Florida Regulations 69L-3.01915

From Wcc
Jump to: navigation, search

Florida > Regulations

§ 69L-3.01915 Temporary Partial Disability Benefits (Dates of Accident on or After October 1, 2003)

(1) Letter requirement - The claims-handling entity shall mail an informational letter

to the employee and employer within 5 business days after the claims-handling entity's knowledge of the employee's release to restricted work. This letter shall explain the employee's eligibility for temporary partial disability benefits and the obligation to report earnings. These earnings would include the receipt of any 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 released you to return to work, but because of your work-related accident, you have been given restrictions on the type of work you can now do. Because you have not reached maximum medical improvement (the date after which your doctor says your injury will probably not get better), you may continue receiving workers' compensation benefits approximately every two weeks if you are not able to earn at least 80% of the weekly wages you were making before your injury.

(a) These benefits, called Temporary Partial Disability benefits, will be paid until:

1. You reach maximum medical improvement or can return to work without restrictions; 2. You receive the maximum of 104 weeks allowed by law for either Temporary Total Disability benefits, Temporary Partial Disability benefits or Training and Education Temporary Total benefits, or 104 weeks for the combined benefits; or 3. You earn 80% or more of the weekly wages you were making at the time of your accident.

(b) IMPORTANT: Temporary Partial Disability benefits may be stopped if:

1. You do not notify this office within five (5) business days after you return to work; 2. You are not working due to your own misconduct on the job; 3. You refuse suitable employment offered to you; or 4. You do not return, if requested, Form DFS-F2-DWC-19, "Employee Earnings Report", as adopted in Rule 69L- 3.025, F.A.C., to this claims office within 21 days after you receive it and report the receipt of any earnings, including Unemployment Compensation or Social Security benefits. You may be asked to complete, sign, and return this form once a month. You are to notify this office immediately if you stop making at least 80% of your pre-injury weekly wages. However, if you leave your job without just cause as determined by a judge, your temporary partial disability benefits will be paid based on the amount of money you would have earned had you not left work. For more information about temporary partial disability benefits, please call the Employee Assistance Ombudsman Office (EAO) with 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."

(2) 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 claimshandling 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(4), 440.591 FS. Law Implemented 440.15(4) FS. History-New 1-10-05.