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Florida Administrative Code (Last Updated: November 11, 2024) |
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69. Department of Financial Services |
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69L. Division of Workers' Compensation |
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69L-3. Workers' Compensation Claims |
1(1) Within 21 days after the employee receives a request from either the Division or the 17claim administrator 19for either Form DFS-F2-DWC-14, or Form DFS-F2-DWC-30, as adopted in Rule 3069L-3.025, 31F.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 64claim administrator66.
67(2) Upon request of the Division, employer, or 75claim administrator, 77any 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 10469L-3.025, 105F.A.C., within 21 days after receiving it to report all earnings of any nature, including all social security benefits. The Division, employer, or 128claim administrator 130may require the employee to send Form DFS-F2-DWC-19 no more than once a month.
144(3) If the employee refuses to report information requested in accordance with subsections (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.
201(4) For dates of accident on or after October 1, 2003, upon the request of the 217claim administrator, 219any 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 244claim administrator 246may 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.
297(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.
367(6) If the 370claim administrator 372changes the employee’s compensation rate based on any offset, the 382claim administrator 384shall send to the Division, along with the appropriate income source report, Form DFS-F2-DWC-4, as adopted in Rule 40269L-3.025, 403F.A.C., indicating the change in accordance with the provisions of Rule 41469L-3.0091, 415F.A.C.
416(7) If the employee’s benefits have been suspended due to the employee’s refusal to furnish a signed release, the 435claim administrator 437entity 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 46469L-3.0091, 465F.A.C.
466Rulemaking Authority 468440.15(1)(f)2.a., 469b., (2)(d), 471440.591 FS. 473Law Implemented 475440.15(1), 476(2), (4), 478440.185, 479440.20(3) FS. 481History–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.
