Florida Regulations 69L-3.0191

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§ 69L-3.0191 Temporary Disability Benefits (Dates of Accident January 1, 1994 through September 30, 2003)

History:



(1) Temporary disability benefits include temporary total and temporary partial disability benefits and are payable for a maximum of 104 weeks. An employee's eligibility for temporary disability benefits ceases after the employee has received 104 weeks of temporary total disability benefits paid pursuant to Section 440.15(2)(a), F.S., or after the employee has received 104 weeks of temporary partial disability benefits paid pursuant to Section 440.15(4), F.S., or after the employee has received 104 weeks of any combination of these two benefits.

(2) An employee is eligible for temporary partial disability benefits if the employee has received a medical release to return to work, is unable to earn at least 80% of the employee's pre-injury average weekly wage, has not reached maximum medical improvement, and has not received payment for 104 weeks of temporary total or temporary partial disability benefits or any combination of the aforementioned benefits. The Division does not require an employee to request temporary partial disability benefits by filing a form promulgated by the Division. The claims-handling entity shall not require the employee to demonstrate eligibility for temporary partial disability benefits by submitting documentation indicating the employee has looked for work.

(3) Within five (5) days of its knowledge that the employee has been released to return to work, unless the employee's eligibility for temporary partial disability benefits has expired, the claims-handling entity shall mail to the employee an informational letter which explains the employee's eligibility for temporary partial disability benefits. The letter must advise the employee about the employee's obligation to report, at the claims-handling entity's request using Form DFS-F2-DWC-19, as adopted in Rule 69L- 3.025, F.A.C., the employee's receipt of any and all of the following: salary, wages, unemployment compensation benefits, or Social Security benefits. The letter to the employee must contain at least the following: "Your doctor has said that you are able to return to work, but you have not reached maximum medical improvement from your injury (maximum medical improvement is the date after which a doctor says you will not get any better from your injury). You are eligible for temporary partial disability benefits if you cannot make at least 80% of the wages you were making at the time of your accident after the doctor says you can return to work. These benefits will continue until one of the following happens:

(a) Your doctor says you have reached maximum medical improvement from your injury; or (b) You have received 104 weeks of either temporary total or temporary partial disability benefits, or both combined; or (c) You are making 80% or more of the wages you were making at the time of your accident. If you earn wages after the doctor says you can return to work, you must immediately contact this office and give us the name of your employer and the amount of money you are making. If you stop making at least 80% of the wages you were making at the time of your accident, you should also contact this office immediately. If you receive unemployment compensation benefits or Social Security benefits, you must immediately contact this office and tell us what kind of benefits you are getting and the amount of those benefits. If the form "Employee Earnings Report" (Form DFS-F2-DWC-19) was sent with this letter, you must fill it out, sign it and return it within 21 days after you received it. You may be asked to fill out one of these forms once a month. If you do not fill out, sign and return the form, your compensation benefits may be stopped until you return the form. If you turn down an offer of a job that you can do, your compensation benefits may be stopped. For more information about temporary partial disability benefits, please call the Employee Assistance and Ombudsman Office (EAO) of the Division of Workers' Compensation at any of its local offices listed in your "Important Workers' Compensation Information For Florida Workers" brochure, or at 1 (800) 342-1741."

(4) Calculations and payment of temporary partial disability benefits: Temporary partial disability benefits shall be calculated pursuant to Section 440.15(4)(a), F.S., even when the employee's earnings are $0. Temporary partial benefits calculated for any given week are subject to the maximum weekly compensation rate as defined by Section 440.12, F.S. The claims-handling entity shall investigate an employee's post-injury earnings, to determine the amount of temporary partial disability benefits for which the employee is entitled, and to ensure the timely payment of those benefits.

(a) No post-injury earnings - If the claims-handling entity has determined there are no earnings, the first installment of temporary partial disability benefits is due no later than 14 days after the date the employee's medical release states that the employee may resume work. The claims-handling entity shall pay temporary partial disability benefits to the employee based on $0 earnings. Subsequent payments of temporary partial disability benefits for any biweekly period is due no later than the last day of that biweekly period as long as the employee continues to be eligible. (b) Post-injury earnings -

1. If re-employed and the employee or employer has notified the claims-handling entity within 5 business days after returning to work, the first installment is due within 7 days after the last date of the post-injury employer's first biweekly work week as defined in subsection 69L- 3.002(2), F.A.C. Subsequent payments of temporary partial disability benefits for any biweekly period are due no later than 7 days after the end of the last date of that biweekly period as long as the employee continues to be employed and eligible. 2. Once re-employed, the first week of temporary partial disability may be paid as a partial week in order to coincide with the postinjury employer's work week. To determine the amount of benefits due for a partial week:

a. Divide the pre-injury average weekly wage by the preinjury number of days employed per week to calculate the daily rate; b. Multiply this daily rate by the number of days the employee worked during the post injury employer's work week; c. Multiply this amount by 80%; d. Subtract the partial week's earnings; and e. Multiply the difference by 80%, resulting in the temporary partial benefit due for this partial week.

(c) No confirmation of earnings - At any time the claims-handling entity is unable to confirm earnings information from the employee's post injury employer or employers, the claims-handling entity shall calculate benefits based on the last wage information submitted or obtained and continue to pay temporary partial disability benefits.

1. If the last known earnings are $0, payments of temporary partial disability benefits for any biweekly period are due no later than the last day of that biweekly period as long as the employee continues to be eligible. 2. If the last known earnings are greater than $0, payments of temporary partial disability benefits for any biweekly period are due no later than seven (7) days after the last day of that biweekly period as if the employee continues to be employed and eligible. If the employee does not timely return Form DFS-F2-DWC-19, the claims-handling entity may then suspend payment of the employee's temporary partial disability benefits until the claims-handling entity's receipt of the form in accordance with Rule 69L- 3.021, F.A.C.

Specific Authority 440.15(2)(d), (4)(a), 440.185(4), (5), 440.20(3), 440.591 FS. Law Implemented 440.15(2), (4), 440.185(4), (5), 440.20(3) FS. History-New 11-8-94, Formerly 38F-3.0191, 4L-3.0191, Amended 1-10-05.