JIMMY PATRONIS FLORIDA’S CHIEF FINANCIAL OFFICER

WORKERS’ COMPENSATION

System Guide
Revised August 2023

Prepared by:

Division of Workers’ Compensation

Department of Financial Services

Connect with us:

www.MyFloridaCFO.com/Division/WC/
INTRODUCTION
T he Workers’ Compensation System Guide is
intended to give all parties a general overview and
summary of the Workers’ Compensation System. It is
Its purpose is to assist all stakeholders in their roles
and responsibilities. It provides general information
and references that may assist with resolving issues
not intended to supersede or take the place of the and answering questions.
Florida Workers’ Compensation law (Chapter 440,
Florida Statutes) or Florida Workers’ Compensation
Case Law.

NOTE: The maximum number of weekly benefits was impacted by Florida Supreme Court Case No. SC13-1930 & 1976; Westphal
v. City of St. Petersburg. The Division closely follows activities associated with 1st DCA and Supreme Court rulings that may
impact the workers’ compensation system. Therefore, the Division continues to monitor any forthcoming changes prior to
engaging in rulemaking activities or procedural changes related to these topics. We would like to assure all stakeholders that the
Division stands ready to provide whatever support is necessary to ensure a healthy and viable system.

Guide Topics Search guide

EMPLOYEE INFORMATION
Injured Worker Duties.................................................................................................................................................. 4
When you see the doctor ........................................................................................................................................... 5
After seeing the doctor ............................................................................................................................................... 5
Benefits you ma y receive ............................................................................................................................................ 5
If you ha ve a dispute with your ins urance company ......................................................................................... 6
Employee workers’ compensation criminal violations ...................................................................................... 7
How to get more information and help with your claim.................................................................................. 7

EMPLOYER INFORMATION
Employer Duties............................................................................................................................................................. 8
Employer Requirements .............................................................................................................................................. 8
Obtaining Required Coverage ................................................................................................................................ 10
Workers’ Compensation Exemption Eligibility Requirements and Informa tion...................................... 11
Division Enforcement Authority.............................................................................................................................. 13
Employer Workers’ Compensation Criminal Violations .................................................................................. 13
Compliance & Coverage Assistance May Be Obtained From ....................................................................... 14

HEALTH CARE PROVIDER INFORMATION

Provider Duties ............................................................................................................................................................. 15
Medical Bill Reimbursement Disputes .................................................................................................................. 17
Health Care Provider Criminal Violatio ns ............................................................................................................ 17

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INSURANCE COMPANY INFORMATION
Insurance Co mpany Duties ...................................................................................................................................... 18
Reporting Responsibilities of the Claims Handler ............................................................................................ 19
Special Disability Trust Fund .................................................................................................................................... 21
Assessments .................................................................................................................................................................. 21
Penalties That Can Be Assessed Against Insurance Companies................................................................... 21
Penalties and interest for late payment of compensation paid directly to the injured worker along
with the indemnity payment that was late.......................................................................................................... 22
Insurance Co mpanies Unla wful Action................................................................................................................. 23
Insurance Co mpanies Anti-Fraud Responsibilities ........................................................................................... 23

APPENDIX
Additio nal Resources ................................................................................................................................................. 25
Employee Sectio n........................................................................................................................................................ 25
Employer Section......................................................................................................................................................... 25
Health Care Provider Section .................................................................................................................................. 26
Insurance Co mpany Section .................................................................................................................................... 27

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EMPLOYEE INFORMATION
Injured Worker Duties
• After you or your employer report the injury to
the insurance company, many companies will
If you have an accident or are injured on have an insurance claim adjuster call you within

the job you must: 24 hours to explain your rights and obligations.

• Tell your employer you have been injured, as If you receive a message and a number to call,
soon as possible. The law requires that you you should call as soon as possible to find out
what you need to do to get medical treatment.
report the accident or your knowledge of a job-
related injury within 30 days of your knowledge
• Within 3-5 business days after you or your
of the accident or injury, or within 30 days of a
employer report the accident, you should receive
doctor determining you are suffering from a
an informational brochure explaining your rights
work-related injury.
and obligations, and a Notification Letter
• When you do so, you must ask your employer explaining the services provided by the
what doctor you can see. You must see a doctor Employee Assistance Office of the Division of
authorized by your employer or the insurance Workers’ Compensation. These forms may be
company. part of a packet which may include some or all
• Your employer may tell you to call the insurance of the following:
company handling your claim; the name and A copy of your accident report or “First Report
phone number should be on the “Broken Arm” of Injury or Illness,” which you should read to
poster that should be posted at your workplace. make sure it is correct;

• If it is an emergency and your employer is not A fraud statement, which you must read, sign
available to tell you where to go for treatment, and return as soon as possible, or benefits may
go to the nearest emergency room and let your be temporarily withheld until you do so;
employer know as soon as possible what has
A release of medical records for you to sign and
happened. return; and

Medical mileage reimbursement forms that you

should fill out, after seeking medical treatment,
Your employer is required by law to report and send to your claims adjuster for
your injury to the insurance company reimbursement.
within 7 days of when you report your
If you do not receive a call or the information
accident or injury. If they do not do this, ! packet from the insurance company, you can
and they do not give you a phone number
for the insurance company to call, you can call the WC hotline for assistance at 1-800-
call the workers’ compensation (WC) 342-1741.
hotline for assistance at 1-800-342-1741.

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 EMPLOYEES

When you see the doctor

work status, and whether your employer has
work available within your physical restrictions.
• Give the doctor a full description of the accident • You should continue to stay in contact with your
or how you were injured. employer and the insurance company
• Answer all questions the doctor might have throughout your treatment and recovery.
about any past or current medical conditions or
injuries. Benefits you may receive
• Discuss with the doctor if the injury is related to
work or not.
Money you may be entitled to:
• Indemnity Benefits: If you are unable to work for
• If related to work, find out if you can work or
more than 7 days, you should receive money to
not.
partly replace what you were not able to earn
If you are released to work but can’t return to after your accident.
your same job, you should get instructions from
the doctor on what work you can and cannot ! Note: Your weekly benefit can never exceed the
maximum compensation rate for the year in
do.
which your accident or illness occurred. For a
Keep and attend all appointments with your table of the maximum compensation rates visit
doctor, or benefits may be suspended. https://www.myfloridacfo.com/divisio n/wc/insu
rer/bma-rates

After seeing the doctor • Temporary total disability: If your doctor says
• Speak with your employer as soon as you leave you cannot work at all:
the doctor. Tell your employer how much your You should receive money equaling about 66
job means to you, and explain to them what 2/3% of your regular wages at the time you
work the doctor said you can and cannot do. were hurt. Your benefit is paid to you beginning
• If you are admitted to a hospital, call or have with the 8th day you lose time from work.
someone call your employer for you to explain
The first 7 days lost from work is only paid if
what happened and where you are.
you lose more than 21 days from work.
• Give your employer the doctor’s note as soon as
possible. If your injury is critical, you may receive 80% of

• Ask your employer if they have work for you to your regular wages for up to 6 months after the

return to that does not require you to do things accident.

the doctor said you cannot do yet.

