reglab/statecodes huggingface dataset:
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-10 - CLAIM FOR REIMBURSEMENT AGAINST THE SPECIAL DISABILITY TRUST FUND › Section 69L-10.019 - Forms

Current through Reg. 50, No. 138; July 16, 2024
The following forms are incorporated by reference into these
				  rules and are available from and shall be filed with: SDTF, Division of
				  Workers' Compensation, 1579 Summit Lake Drive, Tallahassee, FL 32317.
(1) DFS Form DFS-F1-SDF-1 - Proof of Claim
				(Rev. 3/09).
(2) DFS Form
				DFS-F1-SDF-2 -Reimbursement Request (Rev. 3/09).
Rulemaking Authority
					 440.49(7),
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 4-19-92, Amended 8-18-93, Formerly 38F-10.019,
					 4L-10.019, Amended 3-16-09.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.002 - Definitions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.002, 4L-11.002, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.003 - Procedure for Obtaining Identity Card (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.003, 4L-11.003, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.004 - Time and Procedure for Notifying Injured Employees (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.004, 4L-11.004, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.005 - Documentation of Placement of a Preferred Worker (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.005, 4L-11.005, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.006 - Time for Filing Application for Identity Card (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.006, 4L-11.006, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.007 - Documentation for Reimbursement of Premium (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.007, 4L-11.007, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.008 - Time for Requesting Reimbursement (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.008, 4L-11.008, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.009 - Procedure When Eligibility for a Card Is Denied (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.009, 4L-11.009, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.010 - Procedure When Request for Reimbursement of Premium is Denied (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.010, 4L-11.010, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-11 - PREFERRED WORKER PROGRAM › Section 69L-11.011 - Forms (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49,
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 11-29-94, Formerly 38F-11.011, 4L-11.011, Repealed
					 9-14-16.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.001 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) "Customary residence" is the injured
				employee's place of permanent residence. Whenever the injured employee changes
				his or her permanent residence, the customary residence changes also.
(2) "Customary vicinity" is the distance
				traveled by the injured employee from his or her customary residence to his or
				her place of employment at the time of injury.
(3) "Training and Education program" means a
				formal course of study or a certificate program in a training and education
				facility, agency or institution operating under chapter 1004, Parts II, III,
				and IV, 1005, F.S., or a career and technical education program defined in
				paragraph  1003.01(4)(c),
				F.S. Outside of the State of Florida, a training and education program shall be
				approved as governed by comparable statutes of that state.
(4) "Good cause" is termination resulting
				from employee conduct:
(a) Evincing such
				willful or wanton disregard of an employer's interests as is found in
				deliberate violation or disregard of standards of behavior which the employer
				has the right to expect of his or her employee; or
(b) Carelessness or negligence of such a
				degree or recurrence as to manifest culpability, wrongful intent, or evil
				design, or to show an intentional and substantial disregard of an employer's
				interests or of the employee's duties and obligations to his or her
				employer.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.002 - Rehabilitation Provider Qualifications (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.491(7),
					 440.591 FS. Law Implemented
					 440.491
					 FS.
New 7-1-96, Amended 6-26-01, Formerly  38F-55.002, Amended
					 5-5-04, 2-22-05, 5-7-09, Formerly
					  6A-22.002, Repealed
					 3-31-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.003 - Reemployment Status Review (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.491(3), (4), (5), (6),
					 (8),
					 440.591 FS. Law Implemented
					  440.491 FS.
New 7-1-96, Amended 6-26-01, Formerly  38F-55.005, Amended
					 5-7-09, Formerly  6A-22.003, Repealed
					 3-31-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.0031 - Reemployment Assessments (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.491(7)(e),
					 440.591 FS. Law Implemented
					 440.491
					 FS.
New 5-5-04, Formerly
					  6A-22.0031, Repealed
					 3-31-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.004 - Notice Requirements (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.491(5), (6),
					 (8),
					 440.591 FS. Law Implemented
					 440.491
					 FS.
New 7-1-96, Amended 6-26-01, Formerly  38F-55.006, Amended
					 3-1-05, 5-7-09, Formerly
					  6A-22.004, Repealed
					 3-31-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.005 - Carrier Referrals for Services

