reglab/statecodes huggingface dataset:
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.025 - Conditional Release of Stop-Work Order and Periodic Payment Agreement

Current through Reg. 50, No. 138; July 16, 2024
(1) The requirements for issuance of a Form
				DFS-F4-1602
http://www.flrules.org/Gateway/reference.asp?No=Ref-15437
,
				Agreed Order of Conditional Release from Stop-Work Order, revised 01/23, and
				incorporated by reference herein, as provided for in Section
				 440.107, F.S., are as follows:
(a) The employer has come into compliance
				with the coverage requirements of Chapter 440, F.S. Compliance with the
				coverage requirements of Chapter 440, F.S., includes demonstration by the
				employer that it is no longer failing to secure the payment of compensation
				within the meaning of Section
				 440.107, F.S.
(b) The employer has paid a minimum penalty
				of $1,000 as a down payment and agreed to remit periodic payments of the
				remaining penalty amount pursuant to either Form DFS-F4-1600-A,
http://www.flrules.org/Gateway/reference.asp?No=Ref-15435
,
				Payment Agreement Schedule for Periodic Payment of Penalty, revised 01/23
				(applicable in cases where the employer was issued a stop-work order), or Form
				DFS-F4-1600-B,
http://www.flrules.org/Gateway/reference.asp?No=Ref-15436
,
				Payment Agreement Schedule for Periodic Payment of Penalty for Order of Penalty
				Assessment, revised 01/23 (applicable in cases where the employer was issued an
				Order of Penalty Assessment). Both of the above forms are incorporated by
				reference herein. The aforementioned and any other forms incorporated by
				reference under this rule may be obtained from the Division of Workers'
				Compensation's Bureau of Compliance, 1579 Summit Lake Drive, Tallahassee, FL
				32317, or from any field office.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.026 - F.A.C. Periodic Reports (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 440.107(7)(a), 440,591 FS. Law
					 Implemented 440.107
					 FS.
New 9-15-10, Repealed
					 11-26-14.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.027 - Penalty Calculation Worksheet

Current through Reg. 50, No. 138; July 16, 2024
(1)
				For purposes of calculating penalties to be assessed against employers pursuant
				to Section  440.107, F.S., the Division
				shall use Form DFS-F4-1595,
https://www.flrules.org/Gateway/reference.asp?No=Ref-15434
,
				Penalty Calculation Worksheet, revised 01/23, which is hereby incorporated by
				reference.
(2) Copies of Form
				DFS-F4-1595, Penalty Calculation Worksheet, are available from the Department
				of Financial Services, Division of Workers' Compensation, 1579 Summit Lake
				Drive, Tallahassee, FL 32317.
Rulemaking Authority
					 440.107,
					 440.591 FS. Law Implemented
					 440.107
					 FS.
New 12-29-04, Amended 10-18-07, 4-12-15, 3-21-17,
					 7-18-23.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.028 - Procedures for Imputing Payroll and Penalty Calculations

Current through Reg. 50, No. 138; July 16, 2024
(1) In the event an employer fails to provide
				business records sufficient for the Department to determine the employer's
				payroll for the time period requested in the business records request for the
				calculation of the penalty pursuant to Section
				 440.107(7)(e),
				F.S., the Department may impute the employer's payroll at any time after
				twenty-one days after receipt by the employer of a written request to produce
				such business records.
(2) The
				employer's time period or periods of non-compliance means the time period(s)
				within the 12-month period preceding the date the Stop-Work Order was issued to
				the employer within which the employer failed to secure the payment of
				compensation pursuant to Chapter 440, F.S., or within the two years preceding
				the date the Stop-Work Order was issued to the employer who understated or
				concealed payroll or has been previously issued a Stop-Work Order. The time
				period or periods of non-compliance must be either the same time period as set
				forth in the business records request for the calculation of penalty or an
				alternative time period or period(s) as determined by the Department, whichever
				is less. The employer may provide the Department with records from other
				sources, including, but not limited to, the Department of State, Division of
				Corporations, the Department of Business and Professional Regulation, licensing
				offices, and building permitting offices to show an alternative time period or
				period(s) of non-compliance.
(3)
				When an employer fails to provide business records sufficient to enable the
				Department to determine the employer's payroll for the time period requested in
				the business records request for purposes of calculating the penalty pursuant
				to Section  440.107(7)(d),
				F.S., the imputed weekly payroll for each current and former employee,
				corporate officer, sole proprietor, or partner identified by the Department
				during its investigation will be the statewide average weekly wage as defined
				in Section  440.12(2),
				F.S., that is in effect at the time the Stop-Work Order was issued to the
				employer, multiplied by 1.5.
(a) If a portion
				of the period of non-compliance includes a partial week of non-compliance, the
				imputed weekly payroll for such partial week of non-compliance will be prorated
				from the imputed weekly payroll for a full week.
(b) The imputed weekly payroll for each
				employee, corporate officer, sole proprietor, and partner will be assigned to
				the highest rated workers' compensation classification code for an employee
				based upon records or the investigator's physical observation of any employee's
				activities.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.030 - Penalties for Employers Currently in Compliance Previously Failing to Secure the Payment of Compensation