You can receive up to a total of 104 weeks of
• If yes, ask when you should report for work. temporary total disability and/or temporary
• If not, make sure your employer has a way to partial disability benefits. **Please see note
contact you if appropriate work becomes regarding Supreme Court decisions.
available.
• Contact the insurance company and let them
know what the doctor said about your injuries,

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 EMPLOYEES

• Temporary partial disability: If you can return to Reemployment Services assistance you
work, but you cannot earn the same wages you may receive:
earned at the time you were hurt: If you are unable to return to your job because of
You will receive money equaling 80% of the permanent work restrictions resulting from your on-
difference between 80% of what you earned the-job injury, you may obtain information or
before your injury and what you are able to assistance from the Bureau of Employee Assistance
earn after your injury. and Ombudsman Office/Reemployment Services
Example: section at the following website, by phone or by e-
mail:
Your average weekly wage: $320
= $256
(Earnings before injury) x .80 • https://www.myfloridacfo.com/divisio n/wc/empl
Your weekly earning after injury: - $150 oyee/reemployment-services
Your actual lost wage: $106
• Telephone: (800) 342-1741 - option 4
$106 x .80 = $84.80
• Email: [email protected]
Weekly temp. partial disability benefit: $84.80
For assistance on how any of the above benefits are
You can receive up to a total of 104 weeks of calculated, call the WC hotline at 1-800-342-1741.
temporary total disability and/or temporary
partial disability. **Please see note regarding If you have a dispute with
your insurance company
Supreme Court decisions.

• Impairment benefits: Once your doctor says you

• First, try to talk about the problem with your
are at Maximum Medical Improvement, you are
adjuster or their supervisor.
as good as he or she expects you to get. At this
point your doctor should evaluate you for: • If you still need assistance, contact the WC
hotline at 1-800-342-1741.
Possible permanent work restrictions and,
A permanent impairment rating. If you receive a • If the insurance company still will not agree to
permanent impairment rating, you will receive pay the benefits that you believe you are
money based on that rating. entitled to, you can file a Petition for Benefits
with the Office of the Judges of Compensation
Medical treatment: Claims.
Your employer is responsible for providing medical You may wish to hire an attorney to represent
treatment. you in this action.

• Do not delay in getting a doctor’s appointment See Appendix A, a flow chart of the dispute
from your employer or insurance company. process.
• Do not go on your own to your private
doctor for treatment. The insurance company ! For assistance on how to fill out and file a
Petition for Benefits, call the WC hotline at
must authorize the doctor who is to treat you.
1-800-342-1741.
If you do not get a doctor’s name from the
insurance company, you should contact your
adjuster and ask for a doctor.

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Employee workers’ How to get more

compensation criminal information and help with
violations your claim
The following are criminal violations of s. 440.105, Division of Workers’ Compensation
F.S., that constitute a felony of the first, second or Employee Assistance and Ombudsman
third degree depending on the monetary value of Office:
the fraud as provided in s. 775.082, s. 775.083, or s. • The Employee Assistance and Ombudsman
775.084, F.S.: Office (EAO) will assist you at no cost with
questions or concerns you may have about your
• Filing a false claim of on-the-job injuries or
workers’ compensation claim.
exaggerating injuries.
• EAO works on your behalf to resolve issues with
• An injured worker or any party making a claim of
your workers’ compensation claim. Issues that
an on-the-job injury will be required to provide
cannot be resolved informally may require the
his or her personal signature attesting that he or
filing of a Petition for Benefits.
she has reviewed, understands, and
acknowledges the following statement: • EAO offices are located around the state to
"Any person who, knowingly and with intent to assist you.
injure, defraud, or deceive any employer or Website:
employee, insurance company, or self-insured https://www.myfloridacfo.com/divisio n/wc/emp
program, files a statement of claim containing loyee
any false or misleading information commits
https://www.myfloridacfo.com/divisio n/wc/emp
insurance fraud, punishable as provided in s.
817.234." loyee/eao/eao-offices

• If the injured worker or party refuses to sign the Phone (toll free): 1-800-342-1741
document, benefits or payments shall be
suspended until such signature is obtained. The Division of Workers’ Compensation
Website: www.myfloridacfo.com/Division/WC/
• For additional information click on “Information
and FAQs” on the left side of the Division’s
homepage.

! NOTE: See Appendix for additional website

information.

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 EMPLOYERS

EMPLOYER INFORMATION
Employer Duties Employer Requirements
If you see an accident on the job or Posting Requirement:
someone reports one: The “Broken Arm Poster” and the “Anti-Fraud
• Contact your insurance company right away. Notice” should be posted in a conspicuous place and
• Stay in contact with your employee and the should identify the name of the insurance company

adjuster until the injured worker is back on the providing coverage and where to call to report an
job. accident or injury. Contact your insurance company
to obtain the poster and the notice.
If the employee is released to work with
restrictions: Recording Requirement:
• Get the doctor’s list of restrictions from the Record all workplace injuries and retain the records
injured worker or directly from the doctor’s
for at least 2.5 years.
office, and
• Meet with the injured worker to see if work is Reporting Requirement:
available that he/she can do. • Report all job-related injuries to the insurance

• If restricted work is available: company within 7 days of discovery.

Discuss with the injured worker: • Provide a copy of the injury report to the injured
worker (Form DFS-F2-DWC-1).
• Starting time and date,
• What you can pay him/her based on new job • Report required wage information to the
duties, and insurance company within 14 days of learning of

Report the restricted work to the adjuster. an injury that will require the employee to miss
work for more than 7 days or that results in a
• Inform the adjuster:
permanent impairment.
• When the injured worker is scheduled to
• If requesting the employee's authorization for
return to restricted work.
release of social security benefit information,
• If the injured worker will not be earning what
give the Form DFS-F2-DWC-14 to the employee,
he/she earned before: submit the Request for Social Security Disability
Send the adjuster wage information on a Benefit Information to the Social Security
weekly or bi-weekly basis to determine if Administration office nearest to the employee's
temporary partial benefits are due. address, and send a copy of the completed form
• If the injured worker is unable to, due to to the Division within 14 days of the request
restrictions, continue working, or (Form DFS-F2-DWC-14).
• If you can’t give him/her restricted work any
longer, or

