Employee Earnings Reports Must Be Fully Completed

In the case of Glinski v. Pan American Bank, 36 Fla. Law Wkly. 2709, decided December 9, 2011, the Employer/Carrier is authorized to stop Claimant's checks when the Claimant does not complete each box in five sections of the Employee Earnings Report Form. When the injured worker fills out the Employee Earnings Report, he or she must mark five boxes on the form before the employee signs and dates and returns the form, otherwise it is neither valid nor acceptable. The Employer/Carrier does not have to pay anything if the Employee Earnings Report Form (DWC-19) is not signed with five boxes checked. It is a good idea for your attorney to look over the form to make sure it has been completed correctly. This is the form:

Florida Administrative Code Rule 69L-3.021(2) requires an employee to return a completed Earnings Report Form within twenty-one days after receipt from the Employer/Carrier. Therefore, the Claimant will lose his or her benefits if he or she does not complete the Employee Earnings Report Form correctly. Sections (3) and (4) of the Code state:

(3) If the employee refuses to report information requested in accordance with subsection (1) or (2) above 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.

(4) For dates of accident on or after October 1, 2003, upon the request of the claims-handling entity, any 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 claims-handling entity may 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.