DI 52120.055: Florida Workers’ Compensation (WC)

changes
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~~Effective Dates: 08/02/2016 - Present~~
Effective Dates: 12/14/2017 - Present
BASIC (09-08)
DI 52120.055 Florida Workers’ Compensation (WC)
Florida is a reverse offset State with the exception of Impairment benefits which are offsettable. See DI 52120.055F in this section for Florida reverse offset procedures.
A. Types of Florida WC payments and payment provisions
1. Temporary Total (TT) and Temporary Partial (TP) Benefits
TT and TP benefits are limited to a maximum of 104 weeks. Payments are 66 2/3 percent of the worker’s average weekly wages subject to a State maximum.
2. Permanent Total (PT) Benefits
PT benefits pay 66 2/3 percent of the worker’s average weekly wages subject to the State maximum. Payments will be made for the duration of the disability or until the individual reaches age 75. For maximum rates see DI 52150.045
3. Permanent Partial (PP) Benefits
PP benefits will not pay more than 75 percent of the State maximum. The number of weeks for which payments will be made is determined based upon the impairment rating.
The individual will receive:
* 2 weeks for each percentage point of impairment from 1 percent through 10 percent.
* 3 weeks for each percentage point of impairment from 11 percent through 15 percent.
* 4 weeks for each percentage point of impairment from 16 percent through 20 percent.
* 6 weeks for each percentage point of impairment from 21 percent and up.
If the individual is earning pre-injury wages or more the benefit periods is reduced by 50 percent.
B. Lump Sum (LS) payments
1. Appeals of Initial WC award
Appeals must be filed within 30 days after the mailing of the copies of the award. Modification of a final compensation order can only be accomplished by two events:
* A “change in condition,” which is defined as a change in the wage earning capacity of the individual, or
* A “mistake in a determination of fact,” which is the absence of evidence to support a finding of fact. The mistake must be made by the deputy/industrial commissioner to qualify as a “mistake in a determination of fact”.
For additional information see DI 52150.065E Policy on Subsequent Addenda to Lump Sum Settlements
2. Award language
* “Accepted a Lesser Amount……”
Sometimes a clause is inserted into a Florida WC settlement stating the individual has accepted a lesser amount in consideration of the receipt of DIB and also stating SSA is precluded from offset. Such a clause is not binding on SSA. SSA is entitled to offset for months prior to the month of adjudication, according to Social Security Ruling 83-29c.
* “Representing Any and All……”
Most LS awards will contain close-out language such as "representing any and all temporary total, temporary partial, permanent impairment, wage loss, or permanent total disability compensation benefits under the Florida Workers' Compensation Act to which the employee might be entitled both now and in the future." This wording does not mean that all these benefit types are included in the award. The language is meant to close out all possible entitlement based on the same injury.
* “Washout”
Older Florida lump sum awards were known as ‘washout’ settlements and many of these were life expectancy cases. Washout just refers to the fact that the claim is closed after the lump sum settlement.
C. Cost-of-Living Adjustments (COLA)
Florida Workers’ Compensation does not provide for a traditional cost of living increase. However, individuals that are permanently and totally disabled are potentially eligible for a supplemental yearly increase of 3 percent. The increase is only payable for individuals under age 62 that are not subject to offset due to receipt of Social Security benefits. When the individual attains age 62, if they are eligible for Social Security benefits they lose entitlement to the supplemental benefits if the date of injury is on or after July 1, 1990. For injuries prior to July 1, 1990, the supplemental payments continue.
D. Attorney fees
Attorneys cannot charge fees more than:
* 20 percent of the first $5,000,
* 15 percent of the next $5,000,
* 10 percent on the additional amount received over the first 10 years, and
* 5 percent on the amount received after 10 years.
E. Retirement insurance benefit (RIB) considerations
Florida WC does not offset for the receipt of RIB. See DI 52120.055F in this section for information on reverse offset at age 62 and age 65.
F. Reverse offset
The following chart explains when to apply reverse offset for Florida cases. Additional information is included after the chart.
When to apply reverse offset
Type of WC Benefit
Apply Reverse Offset?
Permanent Total (PT)
Yes
Temporary Total (TT)
Yes
Permanent Impairment
No
Temporary Partial (TP)
Yes
1. Determine when to impose offset
Reverse Offset applies to periodic and lump sum (LS) awards. Since February, 1990, reverse offset has not applied to permanent impairment wage loss or impairment income benefits.
* Offset of initial DIB award
Social Security is responsible for imposing offset from the first possible month of offset up to, but not including, the month of adjudication.
NOTE: For this section the month of adjudication is determined as the date the adjudicator takes action on the “DECI” screen, EF101, or A101.
* Offset at age 62
SSA will reimpose offset effective with the month of age 62 attainment. Florida is responsible for the offset from the month of adjudication, up to and including, the month prior to the month of attainment of age 62. Refer to DI 52105.001 for applicable instructions when offset is being reimposed at age 62.