• If the doctor releases him/her to regular work

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 EMPLOYERS

Penalties for late filing of a claim that payment shall be the greater of the amount of
was due to the employers failure to interest due or $5.
timely notify the insurer If you as an employer receive a notice from the
If the First Report of Injury (DFS-F2-DWC-1) is filed Division about a late filing with a filing penalty due
late with the Division, due to the late reporting of to the Division and penalties and interest due to the
the accident by the employer to the insurance injured worker, you send the filing penalty payment
company, the employer may be penalized for the to the Division and the penalty & interest payment,
late filing, according to the following schedule: on the late indemnity payments, directly to the
injured worker.
• $100 for 1 through 7 days of untimely filing.
• $200 for 8 through 14 days of untimely filing. Workers’ Compensation Coverage /
• $300 for 15 through 21 days of untimely filing. Compliance Requirements For the
Employer
• $400 for 22 through 28 days of untimely filing.
Chapter 440, F.S., establishes workers’ compensation
• $500 for over 28 days of untimely filing.
coverage requirements for employers.
In addition to the above administrative penalty paid
to the Division, the employer may be liable for 1. Construction Industry: An employer in the
penalties and interest on the late payment of construction industry who employs one or more
compensation, due to the late filing. part- or full-time employees must obtain
workers’ compensation coverage. Sole
Penalties and interest for late payment proprietors, partners, and corporate officers are
of compensation paid directly to the considered employees. Members of a limited
injured worker along with indemnity liability company are considered corporate
payment that was late officers. Corporate officers may elect to exempt
1. If any installment of compensation for death or themselves from the coverage requirements of
dependency benefits, or compensation for Chapter 440.
disability benefits payable without an award is A construction industry contractor, who sub-
not paid within 7 days after it becomes due, contracts all or part of their work, must obtain
there shall be added to such unpaid installment proof of workers’ compensation coverage or a
a penalty of an amount equal to 20 percent of Certificate of Election to be Exempt from all sub-
the unpaid installment, which shall be paid at contractors, prior to work being done. If the sub-
the same time as, and in addition to, such contractor is not covered or exempt, for
installment of compensation. purposes of workers’ compensation coverage,
2. If any installment of compensation is not paid the sub-contractor’s employees shall become

when it becomes due, the employer, insurance the statutory employees of the contractor. The
company or servicing agent shall pay interest at contractor will be responsible to pay any
the rate of 12 percent per year from the date the workers’ compensation benefits to the sub-

installment becomes due until it is paid, whether contractor and its employees.
such installment is payable without an order or 2. Non-Construction Industry: An employer in
under the terms of an order. The interest the non-construction industry, who employs four
or more part- or full-time employees, must

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 EMPLOYERS

obtain workers’ compensation coverage. policy is permitted to work in Florida using the
Corporate officers are considered employees, workers’ compensation policy from their “home
unless they elect to exempt themselves from the state”, as long as the work is temporary in
coverage requirements of Chapter 440. Sole nature. Temporary is defined as no more than
proprietors and partners in the non-construction 10 consecutive days with a maximum of 25
industry are not considered to be employees total days in a calendar year. [For a list of the
unless they elect to be employees. Members of current jurisdictions who have an extraterritorial
a limited liability company will be considered as reciprocity statute, contact the Division of
corporate officers and employees, unless they Workers’ Compensation at 850.413.1609].
elect to exempt themselves from the coverage
requirements of Chapter 440.
Obtaining Required
Coverage
3. Agricultural Industry: Agricultural employers
with six or more regular employees and/or 12 or
more seasonal employees, who work for more 1. Coverage Options: Contact a Florida-licensed
than 30 days, must obtain workers’ insurance agent to obtain a workers’
compensation liability coverage for those compensation policy. If the employer has applied
employees. for and been rejected by two non-affiliated
4. Out-of-State Employers: An out-of-state workers’ compensation insurers in the voluntary
employer engaged in work in Florida must market, within the last sixty (60) days, they may
immediately notify their insurance carrier that it contact the Florida Workers’ Compensation Joint
has employees working in Florida. A company Underwriting Association (FWCJUA) at (941) 378-
that has employees working in Florida must have 7400 or go to their website at www.fwcjua.com.
a Florida workers’ compensation insurance The employer may also consider leasing
policy or an endorsement must be added to the employees from a Professional Employer
out-of-state policy that lists Florida in Section Organization or PEO. In this circumstance, the
3.A. of the policy. A contractor working in Florida PEO becomes the employer and provides
who contracts with an out-of-state workers’ compensation coverage to each
subcontractor must obtain proof of a Florida employee who is paid by the leasing PEO.
workers’ compensation policy or an 2. Accurate Employer Job Classification and
endorsement to the out-of-state employer’s Payroll: Since workers’ compensation premiums
policy that lists Florida in Section 3.A. of the are based on the information provided by the
policy, on the declaration page. Otherwise, the employer, it is important that accurate
Florida contractor’s policy must include the out- information such as what type of work is being
of-state subcontractor and their employees per performed (i.e. interior trim carpentry, roofing,
Chapter 440.10 (1) (g), Florida Statutes. restaurant, clerical, etc.) and estimated payroll
Extraterritorial Reciprocity: Out-of-state for each job classification code is reported to the
employers whose home jurisdiction has in its insurance company. If any changes occur in the
statute an “extraterritorial reciprocity” clause job duties or services performed or the
allowing temporary employees from another employer’s payroll amount during the policy
jurisdiction (including Florida) to work under term, the employer must notify its insurance
the “home state’s” workers’ compensation company.

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 EMPLOYERS

Workers’ Compensation
3. Professional Employer Organization or
Employee Leasing Company: If an employer
enters into an employee leasing agreement with a
Exemption Eligibility
licensed employee leasing company, the
agreement entails workers’ compensation Requirements and
Information
coverage only for employees listed with the
employee leasing company. The client company
is responsible for workers’ compensation General Information
coverage for all non-leased employees. The An individual who meets the eligibility requirements
payroll for all employees must be paid through to obtain an exemption pursuant to s. 440.05, F.S.,
the leasing company. Any changes in job duties may elect an exemption from the coverage
or status of an employee must be reported to the requirements of Chapter 440, F.S. Once an
leasing company promptly. exemption is obtained, the exempted individual may
4. Individual Self Insurers: Pursuant to Chapter not receive workers’ compensation benefits when
440.38, F.S., an employer may become he/she sustains a work-related injury. Certificates of
individually self insured and secure the payment Election to be Exempt shall apply only to the type of
of workers’ compensation by providing proof of industry listed on the Notice of Election to be
financial strength necessary to ensure timely Exempt.
payments of current and future claims.
Authorization and regulation of individual self Exemption Eligibility Information
insurers is through the Division. A. Non-Construction Industry:
5. Commercial Self-Insurance Funds: Pursuant to Corporation:
Chapter 624.462, F.S., a group of persons may • The corporation must be registered and listed
form a commercial self-insurance fund for as active with the Florida Department of
purposes of pooling and spreading liabilities for State, Division of Corporations.
any commercial and/or casualty insurance. • The applicant must be listed as an officer of
Authorization and regulation of commercial self- the corporation in the records of the Florida
insurance funds is through the Office of Insurance Department of State.
Regulation.
• Applicant cannot be affiliated with an ACTIVE
Stop Work Order (SWO), Order of Penalty
Assessment (OPA) or Working in Violation
(WIV).
Limited Liability Company (LLC):

• The LLC must be registered and listed as

active with the Florida Department of State,
Division of Corporations.
• The applicant must attest to a minimum 10
percent ownership of the LLC.
• No more than 10 members of an LLC may
elect to be exempt.

