1. Average Weekly Temporary Total Disability Benefit: means the weekly average of all benefits paid

2. Carrier: includes employers, self-insured funds, individual, insurer, company, association, organization, and society.

3. Carrier Code #: means the internal audit number which the Division assigns each individual insurance carrier, self-insured employer, or self-insured fund upon receipt of notification to write or administer workers’ compensation insurance in Florida.

4. Carrier File #: means the internal identification number assigned to a file by a carrier.

5. Carrier Name, Address and Telephone: means the name, mailing address and telephone number of the carrier with responsibility for handling the claim

6. Compensation Rate: means 662/3 percent of the employee’s average weekly wage

7. Date Prepared: means the date the form was prepared by the adjuster

8. Division: means the Division of Workers’ Compensation

9. Document: means any form, report or electronic data submission

10. File or filed: means a document has been received by the party to whom it was sent.

11. 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.

12. First Aid Case: means a work injury or illness, which is treated at the work place

13. Fraud Statement: means the notice which must be included on all claims forms

14. 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.

15. Lost Time Case: means a work injury or illness which has caused the employee to be out of work for more than seven days

16. Medical Only Case: means a work-related injury, which requires treatment

17. Payment Period for Supplemental Income Benefits: means the period of 3 consecutive calendar months immediately following the filing period

18. Impairment Rating: means the rating on which the carrier will base its determinations concerning the employee’s indemnity benefits.

19. PI: means permanent impairment benefits for dates of accident

20. PT: means permanent total disability benefits.

(1) The carrier/employer shall ensure that all parts of all documents filed with the Division pursuant to this section are complete and legible.

(2) Carriers or employers shall respond to any written request for information by the Division no later than 14 days after receiving the request.

(3) The carrier, where required, shall include on every document it submits to the Division the following information:

(a) The employee’s name.

(b) The employee’s social security number.

(c) The month, date and year of the employee’s accident, (month/day/year).

The carrier shall supply to employees LES Form DWC-40, Statement of Quarterly Earnings for Supplemental Income Benefits for Supplemental Income Benefits for dates of accident and LES Form DWC-3, Request for Wage Loss/Temporary Partial Benefits.

Notice of Denial -

(1) Whenever the carrier disputes the employee’s entitlement to benefits, it shall complete LES Form DWC-12

(2) If the carrier initially denies the compensation of or coverage for a lost time case, it shall send LES Form DWC-12 to the Division within 14 days after the carrier receives notice of the injury or death.

The carrier shall complete LES Form DWC-13 for all dates of accident, and shall include the following information:

(a) The type of reports being sent.

(b) The exact average weekly wage and compensation rate as of the date the report is sent, in dollars and cents.

(c) The “salary end date” for employees who receive salary in lieu of compensation for any period after the date of accident.

(d) The number of weeks and days for which a particular indemnity benefit was paid

(e) The exact cumulative total amount, in dollars and cents, of all benefits paid up to the date the form is sent.

WAGE LOSS BENEFITS FOR TEMPORARY PARTIAL DISABILITY

(1) Employee’s Responsibility: During any two-week period in which wage loss for temporary partial disability is suffered, the employee shall file a DWC-3, Request for Wage/Loss/Temporary Partial Benefits, with the carrier within 14 days.

(2) Carrier’s Responsibilities: Within five (5) working days of its first knowledge of the date of temporary partial disability, the carrier shall mail to the employee an informational letter, which explains the employee’s eligibility for temporary partial wage loss benefits, together with at least four (4) copies of the DWC-3, Request for Wage/Temporary Partial Benefits.

To show that the employee has made a genuine effort to obtain employment, they must list the dates, names addresses, type of work, person contacted and the telephone number of the places of employment that they have contacted on the reverse side of the REQUEST FOR WAGE LOSS/TEMPORARY PARTIAL BENEFITS form.

Please note that the Florida Workers’ Compensation Law allows the employer to evaluate the employee’s efforts to obtain gainful employment beginning with the 13^th week after they have received the first payment of a temporary partial wage loss benefit. If it can be shown that there are actual job openings within their geographical area and which are within their physical and vocational capabilities, the amount of earnings they could have earned at those jobs can be deducted from their benefit payment.

TEMPORARY DISABILITY BENEFITS

(1) Temporary disability benefits include temporary total and temporary partial disability benefits and are payable for a maximum of 104 weeks. An employee’s eligibility for temporary disability benefits ceases after the employee has received 104 weeks of temporary total disability paid.

(a) An employee is eligible for temporary partial disability benefits if the employee has received a medical release to return to work, is unable to earn at least 80% of the employee’s pre-injury average weekly wage, has not reached maximum medical improvement, and has not received payment for 104 weeks of temporary total or temporary partial benefits or any combination of the aforementioned benefits

(2) 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 return to work. In order for the carrier to more readily make the weekly wage comparison, the first week of temporary partial disability benefits may be paid as a partial week, so that remaining weeks can coincide with the employee’s actual lost-injury paid periods. The carrier’s payment of temporary partial disability benefits for any BI-weekly period is due no later than the last date of that BI-weekly period.

(3) Temporary partial disability benefits shall be calculated by the 80%-80% formula.

SUPPLEMENTAL INCOME BENEFITS

An employee may be eligible to receive Supplemental Income Benefits if an impairment rating of 20 percent or more has been assigned.

(1) Definitions: The following words and terms when used in this rule shall have the following meanings:

(a) “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 benefits.

(b) “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.

(c) “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 three 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.

Supplemental income benefits may not be offset by Social Security or unemployment compensation benefits received by the employee.

“Because your doctor found that you have a permanent impairment of 20% or more due to your work injury, you may be eligible to receive additional worker’s compensation benefits, known as SUPPLEMENTAL INCOME BENEFITS. However, you must also meet the requirements below in order to receive payment for these benefits:

1. You must be unable to earn at least 80% of what you earned before your injury for at least 90 days in a row, and

2. You must try in good faith to find a job that you are able to do and cooperate with any reemployment help offered by the employer, carrier or the Division of Worker’s Compensation.

As an employee, you have many rights that protect you during your time at the salon/workplace. Please take the time to get to know your rights and responsibilities.