Identification Number:
DI 52120 TN 16
Intended Audience:See Transmittal Sheet
Originating Office:OISP
Title:State Specific Workers Compensation (WC) Procedures
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 521 – Workers' Compensation/Public Disability Benefit (WC/PDB) Offset
Subchapter 20 – State Specific Workers' Compensation (WC) Procedures
Transmittal No. 16, 10/26/2018

Audience

PSC: BA, CA, DS, IES, PETE, RECONR, SCPS;
OCO-OEIO: BIES, BTE, CR, CTE, ERE, FCR, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BTE, CR, CST, CTE, CTE TE, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, OA, OS, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a minor update to FL WC POMS to include a reminder to check available online resources for WC payment information in DI 52140.020..

This is a Quick Action Transmittal (QAT). This revision does not change or introduce new policy or procedure.

Summary of Changes

DI 52120.055 Florida Workers’ Compensation (WC)

Subsection G.added 2nd paragraph.

DI 52120.055 Florida Workers’ Compensation (WC)

Florida is a reverse offset State with the exception of Impairment benefits, which are offsettable. For Florida’s reverse offset procedures, see DI 52120.055F in this section.

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 State 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; and

  • 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 period 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:

  1. a. 

    A “change in condition,” which is defined as a change in the wage earning capacity of the individual, or

  2. b. 

    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

The following examples are 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 closeout 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 closeout 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. For information on reverse offset at age 62 and age 65, see DI 52120.055F in this section.

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 re-impose 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 re-imposed 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 from 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 Verification/Proof of Workers’ Compensation/Public Disability Benefit (WC/PDB) in section DI 52145.001.

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:

  1. a. 

    Reverse offset rules do not apply to wage loss or impairment benefits;

  2. b. 

    Wage loss benefits are offsettable whether paid as periodic benefits or LS;

  3. c. 

    Offset will not be removed; and

  4. d. 

    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 February 1990.

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.

For systems inputs see DI 52120.055F.3. in this section and for initial claims instructions see DI 52120.055F.4. in this section.

Example:

NH is awarded DIB with a date of entitlement of February 2007. The claim is adjudicated October 15, 2007. SSA will offset the NH’s benefit from February 2007 through September 2007. SSA will pay the NH his or her full DIB PIA from October 2007 and continuing. The reverse jurisdiction start date is October 2007.

This same NH turns age 62 on February 12, 2008. SSA will impose offset again effective with February 2008 and continuing. The reverse jurisdiction stop date is January 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 re-impose offset effective with the date entered.

CAUTION: Enter a stop date only if it is clear that offset should be re-imposed. 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; and

  • 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; and

  • possible RIB election per DI 52150.030

6. Re-imposition of offset at age 62 – DIB onset March 01, 1981 or later and MOET September 1981 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. For Offset Effective Dates, see DI 52150.020 and for WC/PDB Offset Ending Date, see DI 52150.025.

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 re-imposition 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). Go to this website 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; and

  • 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; and

  • return the DFS-F2-DWC-14 to the requestor shown in Part IV.

G. Verifying WC

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.

Once you are certain the WC evidence is not already in file, check the Workers' Compensation (WC) Resource Page in DI 52140.020 since FL is a State that provides SSA with access to its online records. The value of online records can vary from State to State and some development may still be required. However, the sites available usually provide contact information for the employer, WC carrier or the WC attorney, which can jump-start the development process. Also included in the WC resource intranet site is a list of individuals in the PC with online access to those individual State records.

After attempting to develop proof of WC directly from the NH or their attorney per DI 52145.001F, Field Offices can verify FL WC by sending an e562 (Request for Assistance) to the FO servicing the Florida zip code for the NH’s employer at the time of the FL WC injury/claim. This information is found in the Modernized Claims System (MCS) on the “WPAD” screen, or in information or documentation provided by the NH or their attorney.

Processing Centers only may contact the Southeastern Program Service Center (SEPSC) to verify FL WC by sending an email to the mailbox to SEPSC’s Operations Support Branch (||SEPSC OSB). 

Detailed Florida WC claim documentation is available for access without a password at the website for Florida’s Office of the Judges of Compensation Claims. Type all of the available information on the case search page.

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

  • 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


DI 52120 TN 16 - State Specific Workers Compensation (WC) Procedures - 10/26/2018