Current through Reg. 50, No. 138; July 16, 2024
(1) A
				carrier may make a referral of an injured employee at anytime to the Department
				to be considered for the Department provided reemployment services program. The
				carrier shall make referrals to the Department for reemployment services by
				submitting either an electronic Request for Screening form DFS-F3-DWC-23,
				through the Reemployment Services Web Portal located on the internet at
https://wcres.fldfs.com/resportal/login.aspx
or on a Request for Screening form DFS-F3-DWC-23, which is incorporated by
				reference in rule  69L-22.011, F.A.C.
(2) Upon discontinuation of carrier sponsored
				services pursuant to section
				 440.491(5),
				F.S., the carrier shall make referrals to the Department for reemployment
				services by submitting either an electronic Request for Screening form
				DFS-F3-DWC-23, through the Reemployment Services Web Portal located on the
				internet at
https://wcres.fldfs.com/resportal/login.aspx
or on a Request for Screening form DFS-F3-DWC-23, which is incorporated by
				reference in rule  69L-22.011, F.A.C.
(3) A Form DFS-F3-DWC-23 submitted by the
				carrier to the Department shall not be considered complete until signed by the
				injured employee.
Rulemaking Authority
					 440.591 FS. Law Implemented
					 440.491
					 FS.
New 7-1-96, Amended 6-26-01, Formerly  38F-55.008, Formerly
					  6A-22.005, Amended
					 3-31-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.006 - Screening Process

Current through Reg. 50, No. 138; July 16, 2024
(1) A request for
				screening must be made using Form DFS-F3-DWC-23, Request for Screening, as
				incorporated by reference in Rule
				 69L-22.011, F.A.C. Before the
				Department will consider a request complete and initiate a screening, the
				injured employee must:
(a) Complete, sign and
				submit Form DFS-F3-DWC-23, Request for Screening;
(b) Complete, sign and submit Form
				DFS-F3-DWC-27, Reemployment Services Questionnaire, as incorporated by
				reference in Rule  69L-22.011, F.A.C.;
(c) Provide documentation to establish
				identity and employment eligibility. Such documentation shall be consistent
				with the acceptable documents for verifying identity and employment eligibility
				as required by the U.S. Department of Homeland Security, U.S. Citizenship and
				Immigration Services' Form I-9, Employment Eligibility Verification (Effective
				10/21/19), which is incorporated by reference herein and available at
http://www.myfloridacfo.com/Division/wc/
or
http://www.flrules.org/Gateway/reference.asp?No=Ref-15498
.
(d) Provide the most current DFS-F5-DWC-25,
				Florida Workers' Compensation Uniform Medical Treatment/Status Report Form, as
				incorporated by reference in Rule
				 69L-7.720, F.A.C., from all
				authorized treating physicians.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.007 - Vocational Evaluations

Current through Reg. 50, No. 138; July 16, 2024
(1) The provision
				of Department sponsored vocational evaluations shall be limited to one (1) per
				injured employee, per date of accident. Vocational evaluations shall be adapted
				to the specific needs of the injured employee to insure validity.
(2) A vocational evaluator under contract
				with the Department to provide vocational evaluations shall:
(a) Ensure any test site used for Department
				sponsored vocational evaluations meets the definition of "test site" set forth
				in subsection  69L-22.001(9),
				F.A.C.;
(b) Be responsible for the
				administration, scoring and interpretation of all testing instruments and work
				samples used as part of the vocational evaluation process;
(c) Remove or cure conditions that invalidate
				test results;
(d) Provide adaptive
				evaluation tools or techniques to accommodate any physical or functional
				disability or language barrier;
(e)
				Conduct an initial interview with the injured employee; and,
(f) Submit to the Department, within
				forty-five (45) calendar days of Department approval of services, a written
				report which shall:
1. Include an
				interpretation of testing instruments and work samples used, specifying the
				form and level of tests, percentile scores, norm groups, grade levels, standard
				scores and stanine scores as applicable to the test instrument;
2. Identify the injured employee's physical
				and intellectual capabilities, aptitudes, achievements, work related behaviors,
				and interests. The sole interests of the injured employee cannot be the only
				basis for the vocational evaluator's recommendation;
3. Identify residual or transferable
				skills;
4. Identify the most
				appropriate vocational objectives;
5. Identify which reemployment service(s) are
				necessary for the injured employee to return to suitable gainful
				employment;
6. Discuss how the
				provision of the recommended service(s) will facilitate reemployment;
				and,
7. When a training and
				education program is recommended, include the rationale for the recommended
				program, the entrance, enrollment and exit requirements of the program, the
				anticipated program costs and the proximity of the training and education
				facility to the injured employee's customary
				residence.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.008 - Reemployment Services and Programs