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 EMPLOYERS

• Applicant cannot be affiliated with an ACTIVE • An applicant associated with a payment that
Stop Work Order (SWO), Order of Penalty is insufficient is not eligible for an exemption.
Assessment (OPA) or Working in Violation
(WIV).
! Out-of-state contractors that are corporations
or limited liability companies can qualify as
B. Construction Industry: foreign corporations or foreign limited liability
Corporation: companies by filing specific forms and
• The corporation must be registered and listed documentation with the Florida Division of

as active with the Florida Department of Corporations. For more information, please call
State, Division of Corporations. (850) 245-6051 or log on to
https://dos.myflorida.com/sunbiz/.
• The applicant must be listed as an officer of
the corporation in the records of the Florida
How to Obtain an Exemption:
Department of State.
The Division of Workers' Compensation offers an
• The applicant must attest to a minimum 10
online system for applicants to apply for or renew a
percent ownership of the corporation.
Certificate of Election to be Exempt from Florida's
• No more than three officers of a corporation Workers' Compensation Law. To access the DWC
or of any group of affiliated corporations Notice of Election to be Exempt online application
(including LLCs) may elect to be exempt. system, visit www.myfloridacfo.com/Division/WC/
• A $50.00 application fee is required. The exemption applicant must personally sign the

• Applicant cannot be affiliated with an ACTIVE application and attest that he or she has reviewed,

Stop Work Order (SWO), Order of Penalty understands, and acknowledges the information as
Assessment (OPA) or Working in Violation stated on the application. Furthermore, any person

(WIV). other than the applicant signing the application

may be guilty of a felony of the third degree. For
• An applicant associated with a payment that
additional information concerning workers’
is insufficient is not eligible for an exemption.
compensation exemptions, please contact the
Limited Liability Company (LLC):
Division’s Customer Service Unit at 850-413-1609
• The LLC must be registered and listed as or email [email protected].
active with the Florida Department of State,
Division of Corporations.

• The applicant must attest to a minimum 10

percent ownership of the LLC.
• No more than three officers of an LLC or of
any group of affiliated LLCs (including
corporations) may elect to be exempt.
• A $50.00 application fee is required.
• Applicant cannot be affiliated with an ACTIVE
Stop Work Order (SWO), Order of Penalty
Assessment (OPA) or Working in Violation
(WIV).

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 EMPLOYERS

Division Enforcement
employee duties or fails to utilize Florida’s class
codes and workers’ compensation rates.

Authority A Stop-Work Order May Be Released:

• When an employer provides proof of
Enforcement and Authority:
compliance and pays a penalty of $1,000, as a
• The Florida Division of Workers’ Compensation
down payment, and agrees to enter into a
is responsible for enforcing employer
payment agreement with the Division for the full
compliance with the coverage requirements of
amount. The penalty is a minimum of $1,000 and
the workers’ compensation law. Compliance
is based on the insurance premiums which
investigators have the authority to enter and
should have been paid, but were not (evaded
inspect any place of business for purposes of
premium), multiplied by 2 for up to 2 years.
ensuring employer compliance with workers’
compensation law. Investigators can also request
an employer’s business records. An employer
Employer Workers’
must produce the required business records
within twenty-one days of receiving the Compensation Criminal
Violations
Division’s written request for records.

• The failure of an employer to comply with the

workers' compensation coverage requirements is The following are criminal violations of s. 440.105,
considered to pose an immediate danger to F.S., and constitute a misdemeanor of the first
public health, safety, and welfare; the Division degree, punishable as provided in s. 775.082 or s.
shall issue a Stop-Work Order within 72 hours of 775.083, F.S.
determination of non-compliance, which
requires the employer to cease all business
It is unlawful to knowingly:
operations. • Coerce or attempt to coerce, as a precondition
to employment or otherwise, an employee to
• If an employer conducts business operations in
obtain a certificate of election of exemption
violation of a Stop-Work Order, the employer
pursuant to s. 440.05, F.S.
shall be assessed an additional penalty of $1,000
per day for each day of violation. • Discharge or refuse to hire an employee or job
applicant because the employee or applicant has
A Stop-Work Order Can Be Issued: filed a claim for benefits.
• When an employer who is required to secure
• Discharge, discipline, or take any other adverse
Florida workers’ compensation coverage fails to
personnel action against any employee for
do so;
disclosing information to the Division or any law
• When the employer fails to provide records
enforcement agency relating to any violation or
requested by the Division of Workers’ suspected violation of any of the provisions of
Compensation within twenty-one days of Chapter 440.
request;
• Fail to update applications for coverage as
• When an employer materially understates or required by s. 440.381(1), F.S., within 7 days after
conceals payroll, misrepresents or conceals the reporting date for any change in the

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 EMPLOYERS

Compliance & Coverage

required information, or to post notice of
coverage pursuant to s. 440.40, F.S.
• Participate in the creation of the employment Assistance May Be
Obtained From:
relationship in which the employee has used any
false, fraudulent, or misleading oral or written
statement as evidence of identity. 1. Construction Policy Tracking Database: The
The following are criminal violations of 440.105, F.S., Construction Policy Tracking Database provides
and constitute a felony of the first, second or third information to contractors regarding the
degree depending on the monetary value of the coverage status of the contactors they use. This
fraud as provided in s. 775.082, s. 775.083, or s. easy-to-use system will send contractors
775.084, F.S.: automatic electronic notification of any changes
to their sub-contractors’ coverage status. The
• Working without workers’ compensation
only action required of the contractor is to
coverage, if required.
register and list the sub-contractors for whom
• Submitting an altered or fraudulent certificate as he/she would like to receive coverage
proof of coverage for workers’ compensation notification.
insurance or a false “exemption” certificate.
2. Proof of Coverage Database (Compliance):
• Misclassifying employees to lower premiums or The Compliance Database provides information
treating employees as subcontractors when they regarding workers' compensation coverage and
are not in order to hide or conceal payroll. exemptions from workers' compensation for
• Violating a stop-work order. employers.

