Current through Reg. 47, No. 188; September 28, 2021
When used in this chapter, the following terms have the
Weekly Temporary Total Disability Benefit" means the weekly average of all
benefits paid pursuant to paragraphs
(b), F.S. The weekly average shall be determined by dividing the
total amount of temporary total disability benefits paid to date, by the number
of weeks and days paid as calculated pursuant to paragraph 440.14 (1)(g), F.S.
If no temporary total benefits were paid, the average weekly temporary total
disability benefit shall be 66 2/3% of the employee's average weekly wage,
subject to the maximum compensation rate in accordance with Section
(2) "Biweekly work week" means
two consecutive 7-day periods coinciding with the post injury employer's work
week. For the purposes of calculating Temporary Partial Benefits pursuant to
F.S., the first biweekly work week includes the week the employee returned to
(3) "Claim Administrator"
means any insurer, claims-handling entity, qualified servicing entity, service
company/third-party administrator (Service Co/TPA), self-serviced self-insured
employer or fund, or managing general agent and includes all claims office
locations that will be responsible for adjusting and submitting workers'
compensation claims to the Division.
(4) "Class Code" means the 4-digit code
assigned by the National Council on Compensation Insurance (NCCI) for the
particular occupation of the injured employee, as it exists in the NCCI
Scopes[TM] Manual 2004 Edition, which is hereby incorporated by reference. A
listing of Class Codes may be obtained by contacting NCCI's Customer Service
Center at (800) 622-4123.
"Compensation Rate" means 66 2/3% of the employee's average weekly wage
pursuant to Section 440.14, F.S., as calculated by the claim administrator, as
ordered by a Judge of Compensation Claims, or to which the parties have
(6) "Date Payment
Mailed" means the date payment of a benefit left the control of the claim
administrator (or the claim administrator's legal representative if delivery is
made by the legal representative) for delivery to the employee or the
employee's representative, whether by U.S. Postal Service or other delivery
service, hand delivery, or deposit by electronic funds transfer.
(7) "Date Prepared" means the date the form
was prepared by the adjuster or claims representative to be sent to the
Division or other parties.
"Days" means calendar days unless otherwise noted.
(9) "Denied Case" means any case for which
the claim administrator has denied liability for all workers' compensation
(10) "Document" means any
notice, form, or report which shall be submitted to the Division under this
chapter or which the Division requests in connection with any matter covered by
this chapter. Unless otherwise specified, this definition includes data
submitted to the Division using Electronic Data Interchange (EDI) or another
Division approved electronic format.
(11) "File" or "Filed" means a document has
been received and accepted in accordance with Rule
F.A.C., by the Division.
"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 subparagraph
7., F.S. (1994), which is incorporated herein by reference, except for the
second filing period, which may consist of less than 13 weeks if the first
payment period was pro-rated. The "initial filing period" is the filing period
which occurs during the last 13 weeks of impairment income benefits.
(13) "First Aid Case" means a work injury or
illness which is treated at the work place, does not require medical treatment
for which charges are incurred, and does not cause the employee to miss work
for more than one day.
Salary in Lieu of Compensation" means the monies an employer paid the employee
as salary, wage, or other remuneration for a period of disability for which the
insurer would have otherwise been obligated to pay compensation
(15) "Full Salary End
Date" means the date through which the employer paid full salary in lieu of
(16) "Indemnity Only
Denied Case" means any case for which the claim administrator has denied all
indemnity benefits at the time of the filing of the DFS-F2-DWC-1, however,
compensability of the case is accepted and medical benefits will be
(17) "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 pursuant to section 440.15, F.S. (1994), which is
incorporated herein by reference.
(18) "Insurer Code #" means the
Division-assigned number for the insurer as defined in subsection 440.02(38),
F.S., which bears the financial risk of the claim.
(19) "Lost Time Case" means a work-related
injury or illness, which has caused the employee to be disabled for more than 7
calendar days or for which indemnity benefits have been paid. Lost time cases
shall also include compensable volunteer workers to whom no indemnity benefits
will be paid, but who have been disabled for more than 7 calendar days from
work; compensable death cases for which there are no known or confirmed
dependents; and injuries which result in the disability of more than 7 calendar
days for which the employer is continuing to pay full salary in lieu of
compensation for any portion thereof. The 7 calendar days of disability do not
have to be consecutive, but are cumulative and can occur over a period of
(20) "Medical Only Case"
means a work-related injury or illness, which requires medical treatment for
which charges will be incurred, but which does not cause the employee to be
disabled for more than 7 calendar days.
(21) "Medical Only to Lost Time Case" means a
work-related injury or illness, which initially did not result in disability of
more than 7 calendar days but later resulted in a disability of more than 7
calendar days. Medical only to lost time cases shall include previous medical
only cases in which Impairment Income Benefits are paid based on obtaining
Maximum Medical Improvement with a Permanent Impairment Rating greater than
zero (0) % and settlement only cases involving payment of indemnity
(22) "NAICS Code" means
the 5 or 6-digit code published in the North American Industry Classification
System (NAICS) 2007 and 2012 Editions, hereby incorporated by reference, that
represents the nature of the employer's business. Classification information
may be obtained by contacting the NAICS Association, 341 East James Circle,
Sandy, Utah 84070, or visiting the website:
(23) "Notification" or "Knowledge" means an
entity's earliest receipt of information, including mail, telephone, facsimile,
direct personal contact or electronic submission.
(24) "Overall Maximum Medical Improvement"
means the date on which maximum medical improvement has been achieved with
respect to all compensable medical or psychiatric conditions caused by a
compensable injury or disease.
"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, pursuant to Section 440.15, F.S.
(26) "Send" means to transmit a document to
the party or parties intended to receive it, including by mail, hand delivery,
or electronic transmission.
"Service Co/TPA" means an entity, which has contracted with an insurer for the
purpose of providing all services necessary to adjust workers' compensation
claims on the insurer's behalf.
(28) "Service Co/TPA Code #" means the
internal audit number assigned by the Division to a service company, adjusting
company, managing general agent or third party administrator.