Florida Regulations 69L-3.021

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§ 69L-3.021 Additional Income Source Reports.

History:



(1) Within 21 days after the employee receives a request from either the Division or the claims-handling entity for either Form DFS-F2-DWC-14, or Form DFS-F2- DWC-30, as adopted in Rule 69L- 3.025, F.A.C., the employee shall complete the form and return it to the party requesting the information. The employee shall renew the authorization each 12 months upon a request by the Division, employer or claims-handling entity.

(2) Upon request of the Division, employer, or claims-handling entity, any employee eligible for temporary total, temporary partial, permanent total disability or permanent total supplemental compensation shall complete, sign, and return Form DFS-F2-DWC-19, as adopted in Rule 69L-3.025, F.A.C., within 21 days after receiving it to report all earnings of any nature, including all social security benefits. The Division, employer, or claims-handling entity may require the employee to send Form DFS-F2-DWC-19 no more than once a month.

(3) If the employee refuses to report information requested in accordance with subsection (1) or (2) above within 21 days after receipt of the request, payments of workers' compensation disability benefits for temporary total, temporary partial, permanent total or permanent total supplemental compensation shall cease until such time as the employee furnishes the signed form.

(4) For dates of accident on or after October 1, 2003, upon the request of the claimshandling entity, any employee eligible for impairment income benefits shall complete, sign, and return Form DFS-F2-DWC-19 within 21 days after receiving it to report all earnings. The claims-handling entity may require the employee to send Form DFS-F2-DWC-19 no more than once a month. If the employee refuses to report earnings within 21 days after receipt of the request, payments of workers' compensation disability benefits for impairment income benefits shall cease until such time as the employee furnishes the signed form.

(5) The party requesting the employee's authorization for release of social security benefit information shall furnish the Form DFS-F2-DWC-14 to the employee. The requesting party shall be responsible for submitting the Request for Social Security Disability Benefit Information to the Social Security Administration office nearest to the employee's address. The requesting party must send a copy of the completed Form DFS-F2-DWC-14 to the Division within 14 days of the request.

(6) If the claims-handling entity changes the employee's compensation rate based on any offset, the claims-handling entity shall send to the Division, along with the appropriate income source report, Form DFS-F2-DWC-4, as adopted in Rule 69L- 3.025, F.A.C., indicating the change in accordance with the provisions of Rule 69L- 3.0091, F.A.C.

(7) If the employee's benefits have been suspended due to the employee's refusal to furnish a signed release, the claims-handling entity shall send to the Division Form DFS-F2-DWC-4 indicating the effective date and reason code for suspension of the benefits in accordance with the provisions of Rule 69L- 3.0091, F.A.C.

Specific Authority 440.15(1)(f)2.a., b., (2)(d), 440.591 FS. Law Implemented 440.15(1), (2), (4), 440.185, 440.20(3) FS. History-New 10-30-79, Amended 11-5-81, Formerly 38F-3.21, Amended 4-11-90, 1-30-91, 6-10-92, 11-8-94, Formerly 38F-3.021, 4L-3.021, Amended 1-10-05.