Current through Reg. 50, No. 138; July 16, 2024
(1)
				The Department shall approve reemployment services provided through an
				on-the-job training program, job placement or a training and education program
				when recommended in a Department reemployment plan.
(2) When the Department provides a vocational
				assessment or a vocational evaluation to the injured employee, the vocational
				assessment or vocational evaluation shall determine the reemployment services,
				such as are enumerated without limitation in Section
				 440.491(1)(e),
				F.S., necessary to return the injured employee to suitable gainful employment.
				The Department will approve reemployment services if:
(a) The vocational assessment is compliant
				with paragraph  69L-22.006(3)(d),
				F.A.C.; or
(b) The vocational
				evaluation contains the information identified in paragraph
				 69L-22.007(2)(f),
				F.A.C.; and,
(c) The vocational
				evaluation demonstrates that the injured employee:
1. Has no transferable skills which would
				allow for return to suitable gainful employment with the same employer in the
				same, different or modified job or a new employer in the same, modified or
				different job; or
2. Requires
				additional Department sponsored reemployment services to enable the injured
				employee to return to suitable gainful
				employment.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.009 - Employee Responsibilities

Current through Reg. 50, No. 138; July 16, 2024
(1) Upon
				approval of training and education by the Department, the injured employee and
				Department staff shall sign and date:
(a) Form
				DFS-F3-DWC-24, Department and Student Agreement for Sponsorship of Training and
				Education, which is adopted in rule
				 69L-22.011, F.A.C.;
				and,
(b) An Individualized Written
				Reemployment Plan.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.010 - Reporting Services and Costs: Qualified Rehabilitation Provider and Employer or Carrier Responsibilities (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.491(5), (6),
					 (7),
					 440.591 FS. Law Implemented
					 440.491
					 FS.
New 7-1-96, Amended 6-26-01, Formerly  38F-55.013, Amended
					 5-5-04, 5-7-09, Formerly
					  6A-22.010, Repealed
					 3-31-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.011 - List of Forms

Current through Reg. 50, No. 138; July 16, 2024
(1) The following forms
				are to be used with this rule chapter and are hereby incorporated by reference:
(a) Form DFS-F3-DWC-23
http://www.flrules.org/Gateway/reference.asp?No=Ref-06694
(Revised: 12/2015), Request for Screening;
(b) Form DFS-F3-DWC-24
http://www.flrules.org/Gateway/reference.asp?No=Ref-06695
(Revised: 12/2015), Department and Student Agreement for Sponsorship of
				Training and Education;
(c) Form
				DFS-F3-DWC-26
http://www.flrules.org/Gateway/reference.asp?No=Ref-06696
(Effective: 12/2015), Department and Injured Employee Agreement for the
				Provision of Contracted Placement Services;
(d) Form DFS-F3-DWC-27
http://www.flrules.org/Gateway/reference.asp?No=Ref-06697
(Effective: 12/2015), Reemployment Services Questionnaire.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.012 - Expenditures from the Workers' Compensation Administration Trust Fund

