These days, workers who refuse to get vaccinated against COVID-19 may face financial repercussions, from higher health insurance premiums to loss of their jobs.

Now, the financial fallout might follow workers beyond the grave. If they die of COVID-19 and weren't vaccinated, their families may not get death benefits they would otherwise have received.

New York's Metropolitan Transportation Authority no longer pays a $500,000 death benefit to the families of subway, bus and commuter rail workers who die of COVID-19 if the workers were unvaccinated at the time of death.

"It strikes me as needlessly cruel," said Mark DeBofsky, a lawyer at DeBofsky Sherman Casciari Reynolds in Chicago who represents workers in benefit disputes.

Other employers have similar concerns about providing death or other benefits to employees who refuse to be vaccinated.

In Massachusetts, the New Bedford City Council sought to extend accidental death benefits to city employees who died of COVID-19, but the mayor didn't sign that legislation because, among other things, it didn't prohibit payment if the worker was unvaccinated.

President Joe Biden has leaned hard on businesses to make sure their workers are vaccinated. In September, the administration announced all employers with 100 or more workers would be required to either ensure they're vaccinated or test employees every week for COVID-19.

Among employers, "there's a frustration level, particularly at this point when these vaccines are fully approved," said Carol Harnett, president of the Council for Disability Awareness, an industry group. "You're trying to protect yourselves and your employees, both from themselves and the general public."

The New York transportation authority is the highest-profile employer to take this action. Since the pandemic crisis began in 2020, 173 MTA workers have contracted COVID-19 and died. Five of those deaths occurred after June 1 of this year, when the policy changed, according to the MTA.

"We are not aware they have been vaccinated," an MTA spokesperson said of the five workers who died since the policy took effect.

The transit authority's policy was a shift from an earlier pact with workers. In April 2020, as COVID-19 ravaged New York, transit officials and the labor unions representing employees reached agreements that workers who died of COVID-19 would be eligible to receive a $500,000 lump-sum death benefit, just like payments to which families of MTA workers who have other job-related deaths are entitled. The program will continue through the end of this year.

But with COVID-19 vaccines now widely available and fully approved by the Food and Drug Administration, the MTA Board determined that, starting June 1, workers who died of COVID-19 had to have been vaccinated for their families to be eligible for the payment.

The change comes as the MTA has struggled to improve vaccination rates among its roughly 67,000 workers. More than 70% of transit employees are estimated to be vaccinated, according to MTA officials.

A spokesperson for the MTA stressed that the program remains in effect, and noted that it has been extended past its original one-year term. The only change is the vaccination requirement.

"The program is not being revoked," the MTA spokesperson said in an e-mail. "In fact, the MTA has twice extended it."

In the New Bedford case, the City Council unanimously passed a petition in August stating the COVID-19 death of any city employee would be considered to have occurred in the line of duty, enabling family members to receive accidental death benefits.

Mayor Jon Mitchell, however, objected for several reasons — the question of vaccination among them.

"As I am certain the Council would agree, it would be inappropriate to extend accidental death benefits where the employee refused to take a vaccine that had been found to be nearly 100% effective," Mitchell said in a letter to the council. The proposal has been tabled for further negotiation, according to a spokesperson for the mayor.