3. Noncompliance On-line Referral Form: To

report an employer you suspect has failed to
Employees and Employers can submit a secure required workers' compensation
fraud referral to Division of Insurance Fraud insurance coverage, go to the Division of
online at https://first.fldfs.com or by calling Workers’ Compensation’s website at
toll-free 1-800-378-0445 (inside Florida) or www.myfloridacfo.com/Division/WC/ and select
850-413-3261 (outside Florida). A reward
the “Report Suspected Workers’ Comp Non-
of up to $25,000 may be offered to citizens
for information leading to an arrest and Compliance” icon.
conviction in complex fraud schemes. 4. Compliance Stop-Work Order Database: The
Compliance Stop-Work Order Database lists
employers that have been issued a stop-work
order.
5. Notice of Election to be Exempt: To access the
DWC Notice of Election to be Exempt online
application system, visit
https://www.myfloridacfo.com/Division/WC/

These and other databases can be found at

https://www.myfloridacfo.com/Division/WC/

Florida WC System Guide 14

 HEALTH CARE PROVIDERS

HEALTH CARE PROVIDER INFORMATION

Provider Duties
failure to respond to a written request for
authorization within 3 or 10 business days, as
1. A health care provider must comply with the required by statute, will constitute
workers’ compensation statutes, rules and authorization. Payment for authorized
reimbursement manuals. Section 440.13, F.S., treatments must be made within 45 days.
addresses the statutory guidelines for providing • The billing and medical treatment report
medical treatment and care under the workers’ forms that must be used are identified in
compensation health care delivery system. Section 69L-7.720, F.A.C. (See appendix for
Chapter 69L-7, Florida Administrative Code forms and links).
(F.A.C.), addresses the health care provider’s
3. Chapter 69L-7: Workers' Compensation Medical
responsibilities for successfully participating and
Reimbursement and Utilization Review
providing medical treatment under the workers’
specifically addresses the health care provider
compensation system.
responsibility for:
2. A health care provider must get authorization
• Providing only care authorized by the
from the self-insured employer or insurance
insurance company and medically necessary
company before providing medical care to an
to treat the compensable medical condition;
injured worker, or payment may be denied. The
• Providing medical documentation, records
DFS-F5-DWC-25 form is the required document
and reports to support the medical necessity
that health care providers must use to request
of the treatment rendered and to
authorization for treatment. The request for
communicate to the insurance company, the
authorization must be submitted to the
medical condition of the injured worker;
insurance company if the employer is not self-
insured. • Identifying work limitations and restrictions
to facilitate return to work;
• Prior authorization is not required when
emergency treatment and care, as defined in • Properly completing and filing DFS-F5-DWC-

s. 395.002, F.S., is needed to treat the injured 25 forms within three business days of the

worker’s medical condition(s). When an initial treatment and, thereafter, within 24

injured worker is being given emergency hours of each subsequent or follow-up visit,
upon occurrence of an actionable event or
treatment, the provider may verify the name
of the employer and/or insurance company in change in the injured worker’s medical

the Division’s Proof of Coverage Database. condition or the treatment plan, or at a

maximum once every 30 days;
• The self-insured employer or insurance
company must respond to authorization • Cooperating with efforts by the insurance

requests for treatment by the end of the third company and the Division to resolve disputes

business day after receiving a request, or arising from medical treatment and care
rendered;
within 10 days for bills exceeding $1,000
pursuant to Section 440.13(3)(i), F.S. A self-
insured employer or insurance company’s

Florida WC System Guide 15

 HEALTH CARE PROVIDERS

• Completing and filing medical claim bills • The Florida Workers’ Compensation
consistent with established billing and Reimbursement Manual for Hospitals
reporting policies. 6. When bill has not been adjudicated within 45
4. Only physicians licensed by the Florida days of receipt by the carrier, a provider may file
Department of Health under Chapters 458, 459, a non-payment complaint with the Medical
460, 461, 463, or 466, F.S., can determine Services Section via:
permanent impairment. The impairment rating Email: [email protected]; or
guide to be used for calculation of impairment Fax: 850-354-5100; or
rating is specific to the date of accident as USPS: DWC-Medical Services Section, 200 East
follows: Gaines Street, Tallahassee, FL 32399-4232
Materials incorporated by reference in Rule 69L- 7. A health care provider must provide each carrier
7.604, F.A.C., Permanent Impairment: that has authorized them to provide workers’
• The American Medical Association’s Guide to compensation medical services for
the Evaluation of Permanent Impairment, 3rd reimbursement with a signed fraud statement,
Edition for dates of injury on or prior to pursuant to Section 440.105(7), Florida Statutes.
06/30/1990. A carrier cannot require the signed fraud
• The Minnesota Department of Labor and statement more than once per year.
Industry Disability Schedule for dates of injury
on 07/01/1990 through 06/20/1993.
• The 1993 Florida Impairment Rating Guide
(FIRG) for dates of injury on 06/21/1993
through 01/07/1997.
• The 1996 Florida Uniform Permanent
Impairment Rating Schedule for dates of
injury on 01/08/1997 or thereafter.

For further information, please refer to

paragraph 440.15(3)(b), Florida Statutes.

5. The Three-Member Panel annually adopts

schedules of maximum reimbursement
established by the Division for health care
providers and facilities. These schedules are
incorporated in three distinct manuals as follows
and also contain reimbursement policy.
• The Florida Workers’ Compensation Health
Care Provider Reimbursement Manual
• The Florida Workers’ Compensation
Reimbursement Manual for Ambulatory
Surgical Centers

Florida WC System Guide 16

 HEALTH CARE PROVIDERS

Medical Bill Health Care Provider

Reimbursement Disputes Criminal Violations
Florida’s Workers’ Compensation Law provides an The following are criminal violations of s. 440.105,
opportunity for a health care provider to contest the F.S., and constitute a felony of the first, second or
reimbursement paid on a bill. The health care third degree depending on the monetary value of
provider must file its Petition for Resolution of the fraud as provided in s. 775.082, s. 775.083, or s.
Reimbursement Dispute within 45 days of the 775.084, F.S.:
provider’s receipt of the notice of disallowance or
• Any physician licensed under Chapter 458, 459,
adjustment of payment. Additional provider
460, 461, 463, or 466 or any other practitioner
requirements are as follows:
licensed under the laws of this state who
• The Petition must be on the Petition for knowingly and willfully assists, conspires with, or
Resolution of Reimbursement Dispute (DFS- urges any person to fraudulently violate any of
Form 3160-0023). the provisions of this Chapter.
• The petition must be served on the carrier and • Any person or governmental entity licensed
on all affected parties by certified mail. under Chapter 395 to maintain or operate a

• The petition must be accompanied by all hospital in such a manner as to knowingly and
documents and records that support the willfully allow the use of the facility in a scheme
allegations contained in the petition. or conspiracy to fraudulently violate any of the
provisions of Chapter 440.
The carrier is allowed to defend its disallowance or
adjustment of payment decision. The carrier has 30
days from receipt of the petition to file its response
with the Department, with a copy sent to the
provider. The carrier’s response must include all
documentation substantiating its disallowance or
adjustment. Failure to respond timely constitutes a
waiver of all carrier objections to the petition. The
Department has 120 days, after receipt of all
documentation, to provide the petitioner, carrier,
and all affected parties a written determination of
whether the carrier properly adjusted or disallowed
payment. In issuing its decision, the Department
must be guided by Florida’s Workers’ Compensation
Law and relevant administrative rules. For additional
information, please refer to Subsection 440.13(7),
Florida Statutes, and Rule Chapter 69L-31, Florida
Administrative Code.

