments, they are not subject to Federal estate taxes.

Provisions also exist for a Federal benefit to be paid if the recipient was permanently and totally disabled as the result of a catastrophic injury sustained in line of duty; that is, one that permanently prevents the individual from performing any gainful work. Disabilities as a result of occupational diseases or heart attacks do NOT qualify. Applicants must know: (1) Annual appropriations for this disability benefit are limited and applicants could receive a prorated (lesser) amount if appropriated monies do not fully cover all claims eligible for payment during that period, and (2) receiving this disability payment will not permit a later payment of a death benefit if the individual eventually dies as a result of the line of duty injury.


Alabama law is contained in Code of Alabama, Sections 36-30-1 through 36-30-7 (1975). It is administered by the State of Alabama Board of Adjustment, Montgomery, Alabama.

State law provides a $50,000 benefit to the eligible survivor(s) of a fireman.

Fireman is defined as a member of a paid, part-paid, or volunteer fire department of a city, town, county, or other subdivision of the state or of a public corporation organized for the purpose of providing fire protection services in the state. Includes chiefs, assistant chiefs, firemen and all other officers and employees of such departments who actually engage in fire fighting or rendering first aid in case of drowning or asphyxiation at the scene of action.

These persons are presumed to be wholly dependent:

  1. Wife, unless it is shown that she was voluntarily living apart from her husband at time of his death, or unless it is shown, the husband was not in any way contributing to her support for more than 12 months next preceding the occurrence of the injury causing his death.
  2. Minor children under the age of 18 years and those over 18, if physically and mentally incapacitated from earning.
  3. Wife, child, husband, mother, father, grandmother, grandfather, sister, brother, mother-in-law, and father-in-law who were wholly supported by the deceased at the time of death and for a reasonable period of time prior thereto shall be considered his dependents and payment may be made to them.

(Anyone named in subparagraph 3 who regularly derived part of his support from the deceased at time of his death and for a reasonable time prior thereto is considered partially dependent and payment may be made to such individual.)

In the event a fireman, or a volunteer fireman who is a member of an organized volunteer fire department registered with the Alabama Forestry Commission, is killed, either accidentally or deliberately, or dies as a result of injuries received while engaged in the performance of his duties, his dependents shall be entitled to $50,000, unless such death was caused by the willful misconduct of the individual or was due to his own intoxication or his willful failure or refusal to use safety appliances provided by his employer or his willful refusal or neglect to perform a statutory duty or any other willful violation of a law or his willful breech of a reasonable rule or regulation governing the performance of his duties or his employment of which rule or regulation he had knowledge.

Any fireman, or volunteer fireman, whose death results proximately and within 10 years from an injury received while performing his duties shall, for the purposes of this article, be deemed to have been killed while in the performance of such duties.

If the State Health Officer determines from all available evidence that a volunteer fireman, who is a member of an organized volunteer fire
Department registered with the Alabama Forestry Commission, has become totally disabled as a result of any injury such fireman received while engaged in the performance of his firefighting duties and said disability is likely to continue for more than 12 months from the date of injury, such fireman shall be entitled to receive $50,000.

All claims must be presented to the state within one year from the date of death.

There are lengthy specifications as to how benefits will be paid depending upon the numbers and relationships of survivors.

A hearing is held and the survivor(s) are notified in writing as to the time, date, and place of the hearing.


On the next three pages are samples of statements that may be helpful to a fire department.

Sample A is a statement of departmental regulation or standing order that should be included NOW as part of your department’s permanent records. It should be prepared on departmental letterhead stationery and signed by the Fire Chief. File the original as part of your permanent records, and one also might be posted on the bulletin board. All departmental members should be advised of the statement.

Sample B is one way the Fire Chief might certify a department run report or an activity report to be included with the other documents forwarded with a claim.

Sample C is one example of how a Fire Chief might clearly and concisely state the facts concerning an individual whose injury resulted in death in line of duty.

Sample A - For PERMANENT Department Records


I, _______________ Chief of the __________________ Volunteer Fire Department, do order ALL members of this department to take appropriate action at ANY time you may be involved with any fire or other emergency to which you would normally be alerted. I furthermore order all members of this department to take appropriate action when and where they see need for action within the realm of their training and experience, wherever such action may be required. All members of this department are directed to attend any and all firematic meetings, local, county, or state, and other activities that they are delegated to attend as a delegate or member. Travel to and from such firematic meetings shall begin and end at the fire station.

Signed:__________ ____
Typed: (Name and Title)

Sample B - Certifying a Run Report


I certify that the attached Fire Department (Report) (Run Report) (Fire Report) (or other Title of Document) is an exact and true copy of the original document, which is on file in this department.

Signed: ________
Typed: (Name and Title)

NOTE: This statement must be notarized and include the raised seal of the notary.

Sample C - Fire Chief's Statement


This is to certify that __(Name)__ , a firefighter of this fire department, died (at) (about) __(time)__ (am)(pm), on __(Date)__ as the result of injuries received in the line of duty at ___Time)__ (am)(pm), __(Date)__ at __(Give the location, town and state)__ .
Firefighter _____(Name)_____ was engaged in (going to) (participating in) (returning from) __(State what activity & again include location)__ (use whatever space is required) as required by standing orders of this department.

Signed: ___________
Typed: (Name & Title)

NOTE: This statement must be notarized and include the raised seal of the notary.


AAVFD OFFICE 888-972-2833

Alabama State Fire Marshall 334-241-4166

AAVFD Web Site

Alabama Code Title 36-30-1 Thru 7

Alabama Code Web Site

National Fallen Firefighters Foundation

Firefighter Autopsy Protocol

International Assn. of Fire Chiefs


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