Current through Reg. 47, No. 249; December 28, 2021
(1) Letter
requirement - The claim administrator shall mail an informational letter to the
employee and employer within 5 business days after the claim administrator'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 paragraph
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 claim administrator 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 claim administrator 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 claim administrator 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 claim administrator 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 post-injury 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 pre-injury 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 claim administrator is unable to
confirm earnings information from the employee's post injury employer or
employers, the claim administrator 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 claim administrator may
then suspend payment of the employee's temporary partial disability benefits
until the claim administrator's receipt of the form in accordance with Rule
69L-3.021,
F.A.C.
Notes
Fla. Admin. Code Ann. R.
69L-3.01915
Rulemaking Authority
440.15(4),
440.591
FS. Law Implemented
440.15(4)
FS.
New 1-10-05, Amended by
Florida
Register Volume 40, Number 117, June 17, 2014 effective
6-30-14.