Current through Reg. 50, No. 138; July 16, 2024
(1) The Department shall authorize
				reimbursement for reemployment services received from rehabilitation providers
				from the Workers' Compensation Administration Trust Fund at a maximum rate of
				$85.00 per hour. The total reimbursement for a vocational evaluation may not
				exceed $1,100.00 per evaluation.
(2) The Department shall expend funds from
				the Workers' Compensation Administration Trust Fund only:
(a) For vocational evaluations and training
				and education for dates of accident on or after October 1, 1989 through
				December 31, 1993; and,
(b) For
				vocational evaluations, training and education and reemployment services for
				dates of accident on or after January 1, 1994.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-22 - REEMPLOYMENT SERVICES - WORKERS' COMPENSATION › Section 69L-22.013 - Trial Period of Reemployment

Current through Reg. 50, No. 138; July 16, 2024
(1)
				The initiation or termination of a trial period of reemployment constitutes an
				action or change in employment status for purposes of Rule
				 69L-56.404, F.A.C.
(2) The trial period of reemployment shall:
(a) Automatically commence on the date of
				hire, and
(b) Be within the
				physical capabilities of the injured employee, and
(c) Not be a result of coercion or
				intimidation, and
(d) Automatically
				terminate:
1. When the injured employee is
				unable to perform the duties as a result of the permanently disabling
				condition, or
2. One year from the
				date of initiation of the trial period of reemployment if the injured employee
				is able to work 50 percent (50%) of his or her normal pre-injury working hours
				with an earning capacity of at least 80% of his or her previous average weekly
				wage.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.001 - Purpose

Current through Reg. 50, No. 138; July 16, 2024
The purpose and intent of this rule chapter is to promote the
				  self execution of the workers' compensation system through monitoring and
				  enforcement of a regulated entity's fulfillment of its statutory obligations to
				  provide timely payment of workers' compensation benefits to injured workers, to
				  timely pay medical bills to providers, and to timely report workers'
				  compensation medical data to the Department. The timely and accurate reporting
				  of medical data is critical in that it enables the Department to provide
				  current information about medical costs to policymakers and stakeholders so
				  they can make qualitative and objective decisions relating to reimbursements to
				  health care providers. Timely and accurate reporting of first reports of injury
				  or illness is critical in that it allows the Department to monitor claims to
				  ensure that regulated entities are fulfilling their statutory and rule
				  obligations regarding the claims. The purpose of this rule chapter is also to
				  establish performance standards and uniform guidelines for administrative fines
				  and penalties assessed upon regulated entities for violations of Chapter 440,
				  F.S. and other applicable Florida Statutes and Department
				  rules.
Rulemaking Authority
					  440.13(11),
					  440.185 (9),
					 (10),
					 440.20(6),
					 440.525(4),
					 440.591,
					 440.593(5) FS.
					 Law Implemented 440.13(11),
					 440.185,
					  440.20(6), (8),
					  440.525,
					  440.593 FS.
New 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.002 - Scope