Florida WC System Guide 17

 INSURANCE COMPANIES

INSURANCE COMPANY INFORMATION

Insurance Company
continues to lose time past 7 days.
If the injured worker loses days from work that

Duties are not continuous, then the first installment of

compensation is due on the 6th day after the
The Insurance Company has the first 8 calendar days of disability.
responsibility to:
• Investigate and, if denying the claim, do so
• Adjust claims without harassment, coercion, or
within 14 days of obtaining knowledge of the
intimidation.
accident or injury. If more than 14 days are
• Investigate any knowledge or notice of a claim
needed to investigate the claim:
to assure prompt delivery of disability and
• Timely initiate benefits;
medical benefits to an injured worker and ensure
an efficient and self-executing system. • Send the 120-day letter to the injured worker;

This knowledge includes, but is not limited to, • If denied, file a denial of the claim within 120
receipt of any information, written or verbal, days of the initial provision of benefits.
from any source reporting an accident or injury • Pay, disallow, or deny all medical bills properly
or requesting authorization to treat an injury. submitted to the insurance company within 45
days after receipt of a completed bill on the
• Electronically file policy, claims, and medical
proper form.
information with the Division.
• Obtain the DWC-25 form to document the work
• File a First Report of Injury or Illness and mail
status and treatment plan of the injured worker.
copies to the injured worker and the employer.
• Authorize or deny medical referrals in writing,
• Respond to requests for medical treatment by
from authorized health care provider, within 3
authorized doctors within 3 business days after
business days of receipt of the request.
receipt of a written request.
If the referral for testing, examination or
• Send to the injured worker, within 3 days of
treatment is more than $1,000, the
knowledge of the injury, a brochure explaining
authorization or denial must be made within 10
the injured worker’s rights and benefits under
business days of receipt of the written request.
the law and the Employee Notification Letter.
• Obtain a signed fraud statement from the
injured worker.
• Pay the first installment of compensation for
total disability or death benefits within 14 days
after the employer receives notification of the
injury or death.

This applies where the injured worker can’t

return to work and begins losing time from
work immediately following the accident and

Florida WC System Guide 18

 INSURANCE COMPANIES

Reporting Responsibilities of the Claims Handler

Form Rule

1. Information for Employees or Employers

Mail an informational brochure to the injured worker within 3 DFS-F2-DWC-60 or DFS- 69L-3.0035
business days after notification of the injury or illness. F2-DWC-61

Annually mail an informational brochure to the employer. DFS-F2-DWC-65 or DFS- 69L-3.0036

F2-DWC-66

Provide a paper copy of the injury report to the worker and DFS-F2-DWC-1 or Form 69L-56.401
employer within three days when notified of an injury by phone or IA-1
electronic data interchange (EDI).
Provide a paper copy of the form DFS-F2-DWC-4 (or letter if DFS-F2-DWC-4 69L-56.404
applicable, pursuant to 69L-56 and the EDI Event Table) to the
employer and employee for actions or changes specified in rule.

Provide a paper copy of the form DFS-F2-DWC-12 to the employer DFS-F2-DWC-12 69L-56.4012
and employee for any denial or rescission of benefits.
For dates of accident on or after 10/1/03 involving temporary 69L-3.0191
disability, provide an informational letter to eligible injured workers 69L-3.01915
explaining the benefits and requirements of temporary partial
disability within five days of learning of the worker's release to
restricted work.

2. Forms Reported to the Division of Workers' Compensation

Proof of coverage (POC): Submit to the Division by electronic data IAIABC standards for 69L-56.100
interchange policy information for Certificates of Insurance, POC, Release 2.1, 6/1/07
Endorsements, Reinstatements, Cancellations and Non-Renewals Edition and Supplement
pursuant to the filing time periods in Rule 69L-56.210, F.A.C.

Complete and submit an electronic FROI (First Report of Injury) or a IAIABC standards for 69L-56.301
FROI and SROI (Subsequent Report of Injury) combination as Claims EDI Release 3 (EDI)
provided in 69L-56.300, F.A.C. A FROI (First Report of Injury) or a FROI, SROI (EDI),
FROI and SROI (Subsequent Report of Injury) combination as 01/01/09 Edition and
referenced in 69L-56.300, F.A.C. must be reported to the Division Supplement
for lost-time and death cases and receive a Transaction Accepted
Acknowledgement Code on or before 21 days after the Claim
Administrator’s knowledge of the injury, or as otherwise referenced
in rule 69L-56.301, F.A.C.

Complete and submit an electronic SROI to report certain IAIABC standards for 69L-56.404
significant changes in a lost-time case (as specified in rule 69L- Claims EDI Release 3 (paper) 69L-
56.304 & .3045, F.A.C.) and receive a Transaction Accepted FROI, SROI (EDI), 56.304 69L-
Acknowledgement Code on or before 14 days after the Claim 01/01/09 Edition and 56.3045 (EDI)
Administrator has knowledge of the new or changed information. Supplement

Florida WC System Guide 19

 INSURANCE COMPANIES

Form Rule
Upon denial of benefits or rescission of a prior denial, report such DFS-F2-DWC-12 (paper) 69L-56.3012
action to the Division on a DFS-F2-DWC-12 as provided in the rule. FROI, SROI (EDI) (EDI)
For electronic reporting in compliance with 69L-56.300, submit a
FROI or a SROI as provided in the rule.

Complete and submit electronic periodic reports of cumulative IAIABC standards for 69L-56.3013
benefits paid in lost-time cases on a SROI, and receive a Transaction Claims EDI Release 3 (EDI)
Accepted Acknowledgement Code within 30 days after the intervals FROI, SROI (EDI),
specified in rule 69L-56.3013, F.A.C. 01/01/09 Edition and
Supplement

Electronically submit all medical, dental, pharmacy, and health care 69L-7.740
facility claims for both medical only and lost-time cases to the 69L-7.750
Division within 45-calendar days of when the medical bill is paid,
adjusted, disallowed or denied. File all forms electronically in the
format specified in the Florida Medical EDI Implementation Guide
(MEIG) 2010.
Within 14 days after request by the Division, file a completed Form DFS-F2-DWC-35 69L-3.0194
DFS-F2-DWC-35 (Permanent Total Supplemental Worksheet) with 69L-3.01945
the Division's Permanent Total Section.

Within 14 days after a request by the Division, file a completed DFS-F2-DWC-33 69L-3.0194
Form DFS-F2-DWC-33 (Permanent Total Offset Worksheet) with the 69L-3.01945
Division's Permanent Total Section.
Complete and submit an electronic FROI (First Report of Injury) 69L-56.304
with MTC AQ to electronically report any cases changing claim (EDI)
administration to the Division and receive a Transaction Accepted
Acknowledgement Code on or before 21 days after the effective
date of the new Claim Administrator’s acquisition of the claim, in
compliance with 69L-56.304, F.A.C.

If requesting the employee's authorization for release of social DFS-F2-DWC-14 69L-3.021

security benefit information, furnish the Form DFS-F2-DWC-14 to
the employee, submit the Request for Social Security Disability
Benefit Information to the Social Security Administration office
nearest to the employee's address, and send a copy of the
completed form to the Division within 14 days of the request.

