Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-56 - ELECTRONIC DATA INTERCHANGE (EDI) REQUIREMENTS FOR PROOF OF COVERAGE AND CLAIMS (NON-MEDICAL) › Section 69L-56.301 - Electronic First Report of Injury or Illness

Current through Reg. 50, No. 138; July 16, 2024
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-56.4011 and
				   69L-3.025, F.A.C. 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 the
				  injury report by other means as set forth in Section
				   440.185(2),
				  F.S., the insurer or its claim administrator shall send to the Division the
				  electronic form equivalent of the First Report of Injury or Illness for the
				  following cases, and by the following filing time periods:
(1) Initial Payment for "Lost Time Case" or
				"Medical Only to Lost Time Case."
(FROI MTC 00 with SROI MTC IP, EP, CD, VE, or PY as found in
				  the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer
				  & Acknowledgement Detail Records, Release 3, January 1, 2009
				  Edition):
(a) Where the initial
				payment of indemnity benefits, excluding Temporary Partial benefits, Impairment
				Income benefits, and Lump Sum Payment/Settlement
,
is made by
				the claim administrator, or where the employer is paying salary in lieu of
				compensation, or for a compensable death with no known dependents, or a
				compensable volunteer:
1. If disability is
				immediate and continuous for 8 or more calendar days after the workers'
				compensation injury, an Electronic First Report of Injury or Illness will be
				considered timely filed with the Division when it is received by the Division
				and is assigned an Application Acknowledgement Code of "TA" (Transaction
				Accepted) on or before 21 days after the claim administrator's knowledge of the
				injury. The claim administrator shall report Claim Type "I" (Lost
				Time/Indemnity).
2. If the first 7
				days of disability are nonconsecutive or delayed, an Electronic First Report of
				Injury or Illness will be considered timely filed with the Division when it is
				received by the Division and is assigned an Application Acknowledgement Code of
				"TA" (Transaction Accepted) on or before 13 days after the claim
				administrator's knowledge of the employee's 8th day of disability. The claim
				administrator shall report the "Initial Date of Lost Time" (i.e., the
				employee's 8th day of disability) and the "Date Claim Administrator Had
				Knowledge of Lost Time." The claim administrator shall also report Claim Type
				"L" (Became Lost Time/Indemnity).
3. The Electronic First Report of Injury or
				Illness shall be represented by sending the FROI and SROI records as follows:
a. Initial Payment by Claim Administrator:
				FROI MTC 00 (Original) with SROI MTC IP (Initial Payment);
b. Employer Paid Salary in Lieu of
				Compensation: FROI MTC 00 (Original) with SROI MTC EP (Employer
				Paid);
c. Compensable Death, No
				Dependents/Payees: FROI MTC 00 (Original) with SROI MTC CD (Compensable
				Death);
d. Compensable Volunteer:
				FROI with MTC 00 (Original) with SROI MTC VE
				(Volunteer);