Current through Reg. 50, No. 138; July 16, 2024
(1) When an
				investigation commenced by the Department pursuant to Section
				 440.107, F.S., reflects that, on
				the date the investigation commences, the employer is failing to secure the
				payment of workers' compensation, is materially understating or concealing
				payroll, is materially understating or concealing employee duties so as to
				avoid proper classification for premium calculations, or is materially
				misrepresenting or concealing information pertinent to the computation and
				application of an experience rating modification factor, but the employer comes
				into compliance with the workers' compensation coverage requirements prior to
				the issuance of a Stop-Work Order, such employer shall be assessed a penalty
				pursuant to Section 440.107(7)(d)1., F.S., and a Stop-Work Order will not be
				issued for such violations.
(2) For
				purposes of this rule, an investigation commences on the date the Department's
				compliance investigator conducts an inspection of the employer's worksite or
				business, or on the date the employer receives a written request to produce
				business records from the Department pursuant to Section
				 440.107(7)(a),
				F.S., whichever is earlier.
Rulemaking Authority
					 440.107,
					 440.591 FS. Law Implemented
					 440.107
					 FS.
New 3-15-06, Amended
					 7-18-23.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.031 - Stop-Work Orders in Effect Against Successor Corporations or Business Entities

Current through Reg. 50, No. 138; July 16, 2024
(1) Under Section
				 440.107(7)(b),
				F.S., Stop-Work Orders or Orders of Penalty Assessment issued against a
				corporation, limited liability company, partnership, or sole proprietorship
				shall be in effect against any successor corporation or business entity that
				has one or more of the same principals, limited liability company members, or
				officers as the predecessor corporation or business entity against which the
				Stop-Work Order was issued and are engaged in the same or equivalent trade or
				activity.
(a) For employers engaged in the
				construction industry, a corporation, limited liability company, partnership,
				or sole proprietorship and the successor corporation or business entity that
				has been issued a Stop-Work Order or Order of Penalty Assessment, are engaged
				in the same or equivalent trade or activity if they each perform or have
				performed business operations that include operations described in at least one
				classification code listed in Rule
				 69L-6.021, F.A.C.
(b) For employers engaged in the
				non-construction industry, a corporation, limited liability company,
				partnership, or sole proprietorship and the successor corporation or business
				entity that has been issued a Stop-Work Order or Order of Penalty Assessment,
				are engaged in the same or equivalent trade or activity if they each perform or
				have performed business operations that include operations described in at
				least one classification code that is in the manufacturing, goods and services,
				or the office and clerical industry group listed in subsection (6) of this
				rule.
(c) For employers that
				perform business operations described by one of the classification codes in the
				miscellaneous industry groups listed in subsection (6) of this rule, a
				corporation, limited liability company, partnership, or sole proprietorship and
				the successor corporation or business entity that has been issued a Stop-Work
				Order or Order of Penalty Assessment, are engaged in the same or equivalent
				trade or activity if they each perform or have performed the same business
				operation described in one of the classification codes contained in the
				miscellaneous industry groups.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.032 - Contractor Requirements For Obtaining Evidence That Subcontractors Possess Workers' Compensation Insurance or Otherwise Comply with Chapter 440, F.S