Current through Reg. 50, No. 138; July 16, 2024
This rule chapter applies to all regulated entities as
				  defined in this rule chapter and applies to all violations discovered through
				  monitoring, examining, or investigating. This rule chapter shall not be
				  construed as creating any substantive violations not otherwise prescribed by
				  statute or rule.
Rulemaking Authority
					  440.13(11),
					  440.185 (9),
					 (10),
					 440.20(6),
					 440.525(4),
					 440.591,
					 440.593(5) FS.
					 Law Implemented 440.13(11),
					 440.185,
					  440.20(6),(8),
					  440.525,
					  440.593 FS.
New 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.003 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
The following definitions shall apply in the rule
				  chapter:
(1) "Action" - an event or
				events leading to the commission of a violation.
(2) "Audit" - a process whereby the practices
				of regulated entities are examined to verify compliance with Chapter 440, F.S.
				and other applicable Florida Statutes and Administrative Rules. The term
				"audit" is synonymous with the term "examination."
(3) "Batch" - a group of data records that is
				created and evaluated by CPS from manually or electronically submitted data
				received by the Department.
(4)
				"Centralized Performance System (CPS)" - a system that evaluates payment and
				filing data submitted to the Department.
(5) "Department" - the Florida Department of
				Financial Services.
(6) "Department
				Rules" - any and all rules adopted by the Department of Financial Services in
				its administration of Chapter 440, F.S., that apply to insurers or other
				regulated entities.
(7) "Division"
				- the Division of Workers' Compensation within the Florida Department of
				Financial Services.
(8)
				"Examination" - a process whereby the practices of regulated entities are
				examined to verify compliance with Chapter 440, F.S., and Department Rules. The
				term "examination" is synonymous with the term "audit."
(9) "F.A.C." - Florida Administrative
				Code.
(10) "F.S." - Florida
				Statutes.
(11) "Form DFS-F2-DWC-1"
				- Form DFS-F2-DWC-1 (First Report of Injury or Illness), effective 03/2009, or
				an electronic equivalent as required in Rule
				 69L-56.301, F.A.C.
(12) "Investigation" - a Department review
				that is conducted to verify compliance with Chapter 440, F.S., and Department
				Rules.
(13) "Pattern or Practice" -
				a repeated or customary act(s) of non-compliance with any single provision of
				Chapter 440, F.S. or Department Rules on an individual claim or on multiple
				claims.
(14) "Regulated Entity" -
				any insurer as defined in Section
				 440.02(38),
				F.S., employer, service company, servicing agent, third-party administrator,
				claims handling entity, self-serviced self-insured employer or fund, submitter
				of forms or data on behalf of an insurer, or managing general agent that is
				responsible for handling or adjusting claims, or fulfilling an insurer's
				responsibility to transmit workers' compensation data to the
				Department.
(15) "Violation" - any
				finding of non-compliance with Chapter 440, F.S. or Department
				Rules.
Rulemaking Authority
					  440.13(11),
					  440.185 (9),
					 (10),
					 440.20(6),
					 440.525(4),
					 440.591,
					 440.593(5) FS.
					 Law Implemented 440.13(11),
					 440.185,
					  440.20(6), (8),
					  440.525,
					  440.593 FS.
New 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.004 - Monitoring, Examining and Investigating

Current through Reg. 50, No. 138; July 16, 2024
(1) The Department shall monitor, examine, or
				investigate the performance of regulated entities to ensure compliance with
				Chapter 440, F.S. and Department Rules as often as is deemed necessary.
(a) Monitoring includes, but is not limited
				to, the ongoing review of data provided to the Department by regulated
				entities.
(b) Examining or
				investigating includes, but is not limited to, the review of a regulated
				entity's processes and shall be based upon:
1.
				The regulated entity's performance in prior examinations and/or investigations;
				or
2. Information obtained through
				the monitoring process.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.006 - Administrative Penalties and Fines

Current through Reg. 50, No. 138; July 16, 2024
The Department shall utilize the monitoring, examination, or
				  investigation processes to ensure compliance with Chapter 440, F.S. and
				  Department Rules. The Department may assess administrative penalties and fines
				  for violations. Violations within this rule are described in general language.
				  The use of general language shall not be construed to expand or modify the
				  statute. Violations are not necessarily described herein using the language
				  that would be used to formally assert the violation in any specific
				  case.
(1) Indemnity Violations.
(a) Late payments of compensation. In order
				to ensure insurer compliance under Chapter 440, F.S., the Department shall
				monitor, examine, and investigate the performance of insurers. The Department
				shall assess penalties for late payments of compensation that are below a
				minimum 95 percent timely payment performance standard. The insurer shall pay
				to the Workers' Compensation Administration Trust Fund a penalty of:
1. Fifty dollars per number of installments
				of compensation below the 95 percent timely payment performance standard and
				equal to or greater than a 90 percent timely payment performance
				standard.
2. One hundred dollars
				per number of installments of compensation below a 90 percent timely payment
				performance standard.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.007 - Pattern and Practice

