Florida Administrative Code › 60 - DEPARTMENT OF MANAGEMENT SERVICES › 60Q - Division of Administrative Hearings › Chapter 60Q-6 - RULES OF PROCEDURE FOR WORKERS' COMPENSATION ADJUDICATIONS › Section 60Q-6.123 - SETTLEMENTS UNDER SECTION 440.20(11), FLORIDA STATUTES

Current through Reg. 50, No. 138; July 16, 2024
(1) Settlements under Section
				 440.20(11)(a) or
				(b), F.S., involving unrepresented claimants.
(a) When a joint petition signed by the
				parties is filed pursuant to Section
				 440.20(11)(a) or
				(b), F.S., it shall be accompanied by:
1. The settlement stipulation executed by any
				attorneys of record and the employee or claimant;
2. A copy of any prior joint petition and
				order if indemnity benefits were previously settled, or, if unavailable, an
				affidavit from the claimant that indemnity was previously settled;
3. A summary or payout sheet indicating total
				indemnity and medical benefits previously paid, including impairment income
				benefits;
4. The employee's current
				work status and other sources of income, if not addressed in the joint
				stipulation;
5. A status statement
				from the OJCC or such other source as designated by the Deputy Chief Judge
				regarding any child support arrearage balance according to Department of
				Revenue records, and a status statement regarding any child support arrearage
				balance according to the Florida Clerks of the Circuit and County Courts, as to
				whether the claimant has or owes any child support arrearage and, if so, the
				amount thereof;
6. If the claimant
				is not a Florida resident, or was not a Florida resident on the date of
				accident, the judge may require the substantial equivalent of the status
				statements in subparagraph (1)(a)5. from the equivalent authorities in the
				state or county of residence at either the time of settlement or on the date of
				accident;
7. A sworn statement by
				the employee that all existing child support obligations have been disclosed in
				the joint petition;
8. A letter or
				statement in the settlement stipulation from counsel stating that the carrier
				will issue a check in the amount of the arrearage or such other amount to be
				approved by the judge and that the check will be sent to the Department of
				Revenue or the Florida Clerks of the Circuit and County Courts, Central
				Depository;
9. Any other documents
				in the possession of the parties or their attorneys, including any prior
				attorney's fee lien, that is material to the disposition of the
				settlement;
10. For settlements
				under Section  440.20(11)(a),
				F.S., the notice(s) of denial; and
11. For settlements under Section
				 440.20(11)(b),
				F.S., the required notice to the employer, a maximum medical improvement report
				establishing the date of overall physical maximum medical improvement and
				psychiatric maximum medical improvement if the latter applies, permanent
				impairment rating, information concerning the need for future medical care and
				an estimate of the cost of future medical care, or an explanation as to why an
				estimate cannot be reasonably obtained, and other essential medical
				information.