Florida Administrative Code

Rulemaking Authority 440.185(2), (5), (9), 440.19, 440.35, 449.591 FS. Law Implemented 440.185(2), (3), (5), 440.207(2), 440.35 FS. History-New 8-30-79, Amended 12-23-80, 11-5-81, 6-12-84, Formerly 38F-3.04, Amended 1-1-87, 4-11-90, 1-30-91, 11-8-94, Formerly 38F-3.004, 4L-3.004,…

Rulemaking Authority 440.14(5), 440.185(2), (5), (9), 440.20(3), 440.207(2), 440.51(8), (9), 440.591 FS. Law Implemented 440.12, 440.185(2), (5), (9), 440.20(2)(a), (6), 440.41 FS. History-New 4-11-90, Amended 1-30-91, 11-8-94, 12-5-96, Formerly 38F-3.0045, 4L-3.0045, Amended 1-1…

(1) Employer's responsibility: The employer shall report wage information to the claim administrator on Form DFS-F2-DWC-1a, as adopted in rule 69L-3.025, F.A.C., pursuant to section 440.14, F.S. The employer shall provide the claim administrator all required wage information with…

(1) An injured employee or any other party making a claim shall provide his or her personal signature attesting that they have reviewed, understand and acknowledge the fraud statement as specified in section 440.105(7), F.S. (2) A party who makes claims for services provided to t…

For purposes of determining the compensability of employment-related posttraumtic stress disorder for first responders and correctional officers, the following injuries qualify as grievous bodily harm of a nature that shocks the conscience: (1) Decapitation (full or partial), (2)…

Rulemaking Authority 440.185, 440.20(3), 440.591 FS. Law Implemented 440.15(3)(d)2., 440.185, 440.20, 440.207(2), 440.51(8), (9) FS. History- New 1-30-91, Amended 11-8-94, Formerly 38F-3.0091, 4L-3.0091, Amended 1-10-05, 6-30-14, Transferred to 69L-56.404.

Rulemaking Authority 440.185(5), 440.20(3), 440.591 FS. Law Implemented 440.12(2), 440.14, 440.192(8), 440.20(2), (4), (9), (15)(f), 440.207(2) FS. History-New 10-30-79, Amended 11-5-81, 5-30-82, 6-12-84, Formerly 38F-3.12, Amended 4-11-90, 1-30-91, 11-8-94, Formerly 38F-3.012, 4…

Rulemaking Authority 440.185, 440.591 FS. Law Implemented 440.185, 440.51(6) FS. History-New 10-30-79, Amended 11-5-81, Formerly 38F-3.16, Amended 4-11-90, 1-30-91, 11-8-94, Formerly 38F-3.016, 4L-3.016, Amended 1-10-05, 6-30-14, Transferred to 69L-56.4013.

For dates of injury occurring on or after 10/1/2003, if the claim administrator decides to apportion payment of a medical benefit pursuant to section 440.15(5), F.S., it shall send Form DFS-F2-DWC-12, Notice of Denial, or a letter to the employee explaining its apportionment deci…

Rulemaking Authority 440.15(3)(b), 440.185(4), (10), 440.41, 440.591 FS. Law Implemented 440.15(3), 440.185(4), 440.185(10) (1993) FS. History-New 10-30-79, Amended 11-5-81, 5-30-82, 6-12-84, Formerly 38F-3.18, Amended 4-11-90, 1-30-91, 11-8-94, 11-11-96, Formerly 38F-3.018, 4L-3…

Rulemaking Authority 440.15(4)(e), 440.185(4), (10), 440.41, 440.591 FS. Law Implemented 440.15(4)(b), 440.185(4), 440.185(10) (1993), 440.20 (1993) FS. History-New 10-30-79, Amended 11-5-81, Formerly 38F-3.19, Amended 4-11-90, 1-30-91, 11-8-94, 11-11-96, Formerly 38F-3.019, 4L-3…

