Florida Regulations 69L-3.021 36

From Wcc
Jump to: navigation, search

Florida > Regulations

§ Additional Income Source Reports



(1) Within 21 days after the employee receives a request from either the Division or the carrier for either LES Form DWC-14, Request for Social Security Disability Benefits Information, or LES Form DWC-30, Authorization Request for Unemployment Compensation information, 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 carrier.

(2) Upon request of the Division, employer, or carrier, any employee eligible for temporary total, temporary partial, permanent total disability, or permanent total supplemental compensation shall complete, sign, and return LES Form DWC 19, Employee Earnings Report, within 21 days after receiving it to report all earnings of any nature, including all social security benefits. The Division, employer, or carrier may require the employee to send LES Form DWC- 19 no more than once a month.

(3) If the employee willfully fails or refuses to report information requested in accordance with paragraphs (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) The party requesting the employees authorization for release of social security benefit information shall furnish the DWC-14 form 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 employees address. The requesting party must send a copy of the completed LES Form DWC-14 to the Division.

(5) If the carrier changes the employees compensation rate based on any offset, the carrier shall send to the Division, along with the appropriate income source report, LES Form 4 indicating the change in accordance with the provisions of Rule 38F- 3.0091.

(6) If the employees benefits have been suspended due to the employees willful failure or refusal to furnish a signed release, the carrier shall send to the Division LES Form DWC-4 indicating the effective date and reason code for suspension of the benefits in accordance with the provisions of Rule 38F- 3.0091.

(7) When submitting LES Form DWC- 14 to the Social Security Administration, or LES Form DWC-30 to the Division of Unemployment Compensation, the requestor may want to include with the form a self-addressed stamped return envelope or the requestors return address printed on a peel-off adhesive label in order to expedite processing.

Specific Authority 440.591, 440.15(1)(f)2.a., b., (2)(d), F.S. Law Implemented

440.15(1), (2), (4), 440.185, 440.20(3), F.S. HistoryNew 10-30-79, Amended 11-

5-81, Formerly 38F- 3.21, Amended 4-11-90, 1-30-91,6-10-92, 11-8-94.