Florida Administrative Code

(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 History-New 11-28-06, Formerly 59A-31.009, Repealed 8-2-21.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 History-New 11-28-06, Formerly 59A-31.010, Repealed 8-2-21.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 History-New 11-28-06, Formerly 59A-31.011, Repealed 8-2-21.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 History-New 11-28-06, Formerly 59A-31.012, Repealed 8-2-21.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 History-New 11-28-06, Formerly 59A-31.014, Repealed 8-2-21.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 History-New 11-28-06, Formerly 59A-31.015, Repealed 5-22-14.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…

(1) The Division is authorized to conduct an investigation of an alleged violation based upon any of the following results: (a) An audit of medical bill data filed with the Division; or (b) The receipt of a completed Referral Form, DFS-F6-DWC-2000 http://www.flrules.org/Gateway/r…

(1) A Carrier shall not submit a Referral Form, DFS-F6-DWC-2000 http://www.flrules.org/Gateway/reference.asp?No=Ref-00278 (Effective: August 2011), to the Division to report an alleged violation related to: (a) A reimbursement dispute pending a Determination, pursuant to Section …

(1) Form DFS-F7-DWC-2133, Carrier and Self-Insurance Fund Quarterly Premium Report, Premium Documentation Spreadsheet, Carrier Profile and Instructions (Eff. 2/2014), is hereby incorporated by reference and required for use by all carriers and self-insurance funds for quarterly r…

(1) For purposes of its quarterly WCATF assessments under this rule, a carrier or self-insurance fund may offset from its total of premiums collected during the quarter all amounts actually paid or credited to policyholders for dividends and returned premiums during the quarter r…

69L-5.102 General Requirements (Repealed) 69L-5.103 Application (Repealed) 69L-5.104 Alternate Method of Application (Repealed) 69L-5.105 General Requirements (Repealed) 69L-5.106 Financial Statement or Financial Summary (Repealed) 69L-5.107 Actuarial Reports (Repealed) 69L-5.108…

Rulemaking Authority 440.38(2)(b), 440.591 FS. Law Implemented 440.38(6) FS. History-New 5-19-97, Formerly 38F-5.102, 4L-5.102, Amended 3-8-06, 10-29-06, Repealed 3-9-10.

Rulemaking Authority 440.38(2)(b), 440.591 FS. Law Implemented 440.38(1)(b) FS. History-New 5-19-97, Formerly 38F-5.103, 4L-5.103, Amended 3-8-06, Repealed 3-9-10.

Rulemaking Authority 440.591, 440.38(2)(b) FS. Law Implemented 440.38(1)(b), (2)(b) FS. History-New 10-1-82, Amended 12-25-84, Formerly 38F-5.44, Amended 2-3-88, 6-12-91, 12-19-93, 5-14-96, Formerly 38F-5.044, Amended 5-19-97, Formerly 38F-5.104, 4L-5.104, Repealed 3-9-10. RETENT…

Rulemaking Authority 440.38(1)(b), (2)(b) FS. Law Implemented 440.38(1)(b), (2)(b) FS. History-New 5-19-97, Formerly 38F-5.105, 4L-5.105, Repealed 3-9-10.

Rulemaking Authority 440.38(2)(b), 440.591 FS. Law Implemented 440.38(1)(b) FS. History-New 10-1-82, Formerly 38F-5.47, Amended 6-12-91, 12-19-93, 5-14-96, Formerly 38F-5.047, Amended 5-19-97, Formerly 38F-5.106, 4L-5.106, Amended 3-8-06, Repealed 3-9-10.

Rulemaking Authority 440.38(1), (2) FS. Law Implemented 440.38(1), (2) FS. History-New 5-19-97, Formerly 38F-5.107, 4L-5.107, Repealed 3-9-10.

Rulemaking Authority 440.38(1)(b) FS. Law Implemented 440.38(1)(b) FS. History-New 5-19-97, Formerly 38F-5.108, 4L-5.108, Repealed 3-9-10.

Rulemaking Authority 440.38(1)(b) FS. Law Implemented 440.38(1)(b) FS. History-New 10-1-82, Formerly 38F-5.36, Amended 2-3-88, 12-19-93, Formerly 38F-5.036, Amended 5-19-97, Formerly 38F-5.109, 4L-5.109, Repealed 3-9-10.

Rulemaking Authority 440.38(1)(b), (2)(b), (3), 440.385 FS. Law Implemented 440.38(1)(b), (2)(b), (3), 440.385 FS. History-New 5-19-97, Formerly 38F-5.110, 4L-5.110, Repealed 3-9-10.

Rulemaking Authority 440.38(1)(b), (2)(b), 440.51(6)(b), 440.5705 FS. Law Implemented 440.38(1)(b), (2)(b), 440.51, 440.102, 624.24 FS. History-New 10-1-82, Formerly 38F-5.38, Amended 12-19-93, Formerly 38F-5.038, Amended 5-19-97, Formerly 38F-5.111, 4L-5.111, Repealed 3-9-10. SE…

Rulemaking Authority 440.38(1)(b), (2), (4)(b), 440.49(1)(a), 440.56(4) FS. Law Implemented 440.20(16), 440.38(1)(b), (2), 440.49(1)(a), 440.56(4) FS. History-New 10-1-82, Formerly 38F-5.31, Amended 12-19-93, Formerly 38F-5.031, Amended 5-19-97, Formerly 38F-5.112, 4L-5.112, Repe…

Rulemaking Authority 440.38(1)(b), (2), (4)(b), 440.56(4) FS. Law Implemented 440.38(1)(b), (2), (4)(b), 440.56(4) FS. History-New 10-1-82, Amended 12-25-84, Formerly 38F-5.40, Amended 12-19-93, Formerly 38F-5.040, Amended 5-19-97, Formerly 38F-5.113, 4L-5.113, Repealed 3-9-10.