It is not necessary to develop for the exact date that Florida discontinues the offset. However, Florida law concerning age 62 attainment is different than SSA rules. Take efforts to obtain the amount paid in the month of age 62 attainment as this amount may vary from your expectations. The correct amount of WC to use for offset for the age 62 month is the total amount of WC paid for the full month, which includes the RJ WC paid that month.
* Offset at age 65
SSA will impose offset up to but not including the month of age 65 attainment before December 19, 2015. Effective December 19, 2015 or later, WC offset termination extends from age 65 to full retirement age (FRA). See 2015 amendment in DI 52101.005.
NOTE: For SSA purposes, an individual attains their age the day prior to their birthday.
* Appeal reverses DIB cessation
Offset does not apply for the retroactive period beginning with the DIB termination month.
* New period of DIB established
Offset applies for months prior to the month of adjudication of the new DIB award.
* Wage Loss (Permanent Impairment or Temporary Partial) and Impairment Income Benefits
Since February, 1990, reverse offset does not apply to permanent impairment wage loss or impairment income benefits.
NOTE: Most LS awards contain close-out language such as, “representing any and all temporary total, temporary partial, permanent impairment, wage loss, or permanent total disability compensation benefits under the Florida Workers' Compensation Act to which the employee might be entitled both now and in the future." This wording does not mean that all of these benefit types are included in the award. The language is meant to close out all possible entitlement based on the same injury.
Request proof of verification to resolve any questions about the type of benefit in an LS award in Florida. See DI 52145.001 – Verification/Proof of Workers’ Compensation/Public Disability Benefit (WC/PDB).
Permanent Impairment Wage Loss on or after 02/1990
Effective with any adjudicative decision on the individual's receipt of permanent impairment wage loss under section 440.15(3)(B) of Florida law made in or after 02/90:
* Reverse offset rules do not apply to wage loss or impairment benefits.
* Wage loss benefits are offsettable whether paid as periodic benefits or LS.
* Offset will not be removed.
* Consider a possible return to work as there is work involved by the individual.
NOTE: Offset will not be imposed on any case where the decision not to offset wage loss was made prior to 02/90.
Impairment Income Benefits
Effective with injuries occurring on or after 10/1/94, wage loss was replaced by impairment income benefits. They are subject to offset by SSA. The maximum number of weeks for these benefits is 401. A diary should be prepared for removal of offset when payments end.
Temporary Partial Wage Loss
Temporary partial wage loss under Florida law section 440.15(4) falls under “RJ”.
2. Determine reverse jurisdiction start and stop dates
* The reverse jurisdiction start date is the calendar month of the DIB claim adjudication.
* The reverse jurisdiction stop date, if applicable, is the month before the NH attains age 62.
See DI 52120.055F.3. in this section for systems inputs and DI 52120.055F.4. for initial claims instructions.
Example:
NH is awarded DIB with a date of entitlement of 02/2007. The claim is adjudicated 10/15/2007. SSA will offset the NH’s benefit from 02/2007 through 09/2007. SSA will pay the NH his or her full DIB PIA from 10/2007 and continuing. The reverse jurisdiction start date is 10/2007.
This same NH turns age 62 on 02/12/2008. SSA will impose offset again effective with 02/2008 and continuing. The reverse jurisdiction stop date is 01/2008.
3. Systems input for reverse jurisdiction start and stop dates
MCS and ICF will allow you to input reverse jurisdiction start and stop dates. Determine the start and stop dates per instructions above. If applicable, you can input a future stop date for age 62 attainment. If a stop date is entered, the system will automatically reimpose offset effective with the date entered.
CAUTION: Enter a stop date only if it is clear that offset should be reimposed. In many cases, development may be needed to determine the proper amount of offset at age 62.
4. Initial claims taking considerations
When processing a DIB claim involving Florida WC you will need to know the month of adjudication to accurately process the offset. DO NOT make an input for Non-Medical Completion (SPORT). You will need to wait until the claim is allowed so you can enter the correct offset information. Follow this procedure:
* Indicate on the WPCL screen that “Y” reverse jurisdiction is involved.
* Code the start date as 3 months from the filing date.
* Establish an issue on the DW01 for WC. Set the tickle date equal to the tickle set for your DDSDEC.
* If the Claim is allowed, change the start date on the WPCL screen to the month of adjudication, per note below. Complete and send a Form DFS-F2-DWC-14, Request for Social Security Benefit Information http://www.myfloridacfo.com/division/WC/pdf/DFS-F2–DWC-14.pdf .
NOTE: Remember, the month of adjudication is determined as the date the adjudicator takes action on the “DECI” screen, A101, or EF101.
5. Age 62 diaries
Diary 4 months prior to attainment of age 62 for development of:
* WC verification, to see if WC continues
* Proof of age, if not yet established
* Possible RIB election per DI 52150.030
6. Reimposition of offset at age 62 – DIB onset 03/01/81 or later and MOET 09/81 or later
To correctly impose offset at age 62 you must first determine if offset has been previously considered.
