Florida Administrative Code

(1) Effective March 1, 2002, every insurer authorized to insure employers in the State of Florida, except for individual self-insurers approved under Section 440.38, F.S., shall file policy information electronically to the Division rather than by filing on paper forms previously…

(1) In order to send Proof of Coverage data electronically to the Division, the insurer or third party vendor shall complete the testing requirements set forth in Section 1 of the Florida Division of Workers' Compensation Proof of Coverage Electronic Data Interchange (EDI) Implem…

(1) Except for cancellation for nonpayment of premium or failure to pay deductible, or cancellation or non-renewal at the request of the insured, an insurer shall not cancel or non-renew any workers' compensation insurance policy, contract of insurance, or renewal until at least …

For any workers' compensation insurance policy, contract of insurance or renewal written for an employee leasing company or clients of an employee leasing company, with a policy effective date on or after October 1, 2009, the insurer shall electronically file any workers' compens…

Pursuant to Section 440.593(1), F.S., the Division may establish different deadlines for filing required reports electronically than are otherwise required when reporting information by other means. Accordingly, notwithstanding the deadlines for filing policy information by other…

(1)(a) On or before the implementation schedules set out in paragraphs (3)(a) and (b) of this section, every insurer shall file claims information for all "Lost Time/Indemnity," "Medical Only to Lost Time," and "Denied" cases via electronic data interchange (EDI) pursuant to para…

On or before the compliance date established in the insurer's Primary Implementation Schedule set forth in paragraph 69L-56.300(3)(a), F.A.C., the insurer shall file the electronic form equivalent for claims information otherwise reported on Form DFS-F2-DWC-1 adopted in Rules 69L…

(FROI/SROI MTC 04, SROI MTC PD as found in the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer & Acknowledgement Detail Records, Release 3, January 1, 2009 Edition). On or before the compliance date established in the insurer's Primary Implementation Sc…

(SROI MTC SA, FN as found in the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer & Acknowledgement Detail Records, Release 3, January 1, 2009 Edition). On or before the compliance date established in the insurer's Primary Implementation Schedule set for…

(FROI/SROI MTC 02, FROI MTC AQ, AU, SROI IP, PY, EP as found in the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer & Acknowledgement Detail Records, Release 3, January 1, 2009 Edition). (1) Electronic Notice of Action or Change (MTC 02). On or before t…

(SROI MTC 02, CA, CB, AB, S1-S8, P7, RB, ER as found in the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer & Acknowledgement Detail Records, Release 3, January 1, 2009 Edition.) (1) Electronic Notice of Action or Change (SROI MTC 02). On or before the …

(FROI MTC 01 as found in the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer and Acknowledgement Detail Records, Release 3, January 1, 2009 Edition.) (1) The claim administrator shall send FROI MTC 01 (Cancel) immediately upon the claim administrator's …

(1) Insurers shall send Claims EDI Filings required in Rules 69L-56.301, 69L-56.3012, 69L-56.3013, 69L-56.304, 69L-56.3045, 69L-56.307 and 69L-56.330, F.A.C., to the Division using only the following transmission methods: (a) Advantis Value Added Network (VAN); or (b) Secure Sock…

(1) Prior to sending an initial test transmission, the claim administrator shall file the EDI Trading Partner forms required in subsection 69L-56.300(2), F.A.C. If a form is incomplete and does not contain responses to all of the required fields in accordance with the form instru…

Rulemaking Authority 440.591, 440.593 FS. Law Implemented 440.593 FS. History-New 5-29-05, Amended 1-7-07, Repealed 5-17-09.

(1) An employer shall record all industrial injuries and diseases as follows: (a) For a first aid case that is not required to be reported to the claim administrator, the employer shall maintain a record of the following information regarding the injury or illness: 1. The employe…

(1) A claim administrator shall record all industrial injuries and diseases as follows: (a) Upon receipt of a Form DFS-F2-DWC-1, as adopted in Rule 69L-3.025, F.A.C., the claim administrator shall legibly date stamp the form in the "Received by Claims-handling Entity" box. Upon n…

(1) If the claim administrator denies entitlement to any benefit, or subsequently rescinds that denial, it shall send a copy of Form DFS-F2-DWC-12, as adopted in Rule 69L-3.025, F.A.C., to the employee, employer and any additional party requesting payment or authorization. The Fo…

(1) The claim administrator shall send Form DFS-F2-DWC-13, as adopted in Rule 69L-3.025, F.A.C., to the Division for the following cases: (a) Lost time cases as defined in subsection 69L-3.002(19), F.A.C., which include lost time cases in which no indemnity benefits have been pai…

Forms DFS-F2-DWC-1, DFS-F2-DWC-4, DFS-F2-DWC-12 and DFS-F2-DWC-13, as incorporated in Rule 69L-3.025, F.A.C., shall be reported to the Division using Electronic Data Interchange (EDI). Requirements for EDI reporting are located in Rules 69L-56.301, 69L-56.304, 69L-56.3045, 69L-56…

The claim administrator shall send Form DFS-F2-DWC-4, as adopted in Rule 69L-3.025, F.A.C., to the Division as specified in this section for any industrial accident or injury filed for lost time cases as defined in subsection 69L-56.4011(2), F.A.C., within 14 days of the claim ad…

If an insurer contracts with a claim administrator or third party vendor to electronically send transactions to the Division on the insurer's behalf, or uses a claim administrator or third party vendor's software product for electronically sending transactions to the Division, th…

(1)(a) Upon issuance of an insurance policy or certificate of membership in a self-insurance fund or a renewal certificate thereof, the insurer or self-insurance servicing agent shall electronically send the compensation notice to the employer or furnish the employer with a suffi…

Rulemaking Authority 440.05(9), 440.591 FS. Law Implemented 440.05 FS. History-New 11-20-79, Amended 4-15-81, 1-2-86, Formerly 38F-6.09, Amended 5-28-91, 2-15-94, 2-2-00, 3-5-02, Formerly 38F-6.009, 4L-6.009, Amended 2-19-07, 1-7-08, 12-31-08, Repealed 9-4-13.

