The Holiday Season Is Upon Us, And It Is Time To Perform Year-End Maintenance On Permanent Total Disability Cases

December 4, 2015 by Joe G. Durrett, Associate

Sometimes it is easy to neglect cases involving claimants who have been receiving permanent total disability benefits for long periods of time. The claims are placed on automatic pay status and forgotten. However, they should be evaluated at least on an annual basis. The worst-case scenario would be to discover benefits have been paid to a claimant who has been deceased for an extended period.

Many permanent total disability cases will need to be adjusted at year’s end to reflect the increase in supplemental payments for the following year. This would also be a good time to review the case for other issues as well.

If supplemental PTD benefits are being paid, most likely the year-end biweekly payment will include a partial payment at the previous year’s rate and partial payment at the increased rate for the new year. This is a fairly easy calculation, but neglecting to do so has resulted in many claimant’s attorney’s fees being owed. Many claimants’ attorneys make it a practice to review the payments made to their PTD clients following the new year changes.

The year-end supplemental calculation is made by determining the daily supplemental benefit at the previous year’s rate and multiplying this by the number of days during the biweekly period falling during the previous year. Then calculate the daily supplemental rate for the new year, and multiply this by the number of days during the biweekly period falling within the new year. The sum of the two amounts is the supplemental benefit owed to the claimant for the last biweekly payment of the year.

Florida Statute Section 440.15(1)(f)2.b. requires claimants to periodically report earnings of any nature and Social Security income to a carrier. Florida Administrative Code Rule 69L-3.021 provides the claimant must complete and return Forms DWC-14 and DWC-19 within 21 days of receipt. The DWC-14 may be submitted to the claimant annually and the DWC-19 monthly. If neither of these forms has been submitted to a claimant within a year, they should be at year’s end. Upon receipt, the DWC-19 should be analyzed for outside earnings and self-employment. The Social Security amounts paid to the claimant as well as their beneficiaries should be compared to previous years DWC-19 forms for significant changes. The claimant-completed DWC 14 form should be submitted to the Social Security Administration, and when returned, evaluated for application or current correctness of a Social Security offset.

For dates of injury on or after July 1, 1990, entitlement to supplemental benefits ends at 62 if the claimant was found to be PTD before this age. (The Burger King Corporation/Cigna v. Moreno 689 So.2d 288 (Fla. 1st DCA 288) decision, subsequent cases, and statutory changes are beyond the scope of this article). Furthermore, any Social Security offset will terminate at age 62. When performing the year- end maintenance, the claimant’s age should be determined. If the claimant is approaching age 62, this should be noted on the calendar so as to discontinue the supplemental benefit and offset at age 62.

If a Grice offset is being taken, the Social Security disability benefit should be excluded from the calculation at age 62 as well.

  Joe G. Durrett, Associate
  (850) 222-8121