Current through Reg. 50, No. 138; July 16, 2024
(1) A pattern or
				practice constitutes a willful violation if the regulated entity that committed
				the pattern or practice:
(a) Did so
				intentionally and with knowledge of the act's unlawfulness or with disregard to
				the unlawfulness of the act; or
(b)
				Failed to comply with an order of the Department and the insurer has exhausted
				all appellate rights.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.021 - Minimum Performance Standards (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.20(8)(c),
					 440.13(11)(b),
					 440.591 FS. Law Implemented
					 440.20,
					 440.13(11)
					 FS.
New 8-29-94, Formerly 38F-24.021, 4L-24.021, Repealed
					 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.0211 - Monitoring (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.20(15)(f),
					 440.591 FS. Law Implemented
					 440.20(15)
					 FS.
New 8-29-94, Amended 5-14-95, Formerly 38F-24.0211,
					 4L-24.0211, Repealed 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.022 - Auditing (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					  440.13(11) (b),
					 440.20(8)(c),
					 (17),
					 440.591 FS. Law Implemented
					 440.13(11),
					  440.20 FS.
New 8-29-94, Amended 5-14-95, Formerly 38F-24.022,
					 4L-24.022, Repealed 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.0222 - Re-Audit and Certification for Noncompliance (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(11)(b),
					 440.20(15)(f),
					 440.591 FS. Law Implemented
					 440.20
					 FS.
New 8-29-94, Amended 5-14-95, Formerly 38F-24.0222,
					 4L-24.0222, Repealed 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.0231 - Benefits and Administration Trust Fund Penalties Improper Filing Practices (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					  440.13(11)(b),
					 440.185,
					 440.591,
					 440.593(5) FS.
					 Law Implemented 440.13(11)(b),
					  440.185(9),
					  440.20(8)(a) 
					 FS.
New 8-29-94, Amended 5-14-95, 6-4-97, 11-28-01, Formerly
					 38F-24.0231, 4L-24.0231, Amended 1-8-04, 5-8-08, Repealed
					 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.024 - Medical Penalties (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(11)(a),
					 440.20(8)(c),
					 440.591 FS. Law Implemented
					 440.13(9)(f),
					 (11)
					 FS.
New 8-29-94, 5-14-95, Formerly 38F-24.024, 4L-24.024,
					 Repealed 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-24 - INSURERS' STANDARDS AND PRACTICES › Section 69L-24.0241 - Employee Failure to Appear for Independent Medical Examination (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.591 FS. Law Implemented
					 440.13(5)(d)
					 FS.
New 8-29-94, Amended 5-14-95, Formerly 38F-24.0241,
					 4L-24.0241, Repealed 1-12-10.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-26 - EMPLOYEE ASSISTANCE AND OMBUDSMAN OFFICE › Section 69L-26.002 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
For the purposes of these rules, the following definitions
				  shall apply:
(1) "Carrier" means any
				insurance carrier, or any individually self-insured employer licensed as such
				pursuant to section  440.38, F.S., or group
				self-insurance fund licensed as such pursuant to Section
				 624.462, F.S., providing
				workers' compensation insurance and including the servicing agent and servicing
				company of any of the above.
(2)
				"Contact" as that term is used in Chapter 93-415, Section 24, Laws of Florida.
				[creating Section  440.191(2)(a),
				F.S.] means a party to a workers' compensation dispute has made "contact" with
				the EAO if he or she has done any of the following:
(a) Submitted to the EAO a Request for
				Assistance form (EAO-1, dated 6/17/94 and hereby incorporated by reference)
				which meets all the requirements set out in these rules; or
(b) Personally telephoned the EAO, spoken to
				an EAO representative, requested the assistance of the EAO, and as a result,
				the EAO has completed a Request for Assistance form (EAO-1) on behalf of the
				party so requesting.
(c) In the
				case of a minor or incompetent person, written or oral correspondence in accord
				with paragraph (2)(a) or (b), above, requesting assistance from the EAO on
				behalf of the minor or incompetent person by his or her legally appointed
				guardian, shall constitute "contact" with the EAO for the purposes of these
				rules.
(d) In the case of a
				deceased person, written or oral correspondence in accord with paragraph (2)(a)
				or (b), above, requesting assistance from the EAO on behalf of a deceased
				person by his or her personal representative shall constitute "contact" with
				the EAO for the purposes of these rules.
(e) The following will not be accepted by the
				EAO as a request for assistance and do not constitute "contact" with the EAO
				for purposes of these rules:
1. Written
				requests for assistance not submitted in accordance with these rules and on a
				Request for Assistance form (EAO-1); or
2. Written requests for assistance
				transmitted to the EAO by fax; or
3. Written requests for assistance not signed
				by the party to a workers' compensation dispute; or if the party to a dispute
				has retained an attorney, not signed by that attorney on behalf of the party;
				or if the party to a dispute is a minor or incompetent person, not signed by
				his or her legal guardian; or if the party to a dispute is deceased, not signed
				by his or her personal representative; or if the requestor is a health care
				provider that has provided authorized treatment to an injured worker, not
				signed by the health care provider; or
4. Telephone calls of an attorney to the EAO
				made on behalf of a party to a workers' compensation dispute, unless the
				attorney is the party to a dispute and is requesting assistance on his or her
				own behalf.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-26 - EMPLOYEE ASSISTANCE AND OMBUDSMAN OFFICE › Section 69L-26.003 - Computation of Time (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.591 FS. Law Implemented
					 Chapter 93-415, Section 24, Laws of Florida [creating Section
					  440.191,
					 F.S.].
New 9-29-94, Formerly 38F-25.003, 4L-26.003, Repealed
					 5-7-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.001 - Definitions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.001,
					  59A-29.001, Amended 2-6-13,
					 Repealed 11-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.002 - Eligibility Requirements for Certification (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.002,
					  59A-29.002, Amended 2-6-13,
					 Repealed 11-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.003 - Certification Time Frames (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.002,
					  59A-29.003, Amended 2-6-13,
					 Repealed 11-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.004 - Occasional Health Care Providers (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.004,
					  59A-29.004, Repealed
					 2-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.005 - Revocation of Certification Status (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.005,
					  59A-29.005, Amended 2-6-13,
					 Repealed 11-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.006 - Decertification Process (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (8),
					 (13)
					 FS.
New 3-14-95, Formerly 38F-53.006,
					  59A-29.006, Repealed
					 2-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.007 - Recertification Process (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.007,
					  59A-29.007, Repealed
					 2-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.008 - Verification of Certification Status (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 F.S.
New 3-14-95, Formerly 38F-53.008,
					  59A-29.008, Amended 2-6-13,
					 Repealed 11-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.009 - Carrier Responsibilities (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.009,
					  59A-29.009, Repealed
					 2-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.010 - Certified Provider Responsibilities (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.010,
					  59A-29.010, Amended 2-6-13,
					 Repealed 11-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-29 - HEALTH CARE PROVIDER CERTIFICATION › Section 69L-29.011 - Workers' Compensation Certification Training Courses (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(3)(a),
					 440.591 FS. Law Implemented
					 440.13(3), (13)
					 FS.
New 3-14-95, Formerly 38F-53.011,
					  59A-29.011, Repealed
					 2-6-13.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-30 - EXPERT MEDICAL ADVISORS › Section 69L-30.003 - Qualifications for Expert Medical Advisor Certification and Re-Certification