Rulemaking Authority 440.15(2)(d), (4)(a), 440.185(4), (5), 440.20(3), 440.591 FS. Law Implemented 440.15(2), (4), 440.185(4), (5), 440.20(3) FS. History-New 11-8-94, Formerly 38F-3.0191, 4L-3.0191, Amended 1-10-05, 6-30-14, Repealed 10-28-15. 69L-3.0192 Impairment Income Benefit…

(1) Letter requirement - The claim administrator shall mail an informational letter to the employee and employer within 5 business days after the claim administrator's knowledge of the employee's release to restricted work. This letter shall explain the employee's eligibility for…

Rulemaking Authority 440.591 FS. Law Implemented 440.15(3) FS. History-New 11-8-94, Formerly 38F-3.0192, 4L-3.0192, Amended 1-10-05, 6-30-14, Repealed 10-28-15.

(1) The initial payment of impairment income benefits shall include payment for all full weeks of entitlement since the date of maximum medical improvement up to the time the initial payment is made. After the employee has reached maximum medical improvement, the claim administra…

Rulemaking Authority 440.15(3)(b)5., 440.591 FS. Law Implemented 440.15(3), 440.20(3), 440.491 FS. History-New 11-8-94, Formerly 38F-3.0193, 4L-3.0193, Amended 1-10-05, 6-30-14, Repealed 10-28-15.

(1)(a) Permanent total benefits paid for injuries occurring prior to July 1, 1955, shall not be made in excess of 700 weeks. Permanent total benefits paid for injuries occurring on or after July 1, 1955, shall continue during the continuance of the employee's entitlement. (b) Whe…

(1) Permanent total benefits paid for injuries occurring on or after October 1, 2003, shall cease at age 75. If it is determined that the injury prevented the employee from working sufficient quarters to be eligible for social security benefits under 42 U.S.C. Section 402 or 423,…

(1) Within 21 days after the employee receives a request from either the Division or the claim administrator for either Form DFS-F2-DWC-14, or Form DFS-F2-DWC-30, as adopted in rule 69L-3.025, F.A.C., the employee shall complete the form and return it to the party requesting the …

Rulemaking Authority 440.591 FS. Law Implemented 440.59 FS. History-New 11-8-94, Formerly 38F-3.0213, 4L-3.0213, Amended 1-10-05, Repealed by Section 11, Chapter 2012-34, Laws of Florida 7-1-12.

(1) The following forms are to be used with this rule chapter and are hereby incorporated by reference: (a) Form DFS-F2-DWC-1 3/16/09 First Report of Injury or Illness (b) Form IA-1 1/1/02 Workers' Compensation - First Report of Injury or Illness, © International Association of I…

For purposes of this rule the following definitions apply: (1) "Board certification" or "board certified" means the physician has been awarded board certification or diplomate status by one or more of the national specialty boards recognized by the State of Florida Department of …

(1) To be certified as an EMA, a physician shall meet the following qualifications: (a) Must have correctly answered 95% of the EMA Tutorial review questions; and, (b) Must hold valid licensure, issued by the Florida Department of Health, with "clear active" status; and, (c) Must…

(1) A physician shall apply for certification by satisfactorily completing the online EMA Tutorial, pursuant to subsection 69L-30.002(6), F.A.C. (2) As part of the EMA certification process, the physician shall agree to provide consultation or services in accordance with the time…

(1) All individuals on the Certification List are eligible to provide EMA services for the Department or a JCC. (2) When services are needed by the Department, the Department shall: (a) Select an EMA from the Certification List; and, (b) Make the necessary arrangements for the EM…

(1) A physician who has been disciplined for a violation pursuant to Section 440.13, F.S., shall not be certified as a Temporary EMA. (2) When the Department needs EMA services and there is no EMA on the Certification List who meets the needs of the Department or who is available…

(1) A physician shall disclose any conflict of interest upon receiving notice of selection as an EMA or Temporary EMA and shall not accept selection if a conflict of interest exists. For the purposes of this rule, "conflict of interest" means that any of the following matters may…

(1) Within 30 calendar days following submittal of the written report, the EMA must submit billing, per the contract with the Department or JCC, for services, documenting total number of hours and total dollar charges for the contracted services. (2) If additional diagnostic test…