! Other forms for reporting information to the Division may be required for dates of injury prior to October 1, 2003.
Please contact the Division for further information.

Florida WC System Guide 20

 INSURANCE COMPANIES

Special Disability Trust Penalties That Can Be

Fund Assessed Against
The Special Disability Trust Fund (SDTF) was created
by the Florida Legislature in 1955 and operates
Insurance Companies
under the authority granted by Chapter 440.49, 1. Medical CPS Timely Disposition
Florida Statutes. The SDTF was created to encourage Penalties:
the re-employment of injured workers by mitigating Pursuant to Section 440.20(6)(b), F.S., the
the potential liability to the employer from a second Division shall impose penalties for late
injury to the employee. The SDTF reimburses payments, disallowances or denials of medical,
insurance companies and eligible self-insured hospital, pharmacy, or dental bills that are below
employers (referred to as the employer/carrier) for a 95% timely performance standard. The
expenses incurred due to claims from an employee insurance company shall pay to the Workers'
who meets the eligibility requirements of the statute Compensation Administration Trust Fund a
and case law. Section 440.49(10), Florida Statutes, penalty of:
limits reimbursement to injuries occurring prior to
• Twenty-five dollars for each bill below the
January 1, 1998. Thus, the SDTF has been
95% timely performance standard, but
prospectively abolished; although, the SDTF
meeting a 90% timely standard.
continues to receive, review, accept, and reimburse
• Fifty dollars for each bill below a 90% timely
eligible claims and levy assessments against
performance standard.
employer/carriers.
2. Medical CPS Timely Filing Penalties:
Assessments Pursuant to Section 69L-24.006(2), F.A.C.,
insurance companies that fail to submit a
Insurance companies, assessable mutuals, self- minimum of 95% of all medical bills timely are
insurance funds and individual self-insurers are subject to an administrative fine. Each untimely
required to pay the Division assessments to support filed medical bill which falls below the 95%
the Workers’ Compensation Administration Trust requirement is subject to the following penalty
Fund and the Special Disability Trust Fund. The schedule:
assessment is applied on a calendar year basis and is • 1-30 calendar days late $5;
based upon actual and calculated premiums.
• 31-60 calendar days late $10;
Please refer to • 61-90 calendar days late $25;
https://www.myfloridacfo.com/divisio n/wc/insurer/as • 91 or greater calendar days late $50.
sessments/rates
3. Medical CPS Rejected Not
for current and historic assessment rates.
Resubmitted Penalties:
Pursuant to Section 69L-24.006(2), F.A.C., each
medical bill that does not pass the electronic
reporting edits shall be rejected by the Division
and considered not filed. If the medical bill
remains rejected and not corrected, resubmitted
and accepted by the Division for greater than 90

Florida WC System Guide 21

 INSURANCE COMPANIES

days, an administrative fine shall be assessed in pattern and practice violations arising from
the amount of $50 for each such medical report. the same action.

4. CPS Penalty Calculation for Each • The entire Rule may be viewed at
https://www.flrules.org/gateway/ChapterHo m
Untimely Filing of the First Report of
e.asp?Chapter=69L-24.
Injury pursuant to Section 440.185(9),
F.S. and Section 69L-24.006(1)(b),
F.A.C.: Penalties and interest for late
• $100 for 1 through 7 days of untimely filing
payment of compensation paid
• $200 for 8 through 14 days of untimely filing directly to the injured worker along
• $300 for 15 through 21 days of untimely filing with the indemnity payment that
• $400 for 22 through 28 days of untimely filing was late:
• $500 for over 28 days of untimely filing 1. Pursuant to Section 440.20(6), F.S., if any
5. Audit Penalties: installment of compensation for death or
dependency benefits, or compensation for
• S. 440.20(8), F.S, states that the Division shall
disability benefits payable without an award is
assess a $50 penalty for each payment of
not paid within 7 days after it becomes due,
indemnity that is below the minimum 95%
there shall be added to such unpaid installment
performance standard and equal to or
a penalty of an amount equal to 20 percent of
greater than a 90% timely payment
the unpaid installment, which shall be paid at
performance standard. The Division shall
the same time as, and in addition to, such
assess a penalty of $100 for each payment of
installment of compensation.
compensation below the 90% timely payment
performance standard. 2. Pursuant to Section 440.20(8), F.S., if any
• S. 440.525, F.S. and Rule 69L-24.007, F.A.C., installment of compensation is not paid when it
Insurers Standards and Practices, states that becomes due, the employer, insurance company
willful or non-willful administrative penalties or servicing agent shall pay interest at the rate of
may be assessed for intentional violation in 12 percent per year from the date the
disregard for the unlawfulness acts, or failure installment becomes due until it is paid, whether
to comply with a Department order. such installment is payable without an order or
Unreasonable delay in claims handling, under the terms of an order. The interest
timeliness and accuracy of payments and payment shall be the greater of the amount of
reports under 440.13, 440.16 and 440.185, F.S. interest due or $5.
or patterns or practices. The penalties
assessments shall be as follows:
• $20,000 for a single willful violation; not to
exceed an aggregate of $100,000 for all
pattern and practice violations for same
action.
• $2,500 for a non-willful violation, not to
exceed an aggregate of $10,000 for all

Florida WC System Guide 22

 INSURANCE COMPANIES

Insurance Companies
Insurance companies are required to report suspect
fraud and can submit a fraud referral to Division of

Unlawful Action Insurance Fraud on-line at https://first.fldfs.com.

It shall be unlawful for any insurance entity to revoke

or cancel a workers' compensation insurance policy
or membership because an employer has returned
an employee to work or hired an employee who has
filed a workers' compensation claim.

Insurance Companies
Anti-Fraud
Responsibilities
Rule Chapter 69D-2, F.A.C. was adopted September
15, 2006, requiring insurance companies and health
maintenance organizations (HMO) to file updated
Special Investigations Unit (SIU Descriptions or anti-
fraud plans pursuant to Section 626.9891, F.S.

The type of filing required depends on the insurance

company’s volume of Florida annual direct written
premium. Those insurance companies that write $10
million or more in annual direct written premium are
subject to s. 626.9891(1), F.S. and 69D-2.003, F.A.C.
and those that write less than $10 million in annual
direct written premium are subject to s. 626.9891(2),
F.S. and 69D-2.004, F.A.C.

For instructions on required anti-fraud filings, click

on “Instructions for Filing SIU Descriptions and Anti-
fraud plans to IFPR” found on the Division of Fraud
website https://myfloridacfo.com/Division/DIFS/.
Filings are required to be submitted via Division of
Insurance Fraud’s on-line electronic database known
as IFPR (Insurance Fraud Plan Reporting).

Use form DFS-L1-1689/SIU for more than $10 million

in Florida annual direct written premium.

Use form DFS-L1-1690/Anti-fraud plans if less than

$10 million in Florida direct written premium.

