Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-3 - WORKERS' COMPENSATION CLAIMS › Section 69L-3.021 - Additional Income Source Reports

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Within 21 days after the employee receives a request from either the Division
				or the claim administrator 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 claim administrator.
(2) Upon request of the Division, employer,
				or claim administrator, 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 claim administrator 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) of
				this rule 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 claim administrator, 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 claim
				administrator 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 claim
				administrator changes the employee's compensation rate based on any offset, the
				claim administrator 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-56.404, F.A.C.
(7) If the employee's benefits have been
				suspended due to the employee's refusal to furnish a signed release, the claim
				administrator 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-56.404,
				F.A.C.
Rulemaking 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.
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, 6-30-14.