(1) Only corporate officers of non-dissolved or active corporations who meet the conditions for the issuance of valid Form DFS-F4-DWC-252, https://www.flrules.org/Gateway/reference.asp?No=Ref-15433 Certificate of Election to be Exempt from Florida Workers' Compensation Law, revis…

(1) Employers must at all times maintain the records required by this rule and must produce the records when requested by the division pursuant to Section 440.107, F.S. (2) Identity, organizational, and occupational records. Every employer shall maintain the notice that assigns t…

(1) An employer who fails to secure compensation as required by Sections 440.10(1) and 440.38(1), F.S., for each employee classified by the employer as an independent contractor but who does not meet the criteria of an independent contractor specified in Section 440.02, F.S., sha…

(1) Every employer who is required to provide workers' compensation coverage for employees engaged in work in this state shall obtain a Florida policy or endorsement for such employees that utilizes Florida class codes, rates, rules and manuals that are in compliance with and app…

(1) The Division adopts the classification codes and descriptions that are specified in the Florida Contracting Classification Premium Adjustment Program, and published in the Florida exception pages of the National Council on Compensation Insurance, Inc. (NCCI), Basic Manual (20…

Rulemaking Authority 440.185(10), 440.591 FS. Law Implemented 440.125, 440.185(11) FS. History-New 3-27-03, Formerly 4L-6.022, Repealed 2-15-16.

Under Section 440.05(14), F.S., an officer of a corporation who elects to be exempt from Chapter 440, F.S., may not recover benefits or compensation under Chapter 440, F.S., and a carrier may not consider any officer of a corporation who holds a valid certificate of election to b…

(1) The requirements for issuance of a Form DFS-F4-1602 http://www.flrules.org/Gateway/reference.asp?No=Ref-15437, Agreed Order of Conditional Release from Stop-Work Order, revised 01/23, and incorporated by reference herein, as provided for in Section 440.107, F.S., are as follo…

Rulemaking Authority 440.107(7)(a), 440,591 FS. Law Implemented 440.107 FS. History-New 9-15-10, Repealed 11-26-14.

(1) For purposes of calculating penalties to be assessed against employers pursuant to Section 440.107, F.S., the Division shall use Form DFS-F4-1595, https://www.flrules.org/Gateway/reference.asp?No=Ref-15434, Penalty Calculation Worksheet, revised 01/23, which is hereby incorpo…

(1) In the event an employer fails to provide business records sufficient for the Department to determine the employer's payroll for the time period requested in the business records request for the calculation of the penalty pursuant to Section 440.107(7)(e), F.S., the Departmen…

(1) "Worksite" for purposes of this rule means a place in Florida where an employer conducts business operations. (2) Upon service of a Stop-Work Order on an employer, the Stop-Work Order shall be effective upon all employer worksites in the state for which the employer is not in…

(1) When an investigation commenced by the Department pursuant to Section 440.107, F.S., reflects that, on the date the investigation commences, the employer is failing to secure the payment of workers' compensation, is materially understating or concealing payroll, is materially…

(1) Under Section 440.107(7)(b), F.S., Stop-Work Orders or Orders of Penalty Assessment issued against a corporation, limited liability company, partnership, or sole proprietorship shall be in effect against any successor corporation or business entity that has one or more of the…

(1) In order for a contractor who is not securing the payment of compensation pursuant to Section 440.38(1)(a), F.S., to satisfy its obligation to obtain evidence of workers' compensation insurance or a Certificate of Election to Be Exempt from a subcontractor pursuant to Section…

(1) For purposes of determining payroll for calculating a penalty pursuant to Section 440.107(7)(d)1., F.S., the Department must when applicable, include the following as remuneration to employees based upon evidence received in its investigation: (a) Wages or salaries paid to em…

(1) Pursuant to Section 440.107, F.S., the Division will reduce the final assessed penalty by 15% if: (a) The employer has not been previously issued a Stop-Work Order or Order of Penalty Assessment; and (b) The employer takes an online workers' compensation coverage and complian…

(1) The Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2024 Edition (HCP RM), is incorporated by reference as part of this rule. The HCP RM establishes reimbursement policies, guidelines, and procedures for services provided by health care providers. Als…

(1) The Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASC RM), 2020 Edition, effective 07/23 is incorporated herein by reference. The policy, procedures, principles, and standards in the ASC RM supplement the requirements and responsibilities…

(1) The Florida Workers' Compensation Reimbursement Manual for Hospitals, (Hospital RM), 2020 Edition, effective 06/23, is incorporated herein by reference The policy, procedures, principles and standards in the Hospital RM supplement the requirements and responsibilities establi…

Health care providers and health care facilities shall upon demand furnish an injured employee or his attorney a copy of his office chart, records and reports. The health care provider or health care facility furnishing the records may charge the employee for copying the records …

Rulemaking Authority 440.13(4), 440.15(3)(b), (d), (f), 440.185(5), 440.20(6)(b), 440.525(2), 440.591, 440.593(5) FS. Law Implemented 440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (14), (16), 440.15(3)(b), (d), (f), (5), 440.185(5), (9), 440.20(6), 440.525(2), 440.593 FS. Hist…

(1) Determination of Physical Impairment Rating. The American Medical Association's Guide to the Evaluation of Permanent Impairment, 3rd Edition, (AMA Guide) (Copyright 1988 by the American Medical Association) is adopted as the schedule for determining the existence and degree o…