"Offset previously considered" includes situations where benefits are actually reduced due to offset, as well as situations where a high ACE or excludable expenses preclude benefit reduction. See DI 52150.020 for Offset Effective Dates and DI 52150.025 for WC/PDB Offset Ending Date.
The ACE and TFB are computed effective with the first month offset is considered. The ACE and TFB will only be changed if conditions in DI 52150.005 - Total Family Benefits - When TFB Can Be Changed or DI 52150.010 - Average Current Earnings - Changing the ACE) apply.
For complete instructions regarding reimposition of offset at age 62, see DI 52105.001.
* Offset previously considered prior to the reverse offset
If offset was previously considered for at least one month before the first reverse offset month, SSA benefit increases (due to recomputations, COLAs, and the combining of maximums) during the reverse offset period are protected.
* Reverse offset start date is equal to the DIB MOET
If reverse offset is effective with the DIB MOET (i.e., offset is first considered at age 62), SSA benefit increases during the reverse offset period are not protected. The month of age 62 attainment is the first possible month of offset and the TFB and ACE are computed effective as of that month.
* New WC award begins during period of reverse offset
The situation may arise where payments from the first WC award end during the period of reverse offset. If the individual then becomes entitled to additional WC payments based on a new WC award (due to a different injury/illness) during the period of reverse offset, the TFB and ACE are established as of the month of age 62 attainment, and prior SSA benefit increases are not protected.
Example 1:
Florida WC
February 2000 - DIB MOET
April 2000 - DIB adjudication date (therefore 04/00 is reverse offset effective date)
February and March 2000 (prior to adjudication) - offset imposed
April 2000 - reverse offset begins
June 2005 - individual attains age 62-offset re-imposed using original ACE & TFB Increases due 04/00 through 05/05 are protected
Example 2:
Florida WC
May 2000 - DIB MOET and DIB adjudication date (i.e., reverse offset begins May 2000 and applies for all months of DIB entitlement prior to age 62)
June 2005 - individual attains age 62 - first month offset is considered and imposed. The TFB is based on the June 2005 monthly benefit amount. None of the prior benefit increases during the reverse offset period are protected.
7. Form DFS-F2-DWC-14, Request for Social Security Disability Benefit Information
The State or the insurance carrier uses the Form DFS-F2-DWC-14, Request for Social Security Benefit Information http://www.myfloridacfo.com/Division/WC/pdf/DFS-F2–DWC-14.pdf to request DIB payment data.
When the FO receives the Form DFS-FS-DWC-14:
* Complete and return to the requestor shown in Part IV.
* Fax a copy to NDRed or eView for documentation.
If the DIB claim is pending, the field office (FO) will:
* Complete the DWC-14 when the DIB decision is made.
* Fax a copy to NDRed or eView.
* Return the DFS-F2-DWC-14 to the requestor shown in Part IV.
G. Verifying WC
~~The State of Florida does not require a PIN/Password to access their Workers' Compensation Claims Database.~~
~~To access the Florida WC site for limited information go to the Workers’ Compensation Claims Database and:~~
* Double click on "ENTER CLAIMS DATABASE."
* Enter the information requested (Individual last name, first name, SSN, individual city)
* Submit query on the "Claims Database Query Screen".
* Available information will be shown on the "Query Results Case File" screen.
* The “Query Results Case File” screen will show the name, address, and phone number of the insurance carrier.
* Call the listed carrier to obtain the WC payment history.
* Information available on the Florida Judicial Commission site can also be accessed without a password. Type all of the available information on the search page.
Effective July 2017, the State of Florida discontinued public access to its Workers’ Compensation Claims Database. A limited number of SSA personnel in the Atlanta Region have secure access to the database for the purpose of verifying WC claims information.
H. References
* Social Security Ruling 83-29c, Reduction of Benefits – Workmen’s Compensation Benefits Paid Under Florida Law
* Social Security Ruling 93-1, Workers’ Compensation Offset – Offset of Wage Loss Benefits - Florida
* PR 02505.011 – Worker’s Compensation Offset in Florida
* Florida Workers' Compensation site http://www.myfloridacfo.com/division/WC
* GN 00302.400 - Point at Which a Particular Age is Attained
* DI 52101.005 - Social Security Amendments with Worker’s Compensation/Public Disability Benefits (WC/PDB) Offset Provisions
* DI 52150.045 - Chart of States’ Maximum Workers’ Compensation (WC) Benefits
* DI 52150.060 - Prorating a WC/PDB Lump Sum Settlement
* DI 52150.030 - Considering the Retirement Insurance Benefit (RIB) Option
* DI 52150.050 - Excludable Expenses
* DI 52150.065 - Complex Lump Sum (LS) Settlement Provisions
* DI 52150.065A. - Life Expectancy Cases

POMS Reference

DI 52120.055: Florida Workers’ Compensation (WC)