Rulemaking Authority 440.591, 440.38(2)(a) FS. Law Implemented 440.20(16), 440.38(1)(b), (2)(a), (b), (4)(b) FS. History-New 10-1-82, Amended 12-25-84, Formerly 38F-5.41, Amended 6-12-91, 12-19-93, Formerly 38F-5.041, Amended 5-19-97, Formerly 38F-5.114, 4L-5.114, Repealed 3-9-10…

Rulemaking Authority 440.38(1)(b), (3)(b)5. FS. Law Implemented 440.38(2), (3) FS. History-New 10-1-82, Formerly 38F-5.42, Amended 12-19-93, Formerly 38F-5.042, Amended 5-19-97, Formerly 38F-5.115, 4L-5.115, Repealed 3-9-10. PAYROLL AND CLAIMS RECORDS

Rulemaking Authority 440.38(2)(b), 440.51(6)(b) FS. Law Implemented 440.20(16)(c), 440.38(1)(b), (2)(b) FS. History-New 10-1-82, Formerly 38F-5.51, Amended 12-19-93, Formerly 38F-5.051, Amended 5-19-97, Formerly 38F-5.116, 4L-5.116, Repealed 3-9-10. FORMS, MANUALS, AND INSTRUCTIO…

Rulemaking Authority 440.57, 440.5705, 440.591 FS. Law Implemented 440.381, 440.57, 440.5705, 624.316, 624.424 FS. History-New 5-19-97, Formerly 38F-5.117, 4L-5.117, Repealed 3-9-10. GENERAL REQUIREMENTS

When used in these rules, the following words or terms shall mean: (1) "Actuarial Report" - A report signed by a member of the American Academy of Actuaries providing an opinion of the appropriate present value of the self-insured reserves incurred in this state, using a four per…

(1) Approval of a self-insurance authorization in accordance with section 440.38, F.S., and these rules will be continuous unless and until revoked or voluntarily terminated. (2) The self-insurance authorization of a Current Self-Insurer is restricted to the authorization holder …

Self-Insurers shall report payroll data for all entities covered under the self-insurance authorization using Form DFS-F2-SI-5 (Self-Insurer Payroll Report), effective 08/09, as incorporated by reference. Failure to submit the required payroll reports, understatement or concealme…

(1) The payroll records of all Current Self-Insurers and Former Self-Insurers shall be open for inspection and audit by the Department, or its Authorized Representative, during regular business hours. Self-insurers are required to maintain payroll records that reflect a true and …

Current Self-Insurers and Former Self-Insurers shall submit loss data for all entities covered under the self-insurance authorization on Form DFS-F2-SI-17 (Unit Statistical Report), effective 08/09, as incorporated by reference, or the electronic equivalent provided by the Depart…

(1) All records supporting the submitted Form DFS-F2-SI-17 (Unit Statistical Report), effective 08/09, as previously incorporated by reference in Rule 69L-5.205, F.A.C., or its electronic equivalent shall be open for inspection and audit by the Department or its Authorized Repres…

(1) Current Self-Insurers and Former Self-Insurers, other than Governmental Entities, shall report their outstanding self-insured workers' compensation liabilities for all entities covered under the self-insurance authorization on Form DFS-F2-SI-20 (Report of Outstanding Workers'…

(1) All records supporting Form DFS-F2-SI-20, (Report of Outstanding Workers' Compensation Liabilities), effective 08/09, shall be open for inspection and audit by the Department, the Association, or their Authorized Representative, during regular business hours. Each self-insure…

Current Self-Insurers and Former Self-Insurers, other than Governmental Entities, shall submit their Financial Statements no later than 120 days after the end of their fiscal year. Failure to submit the required Financial Statements shall constitute good cause for revocation of t…

(1) Current Self-Insurers and Former Self-Insurers, other than Governmental Entities, that do not have Investment Grade Credit Ratings shall be required to submit Actuarial Reports within 120 days after the end of their fiscal year or within 90 days of the date requested by the D…

(1) Any Current Self-Insurer desiring to change its Anniversary Rating Date shall submit a request in writing. (a) Governmental Entities shall submit requests to the: Department of Financial Services Division of Workers' Compensation Bureau of Monitoring and Audit/Self-Insurance …

Current Self-Insurers and Former Self-Insurers shall provide written notification of changes in their contact information within thirty (30) days of the effective date of the change. Notification shall be submitted as follows: (1) Governmental Entities shall submit contact inform…

(1) Current Self-Insurers shall provide written notification of changes in the names and addresses, as well as changes in the structure, of the self-insurer, its affiliates and their wholly or majority owned subsidiaries, along with the Federal Employer Identification Number (FEI…

Affiliated Self-Insurers must execute a new Form DFS-F2-SI-11 (Indemnity Agreement), effective 08/09, as incorporated by reference, within thirty (30) days of changes in the affiliates included under the self-insurance authorization. Copies of this form are available at the Divis…

Notwithstanding any other provisions of these Rules to the contrary, if a parent company that directly or indirectly owns 100% of a Current Self-Insurer, Former Self-Insurer or applicant for self-insurance elects to execute Form DFS-F2-SI-10 (Parental Guaranty and Corporate Resol…

(1) It shall be the sole responsibility of Current Self-Insurers and Former Self-Insurers to provide for competent persons to service their self-insurance program in the areas of claims adjusting, safety engineering and loss control. This shall be done through either the use of t…

(1) Civil Penalties for Delinquent Reports - Failure to timely file legible and complete forms, reports or documents as required by Section 440.38(2)(b), F.S., or these rules, shall subject the party required to file such form, report, or document to assessment by the Department …