Current through Reg. 50, No. 138; July 16, 2024
(1) To be certified as an EMA, a physician
				shall meet the following qualifications:
(a)
				Must have correctly answered 95% of the EMA Tutorial review questions;
				and,
(b) Must hold valid licensure,
				issued by the Florida Department of Health, with "clear active" status;
				and,
(c) Must demonstrate board
				certification or board eligibility applicable to the specialty for which the
				applicant seeks certification by submitting proof of current certification or
				eligibility; and,
(d) Must
				demonstrate experience in the assignment of permanent impairment ratings to
				Florida's injured employees, pursuant to Rule
				 69L-7.604, F.A.C., within the
				two-year period immediately preceding the date of application by submitting a
				minimum of two (2) copies of a completed DFS-F5-DWC-25, Florida Workers'
				Compensation Uniform Medical Treatment/Status Reporting Form, as incorporated
				in paragraph  69L-7.720(1)(d),
				F.A.C., assigning a permanent impairment rating; and,
(e) Must demonstrate experience in performing
				Independent Medical Examinations pursuant to Section
				 440.13(2)  or
				 440.13(5),
				F.S., by submitting a minimum of two (2) copies of a completed Independent
				Medical Examination report for a determination of the appropriateness of
				medical treatment being recommended or provided to an injured employee or for a
				determination of the injured employee's disability and physical limitations,
				within the two-year period immediately preceding the date of application;
				and,
(f) Must have completed twenty
				hours of continuing medical education (CME), specifically related to the
				physician's field of specialty, within the two-year period immediately
				preceding the date of application. Proof of required CMEs must be provided at
				time of application. Completion of courses required for licensure by the
				Florida Department of Health addressing Domestic Violence, HIV-AIDS and
				Prevention of Medical Errors will not be applied to the medical continuing
				education requirements for EMA Certification.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-30 - EXPERT MEDICAL ADVISORS › Section 69L-30.004 - Application Process for Expert Medical Advisor Certification

