Florida Regulations 69L-3.002 3
§ Definitions (Repealed)
When used in this chapter, the following terms have the following meanings:
(1) Average Weekly Temporary Total Disability Benefit means the weekly average of all benefits paid pursuant to ss. 440.15(2)(a) and (b), F.S. The weekly average shall be determined by dividing the total amount of temporary total disability benefits paid to date, by the number of weeks and days paid as calculated pursuant to s. 440.14(1 )(g), F.S. If no temporary total benefits were paid, the average weekly temporary total disability benefit shall be 66 2/3% of the employees average weekly wage, subject to the maximum compensation rate in accordance with s. 440.14, F.S.
(2) Carrier unless otherwise indicated, includes self-insured employers, group self-insured funds, local government workers compensation insured pools, commercial self-insured funds and stock companies, and mutual companies, exchanges and associations authorized to provide workers compensation coverage in this state. Carrier includes every individual, insurer, company, association, organization, society, reciprocal insurer or inter insurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity which is engaged as indemnitor, surety or contractor in the business of entering into contracts whereby one undertakes to indemnify another of pay or allows a specified amount or a determinable benefit upon determinable contingencies.
(3) Carrier Code # means the internal audit number which the Division assigns each individual insurance carrier, self-insured employer, or self-insured fund upon receipt of notification to write or administer workers compensation insurance in Florida. The carrier must include the correct carrier code # on every claims form promulgated under this chapter. A service company, adjusting company, or third party administrator servicing a claim for a self-insured employer or self-insurance fund must include both the carrier code# and the Service Co/TPA Code # on any form promulgated under this chapter.
(4) Carrier File # means the internal identification number assigned to a file by a carrier. The carrier must include the carrier file number where required on any form promulgated under this chapter.
(5) Carrier Name, Address and Telephone means the name, mailing address and telephone number of the carrier with responsibility for handling the claim. If a servicing company is the entity handling the claim on behalf of a self-insured employer, fund or another carrier, the servicing company must include the name, address, and telephone number of the servicing company, and not that of the self-insured employer, fund or other carrier, on the form. The carrier telephone number provided must enable a caller to readily ascertain the name of the adjuster or claims representative handling the claim.
(6) Compensation Rate means 66 2/3 percent of the employees average weekly wage pursuant to s. 440.14, F.S., as calculated by the carrier, as ordered by a Judge of Compensation Claims, or to which the parties have stipulated.
(7) Date Prepared means the date the form was prepared by the adjuster or claims representative to be sent to the Division or other parties.
(8) Days means calendar days unless otherwise noted.
(9) Denied Case means a lost time case for which the carrier has denied liability for all workers compensation benefits.
(10) Division means the Division of Workers Compensation of the Department of Labor and Employment Security of the State of Florida.
(11) Document means any form, report, or electronic data submission which must be submitted to the Division under this chapter or which the Division requests in connection with any matter covered by this chapter.
(12) File or filed means a document has been received by the party to which it was sent.
(13)Filing Period for Supplemental Income Benefits means a period of 13 consecutive weeks (approximately 3 months) for which the employee reports any earnings and files a claim for supplemental income benefits. The filing period shall represent a quarter as set out ins. ^440.1 5^(3)(b)7., F.S., except for the second filing period, which may consist of less than 13 weeks if the first payment period was pro-rated. The initial filing period is the fiIing period which occurs during the last 13 weeks of impairment income benefits.
(14) First Aid Case means a work injury or illness which is treated at the work place, does not require medical treatment for which charges are incurred, and does not cause the employee to miss work for more than one shift.
(16) Initial Payment of Supplemental Income Benefits means payment of supplemental income benefits for the first whole or partial calendar month immediately following the expiration of the impairment income benefit period. The initial payment of supplemental income benefits shall cover the time beginning with the day after the expiration of impairment income benefits and ending with the last date in the initial calendar month.
(17) Lost Time Case means a work injury or illness which has caused the employee to be out of work for more than seven days or for which indemnity benefits have been paid. Lost time cases shall include compensable volunteer workers to whom no indemnity benefits will be paid, but who have lost more than seven (7) days from work; compensable death cases for which there are no known or confirmed dependents; and injuries which result in the loss of more than seven days for which the employer is continuing to pay salary in lieu of compensation.
(18) Medical Only Case means a work-related injury which requires treatment for which charges will be incurred, but which does not cause the employee to miss more than seven days of work.
(19)Medical Only to Lost Time Case means a work injury or illness which initially did not cause a loss of more than seven days of work but later resulted in a loss of more than seven days of work.
(20)Overall Maximum Medical Improvement means the date on which maximum medical improvement has been achieved with respect to all compensable medical or psychiatric conditions caused by a compensable injury or disease.
(21)Payment Period for Supplemental Income Benefits means the period of 3 consecutive calendar months immediately following the filing period. The first payment period may consist of less than 3 full months if the first monthly payment is pro-rated. The last payment period may consist of less than 3 full months if the employee has reached a maximum of 401 weeks of benefits. All other payment periods of supplemental income benefits shall be for 3 full calendar months.
(22) Permanent Impairment Rating means the rating on which the carrier will base its determinations concerning the employees indemnity benefits.
(23) Risk Class Code means the 4 digit code assigned by the National Council on Compensation Insurance (NCCI) for the particular occupation of the injured employee. A listing of Risk Class Codes may be obtained by contacting NCCI at 750 Park of Commerce Drive, Boca Raton, Florida 33487.
(24) Salary Continued in Lieu of Compensation means the monies an employer paid the employee as salary, wage, or other remuneration equalling at least the compensation rate for a period of disability for which the carrier would have otherwise been obligated to pay compensation benefits.
(25)Salary End Date means the date through which the employer paid salary in lieu of compensation.
(26) Send means to transmit a document by U.S. mail, hand delivery, or electronic transmission to the party or parties to receive it. Sending is complete upon transmission by one of these methods. A carrier completing a form shall mark as the Sent to Division date the date it sends the Division the form.
(27) Service Co/TPA Code # means the internal audit number assigned by the Division to a service company, adjusting company, or third party administrator. Any form promulgated under this chapter and filed by a service company, adjusting company, or third party administrator must include the correct Service Co/TPA Code #.
(28) SIC Code means the 4 digit Standard Industrial Classification Code which identifies the nature of the employers business. A listing of SIC Code numbers may be obtained by contacting the Government Printing Office Bookstore, 100 West Bay Street, Jacksonville, Florida 32202