(1) An EMA shall be decertified and removed from the Certification List for any one of the following: (a) Pursuant to a final order, the EMA was found to have engaged in certain violations, including a standard of care or billing violation, or overutilization, under Section 440.1…

The definitions that follow and those in Section 440.13(1), F.S., apply to capitalized terms used in this rule chapter: (1) "Notice of Disallowance or Adjustment" means an Explanation of Bill Review (EOBR) as defined by paragraph 69L-7.710(1)(y), F.A.C. (2) "Petitioner" means the…

(1) The Petition for Resolution of Reimbursement Dispute Form, DFS-F6-DWC-3160-0023, effective 07/2021, is incorporated by reference herein. This form may be obtained on the Department's website at https://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Forms/Def…

(1) The Carrier Response to Petition for Resolution of Reimbursement Dispute, Form DFS-F6-DWC-3160-0024, effective 07/2021, is incorporated by reference herein. This form may be obtained on the Department's website at https://www.myfloridacfo.com/Division/WC/PublicationsFormsManu…

(1) The Department will render a written determination on whether the Carrier properly adjusted or disallowed payment pursuant to Section 440.13(7)(c), F.S., by relying on the Petition Form, Response Form, and all supporting documentation submitted to the Department by the Petiti…

Rulemaking Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7)(e) FS. History-New 11-28-06, Formerly 59A-31.006, Repealed 8-2-21.

(1) The Petitioner must effectuate service on the Carrier and on all affected parties by serving a copy of the Petition Form, and all supporting documentation submitted to the Department, by United States Postal Service (USPS) certified mail on the specific entity identified on t…

(1)(a) The forty-five (45) day time period within which a Petition Form must be submitted to the Department begins upon receipt of the Notice of Disallowance or Adjustment by the Health Care Provider or by an entity designated by the Health Care Provider to receive such notice on…

Rulemaking Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7)(b) FS. History-New 11-28-06, Formerly 59A-31.009, Repealed 8-2-21.

Rulemaking Authority 440.13(7), 440.591 FS. Law Implemented 440.13(7)(b) FS. History-New 11-28-06, Formerly 59A-31.010, Repealed 8-2-21.

Rulemaking Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7)(c) FS. History-New 11-28-06, Formerly 59A-31.011, Repealed 8-2-21.

Rulemaking Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7) FS. History-New 11-28-06, Formerly 59A-31.012, Repealed 8-2-21.

(1) The Petitioner may voluntarily withdraw its Petition Form prior to the conclusion of a final hearing or the issuance of a final order, whichever occurs first, or participate in an informal disposition under Section 120.57(4), F.S. (2) The withdrawal must be in writing and mus…

Rulemaking Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7)(b), 440.13(7)(c) FS. History-New 11-28-06, Formerly 59A-31.014, Repealed 8-2-21.

Rulemaking Authority 440.13(7)(e), 440.134(25)(e), 440.591 FS. Law Implemented 440.13(7) FS. History-New 11-28-06, Formerly 59A-31.015, Repealed 5-22-14.

As used in this rule chapter: (1) "Carrier" is as defined in Section 440.13(1)(c), Florida Statutes ( F.S.). (2) "Division" means The Department of Financial Services Division of Workers' Compensation. (3) "Health Care Provider" (hereinafter referred to as "Provider") is as defin…

A Carrier shall have met the requirements to report to the Division, pursuant to Section 440.13(8), F.S., all instances of overutilization and improper billing and billing errors, including all instances in which the Carrier disallows or adjusts payment, by timely filing the requ…

(1) Any person who elects to submit a report of a violation, as defined in this rule chapter, directly to the Division's Office of Medical Services, shall use the Health Care Provider Violation Referral Form, DFS-F6-DWC-2000 http://www.flrules.org/Gateway/reference.asp?No=Ref-002…

(1) A properly completed Referral Form, DFS-F6-DWC-2000 http://www.flrules.org/Gateway/reference.asp?No=Ref-00278 (Effective: August 2011), filed with Supportive Documentation, must be received by the Division no later than 180 days after the issuance of an EOBR, as defined in Ru…