Florida Regulations 69L-3.0193

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§ 69L-3.0193 Supplemental Income Benefits (Dates of Accident January 1, 1994 through September 30, 2003)

History:



An employee may be eligible to receive Supplemental Income Benefits if an impairment rating of 20% or more has been assigned in accordance with Section 440.15(3)(b), F.S., (1994).

(1) Definitions: The following words and terms when used in this rule shall have the following meanings:

(a) "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 in Section 440.15(3)(b)7., F.S., (1994), except for the second filing period, which may consist of less than 13 weeks if the first payment period was prorated. The "initial filing period" is the filing period which occurs during the last 13 weeks of impairment income benefits. (b) "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. (c) "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.

(2) (a) No later than 15 weeks before the expiration of the impairment income benefit period, the claims-handling entity shall send by certified mail to each employee eligible for supplemental income benefits an informational letter substantially in conformance with subsection (7) of this rule section, and two copies of Form DFS-F2-DWC-40, as adopted in Rule 69L- 3.025, F.A.C. The claims-handling entity shall fill out the first two lines on one of the Forms DFS-F2-DWC-40 before sending it to the employee and indicate the beginning and ending dates of the initial filing period. The second Form DFS-F2-DWC-40 should be left blank. (b) If the claims-handling entity has knowledge that the employee is eligible for supplemental income benefits and fails to timely provide the employee with written notification and forms as required by this rule, the claimshandling entity shall pay supplemental income benefits for all months for which the employee was not provided a form. Payment shall be computed as if the employee had $0 earnings. The claims-handling entity may later obtain repayment of any overpayment in accordance with paragraph (3)(d) of this rule and pursuant to Section 440.15(12), F.S. (c) For any filing period, the claims-handling entity shall add all earnings reported by the employee and divide by the total number of weeks in that filing period to yield a "current average weekly wage." The current average weekly wage shall include any weeks for which $0 earnings were reported.

(3) Payment of Supplemental Income Benefits:

(a) The claims-handling entity shall issue the initial payment (the first whole or partial calendar month) of supplemental income benefits by the 7th day after the expiration of impairment income benefits. The claims-handling entity shall make the first payment of supplemental income benefits with or without receipt of the employee's first Form DFS-F2-DWC-40. If the employee timely filed Form DFS-F2-DWC-40 with the claims-handling entity, the second and third months in the initial payment period shall be paid on the first (1st) day of each month in that payment period. (b) To calculate benefits due for a partial month of the initial payment period: divide the monthly supplemental income benefit payment amount, computed from the "calculation" section on Form DFS-F2-DWC-40, by 4.3; divide that amount by 7 to yield the daily rate; multiply this daily rate by the number of days from the first day of eligibility for supplemental income benefits through the last day of the first calendar month in the payment period. Record this figure on Form DFS-F2-DWC-40 in the box labeled "Payment Amount for Initial Month." (c) Except for the initial payment of supplemental income benefits, payments of additional monthly supplemental income benefits are contingent upon the employee having filed Form DFS-F2-DWC-40 with the claimshandling entity. Subsequent monthly payments of supplemental income benefits for which the claims-handling entity has received Form DFS-F2- DWC-40 shall be paid as follows:

1. The first month in the next payment period shall be paid within 7 days of the claims-handling entity's receipt of Form DFS-F2-DWC-40; 2. The second and third months of this payment period shall be paid on the first day of each month in that payment period. If Form DFS-F2-DWC-40 was not timely returned by the employee to allow the claims-handling entity to issue payment as per paragraphs (a) and (b) above, the claims-handling entity shall within 7 days of receipt of Form DFS-F2-DWC-40 pay any and all months of supplemental income benefits due and owing as of the date the form was received, subject to the information submitted by the employee on the form.

(d) If upon receipt of Form DFS-F2-DWC-40 it is determined that an overpayment of supplemental income benefits has occurred, the claimshandling entity may re-calculate the amount of supplemental income benefits due for the remaining months in that payment period or any subsequent payment periods and obtain repayment, subject to the provisions of Section 440.15(12), F.S. In no case shall the repayment amount be greater than 20% of the monthly supplemental income benefit payment amount. (e) The monthly supplemental income benefit payable shall not exceed the maximum weekly benefit amount as set out in Section 440.12, F.S., multiplied by 4.3.