Current through Reg. 50, No. 138; July 16, 2024
(1) A physician shall apply for certification
				by satisfactorily completing the online EMA Tutorial, pursuant to subsection
				 69L-30.002(6),
				F.A.C.
(2) As part of the EMA
				certification process, the physician shall agree to provide consultation or
				services in accordance with the timetables set forth in chapter 440, F.S., and
				abide by rules adopted by the Department.
(3) The certification process shall be
				considered properly completed when the physician correctly answers 95% of the
				online EMA Tutorial questions and uploads to the above-referenced DWC Medical
				Services Web Portal, the required documentation, as set forth in rule
				 69L-30.003, F.A.C. Failure to
				properly complete the certification process shall result in the application
				being rejected. Subject to the limitations in this rule chapter, a rejected
				applicant can immediately re-apply.
(4) Successful applicants shall receive an
				electronically generated EMA Certificate issued by the Department's Division of
				Workers' Compensation.
(5) Upon
				issuance of the EMA Certificate, the following provider information will be
				recorded on the Certification List:
(a)
				Certificate expiration date;
(b)
				First and Last Name;
(c) DOH
				license number and licensure status;
(d) Place of business, name, address(es) and
				telephone number(s); and,
(e)
				Specialty board affiliation(s) and sub-specialty(ies) and certification
				status.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-30 - EXPERT MEDICAL ADVISORS › Section 69L-30.005 - Selection of Expert Medical Advisors

Current through Reg. 50, No. 138; July 16, 2024
(1) All individuals on the Certification List
				are eligible to provide EMA services for the Department or a JCC.
(2) When services are needed by the
				Department, the Department shall:
(a) Select
				an EMA from the Certification List; and,
(b) Make the necessary arrangements for the
				EMA to provide the services.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-30 - EXPERT MEDICAL ADVISORS › Section 69L-30.006 - Temporary Expert Medical Advisors

Current through Reg. 50, No. 138; July 16, 2024
(1) A
				physician who has been disciplined for a violation pursuant to section
				 440.13, F.S., shall not be
				certified as a Temporary EMA.
(2)
				When the Department needs EMA services and there is no EMA on the Certification
				List who meets the needs of the Department or who is available to provide the
				EMA services needed, the Department may certify a physician as a Temporary EMA,
				for a specific case, if the physician:
(a)
				Holds a clear active medical license or a valid Florida medical school teaching
				certificate pursuant to section
				 458.3145,
				 459.0077,
				 463.0057 or
				 466.002, F.S.; and,
(b) Holds board certification or is board
				eligible in the specialty area needed by the Department to fulfill its
				responsibilities under subsections
				 440.13(9) and
				(11), F.S.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-30 - EXPERT MEDICAL ADVISORS › Section 69L-30.007 - Expert Medical Advisor Responsibilities

Current through Reg. 50, No. 138; July 16, 2024
(1) A physician shall disclose any conflict
				of interest upon receiving notice of selection as an EMA or Temporary EMA and
				shall not accept selection if a conflict of interest exists. For the purposes
				of this rule, "conflict of interest" means that any of the following matters
				may exist, potentially influencing the EMA's opinions and decisions while
				fulfilling responsibilities to evaluate the medical care provided the injured
				employee by the examining physician:
(a)
				Private, business, financial or ownership interests involving potential gain or
				benefit based on the outcome of the case; or
(b) Prior knowledge of the injured
				employee.