Florida WC System Guide 23

 APPENDIX

APPENDIX
FLOW OF BENEFIT DISPUTE RESOLUTION

Employee
BENEFITS in DISPUTE contacts EAO for
Assistance

EAO contacts the Insurance

Insurance Company to Company Pays YES Issue Closed
obtain benefits Claim

NO

DENIAL
The insurance company
ACCEPT
must deny a request for:
DENIAL OF A
indemnity within 14 days; YES Issue Closed
SPECIFIC
medical, within 3-10 days
BENEFIT
depending on the cost of
the benefit.

NO

PETITION for BENEFITS

The employee must file a
CARRIER RESPONSE
Petition for Benefits within 1
The insurance company must
year of the last payment of
MEDIATION pay or respond to the Petition
indemnity or furnishing of
Mediation is held within 130 within 14 days of receipt of the
remedial treatment or care, and
days of filing the Petition Petition specifically denying
all managed care grievances
those benefits they will not
must be exhausted.” (NOTE:
provide.
the 1-year limit pertains only to
contesting a specific benefit.)

Final Hearing
Workers’
Pre-Trial (Within 90 days
SETTLED? NO Compensation
Hearing after the Pre-Trial
Judge
Hearing)

YES

Issue Closed ACCEPT

Issue Closed YES
DECISION

NO

An appeal must be
filed within 30 days
1st District Court
from the date the
of Appeal
WC judge signs
the order

APPENDIX
A

Florida WC System Guide 24

 APPENDIX

Additional Resources
WC Website: https://www.myfloridacfo.com/Division/WC/

WC Hotline: 1-800-342-1741

Employee Section
The State of Florida Employee Assistance Office
https://www.myfloridacfo.com/divisio n/wc/emplo yee/eao/eao-offices
Email: [email protected]

The Maximum Compensation Rates

https://www.myfloridacfo.com/divisio n/wc/insurer/bma-rates

WC Insurer/Claims Administrator Database

https://secure.fldfs.com/wcapps/carrier/Car_Srch10.asp

WC Rehabilitation and Reemployment Program

https://www.myfloridacfo.com/divisio n/wc/emplo yee/reemployment-services

Employer Section
Anti-Fraud Reward Program Notice Poster
https://www.myfloridacfo.com/docs-sf/workers-compensation-libraries/workers-comp-documents/brochures-
and-guides/anti-fraud-notice.pdf

Broken Arm Poster: English | Spanish

Bureau of Compliance District Offices

https://www.myfloridacfo.com/divisio n/wc/emplo yer/boc/bureau-of-compliance-district-offices

Construction Policy Tracking Database

https://contractor.fldfs.com

Compliance Stop-Work Order Database

https://secure.fldfs.com/wcapps/swo/

Proof of Coverage Database (Compliance)

https://dwcdataportal.fldfs.com/ProofOfCoverage.aspx

Florida WC System Guide 25

 APPENDIX

Noncompliance Referral Form (Whistle Blower)

https://apps.fldfs.com/NonCompliance_Referral/mainpage.aspx

WC Forms
https://www.myfloridacfo.com/divisio n/wc/forms

Health Care Provider Section

Dental Claim Form, DFS-F5-DWC-11
A copy of the DWC-11 can be obtained by contacting the American Dental Association https://ada.org/
Instructions for using the DWC-11: https://www.myfloridacfo.com/docs-sf/workers-compensation-
libraries/workers-comp-documents/forms/69l-7/form-dfs-f5-dwc-11-a -instr uctions-rev-01-01-15-(09-29-15).pdf

Disputed Reimbursement Rule, Chapter 69L-31

https://www.flrules.org/gateway/ChapterHo me.asp?Chapter=69L-31

Petition for Resolution of Reimbursement Dispute

https://www.myfloridacfo.com/docs-sf/workers-compensation-libraries/workers-comp-documents/forms/69l-
31/dfs-f6-dwc-3160-0023-(fillable-pdf).pdf

Florida WC Uniform Medical Treatment/Status Reporting Form, DFS-F5-DWC-25

PDF | Interactive PDF | Excel Format | Word Format | Instructions for using

Expert Medical Advisor Certification:

https://msuwebportal.fldfs.com

Health Insurance Claim Form, DFS-F5-DWC-9 (CMS 1500)

Sample form: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Do wnloads/CMS1500.pdf
To purchase this form for use, contact a local form vendor or call 1-800-482-9367 for vendor information.
Instructions for using the DWC-09:
• Health Care Practitioners
• Ambulatory Surgical Centers (for DOS prior to 07/08/2010)
• Work Hardening and Pain Management Programs

Hospital Billing Form (UB-04) (CM1450), DFS-F5-DWC-90 (see page 18):

To purchase this form for use, contact a local form vendor or call 1-800-482-9367 X.1770 for vendor information.
Instructions for using the DWC-90:
• Hospitals
• Ambulatory Surgical Centers (for DOS on or after 07/08/2010)
• Home Health Agencies
• Nursing Home Facilities

Florida WC System Guide 26

 APPENDIX

Statement of Charges for Drugs and Medical Supplies Form, DFS-F5-DWC-10

Form: https://www.myfloridacfo.com/docs-sf/workers-compensation-libraries/workers-comp-
documents/forms/69l-7/form-dfs-f5-dwc-10-rev-1-1-15.pdf
Instructions: https://www.myfloridacfo.com/docs-sf/workers-compensation-libraries/workers-comp-
documents/forms/69l-7/form-dfs-f5-dwc-10-a-instructio ns-rev-12-08-15.pdf

Reimbursement Manuals
https://www.myfloridacfo.com/divisio n/wc/provider/reimbursement-topics

Carrier Response to Petition Form for Resolution of Reimbursement Dispute

https://www.myfloridacfo.com/docs-sf/workers-compensation-libraries/workers-comp-documents/forms/69l-
31/dfs-f6-dwc-3160-0024-(fillable-pdf).pdf

Laws regarding Florida’s Workers’ Compensation, Chapter 440, F.S.

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/0440.html

Rules regarding Florida’s Workers’ Compensation:

https://www.flrules.org/Gateway/Division.asp?DivID=370

Insurance Company Section

Electronic Data Interchange (EDI) Requirements
https://www.myfloridacfo.com/divisio n/wc/edi

WC Publications and Reimbursement Manuals

https://www.myfloridacfo.com/divisio n/wc/ma nuals

The Maximum Compensation Rates

https://www.myfloridacfo.com/divisio n/wc/insurer/bma-rates

Health Care Provider Violation Website

https://hcprov.fldfs.com

Form DFS-L1-1689/SIU Description

Form DFS-L1-1689

Form DFS-L1-1690/Anti-fraud plans

Form DFS-L1-1690

Rule 69L-24, F.A.C., Workers’ Compensation Insurers’ Standard and Practices

https://www.flrules.org/gateway/ChapterHo me.asp?Chapter=69L-24

Florida WC System Guide 27