(4) Filing Requirements:

(a) The employee will not be entitled to supplemental income benefits for any filing period for which Form DFS-F2-DWC-40 has not been filed with the claims-handling entity by the seventh day after the expiration of the payment period associated with that filing period. (b) Within 7 days after the claims-handling entity has made the first payment of supplemental income benefits in any payment period, the claimshandling entity shall send the completed Form DFS-F2-DWC-40 to the Division, the employee, the employer, and any other interested parties. If the claims-handling entity denies payment of supplemental income benefits for any payment period, the claims-handling entity must attach Form DFS-F2-DWC-12, as adopted in Rule 69L- 3.025, F.A.C., to Form DFS-F2-DWC-40 and provide the reason(s) for the denial. (c) The claims-handling entity shall provide the employee with at least two (2) additional Forms DFS-F2-DWC-40 upon payment of the first month for any payment period. The claims-handling entity shall indicate on one of the forms the beginning and ending dates of the employee's next filing period.

(5) The amount payable for supplemental income benefits shall be based on earnings information submitted by the employee for the previous filing period, and shall be paid monthly, with the exception of the initial payment which may be pro-rated. Once the employee has been determined to be eligible for supplemental income benefits for the filing period, the monthly benefit amounts shall be the same for each month of that filing period, unless it is the initial payment of supplemental income benefits for a partial month, or if an adjustment is being made for an overpayment, or if the final payment of supplemental income benefits expires at the 401 week maximum.

(6) Supplemental income benefits may not be offset by social security or unemployment compensation benefits received by the employee.

(7) The informational letter to the employee referred to in subsection (2) of this rule must contain at least the following: "Because your doctor found that you have a permanent impairment of 20% or more due to your work injury, you may be eligible to receive additional workers' compensation benefits, known as SUPPLEMENTAL INCOME BENEFITS. However, you must also meet the requirements below in order to receive payment for these benefits:"

1. You must be unable to earn at least 80% of what you earned before your injury for at least 90 days in a row, and 2. You must try in good faith to find a job that you are able to do and cooperate with any reemployment help offered by the employer, claimshandling entity or the Division of Workers' Compensation. To get your first check for supplemental income benefits, you need to complete, sign and return the enclosed "Statement of Quarterly Earnings for Supplemental Benefits" Form (DFS-F2-DWC-40) to this office. We recommend you return the form no later than 7 days after the end of the filing period, shown in section "A" of the enclosed form. This should enable you to keep your payments coming about every 4 to 6 weeks. Report any wages you earn during the last 13 weeks that you are paid impairment income benefits. Do not include the amount paid to you for your impairment income benefits. Follow the filing instructions on the back of the form to make sure there will not be a break in your payments. Your supplemental income benefits will be calculated by a formula that is based on the wages you report for every filing period on each "Statement of Quarterly Earnings for Supplemental Income Benefits." If you already know that you will not be eligible for payment of supplemental income benefits when your impairment income benefits end, keep this letter and the other blank form for possible future use, because you may later become eligible for supplemental benefits. If you do not work during the filing period, it is suggested that you keep records of all the places you look for work, the dates you look, the type of work you are seeking, and the names of the people you contact. If you turn down the offer of a job that you are able to do, your supplemental income benefits will be calculated on the basis of what that job would have paid you, for as long as the job offer remained open to you. Also, if you refuse to accept training or education offered by the employer, this office, or the Division, your supplemental income benefits may be reduced by one-half. If you have any questions, contact your claims representative at this office, at the address and telephone number listed in this letter. You may also call the Division of Workers' Compensation's Employee Assistance and Ombudsman Office (EAO) at any of its branch offices listed in your employee brochure, or at its toll-free telephone number in Tallahassee at 1 (800) 342-1741."

Specific Authority 440.15(3)(b)5., 440.591 FS. Law Implemented 440.15(3), 440.20(3), 440.491 FS. History-New 11-8-94, Formerly 38F-3.0193, 4L-3.0193, Amended 1-10-05.