Current through Reg. 50, No. 138; July 16, 2024
(1) In order for a
				contractor who is not securing the payment of compensation pursuant to Section
				 440.38(1)(a),
				F.S., to satisfy its obligation to obtain evidence of workers' compensation
				insurance or a Certificate of Election to Be Exempt from a subcontractor
				pursuant to Section  440.10(1)(c),
				F.S., such contractor shall obtain and provide to the Department, when
				requested, the evidence specified in subsections (2), (3), (4), or (5)
				herein.
(2) If a workers'
				compensation insurance policy has been issued to the subcontractor, the
				contractor, as described in subsection (1) of this rule, may obtain one of the
				following documents as evidence of workers' compensation insurance for a
				subcontractor:
(a) A copy of the "Information
				Page" of the subcontractor's workers' compensation insurance policy;
(b) A screen print from the Division of
				Workers' Compensation, Proof of Coverage database confirming that workers'
				compensation coverage is in effect for the subcontractor. The Proof of Coverage
				database can be accessed from the Division's website at
https://dwcdataportal.fldfs.com/ProofOfCoverage.aspx
;
				or
(c) A Certificate of Liability
				Insurance and written documentation obtained either from the producer or
				carrier confirming that workers' compensation coverage is in effect for the
				subcontractor. Written documentation may include a screen print from the
				Division of Workers' Compensation, Proof of Coverage database. The Certificate
				of Liability Insurance shall include the following information and
				documentation in order to be considered valid evidence of workers' compensation
				insurance for purposes of this rule:
1. The
				producer section lists the producer's name, address, and phone
				number;
2. The Insurers Affording
				Coverage section lists the name of the carrier that is providing workers'
				compensation insurance;
3. The name
				of the subcontractor is listed as the insured;
4. The proper policy number is provided for
				the Workers' Compensation and Employers' Liability Insurance, or binder number
				if the policy has not been issued as of the date of the issuance of the
				Certificate of Liability Insurance;
5. The dollar limits of coverage are listed
				for the Workers' Compensation and Employers' Liability Insurance;
6. An authorized representative has signed
				the Certificate of Liability Insurance;
7. The date(s) the work is being performed by
				the subcontractor for the contractor falls within the Policy Effective and
				Policy Expiration dates listed on the Certificate of Liability
				Insurance.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-6 - WORKERS' COMPENSATION COMPLIANCE › Section 69L-6.036 - Online Workers' Compensation Coverage and Compliance Tutorial for 15% Penalty Reduction

Current through Reg. 50, No. 138; July 16, 2024
(1) Pursuant to
				Section  440.107, F.S., the Division will
				reduce the final assessed penalty by 15% if:
(a) The employer has not been previously
				issued a Stop-Work Order or Order of Penalty Assessment; and
(b) The employer takes an online workers'
				compensation coverage and compliance tutorial and correctly answers at least
				80% of the questions within 21 days after the employer's receipt of the
				Division's written request to product business records.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.020 - Florida Workers' Compensation Health Care Provider Reimbursement Manual

Current through Reg. 50, No. 138; July 16, 2024
(1) The Florida Workers' Compensation Health
				Care Provider Reimbursement Manual, 2020 Edition, to become effective July 1,
				2022, is incorporated by reference as part of this rule. The HCP RM contains
				the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member
				Panel, pursuant to section
				 440.13(12),
				F.S., and establishes reimbursement policies, guidelines, codes, and MRAs for
				services provided by health care providers. Also, the HCP RM includes
				reimbursement policies and payment methodologies for pharmacists and medical
				suppliers. The policies and procedures in the HCP RM are in addition to the
				requirements and responsibilities established throught rule Chapter 69L-7,
				F.A.C., Workers' Compensation Medical Reimbursement and Utilization
				Review.
(2) The Current Procedural
				Terminology (CPT®), 2020 Professional Edition,
				Copyright 2019, American Medical Association; the CDT 2020, Dental Procedure
				Codes, Copyright 2020, American Dental Association; in part, for D codes and
				for injectable J codes, and for other medical services and supply codes, the
				HCPCS Level II, Professional 2020 edition, American Medical Association,
				Copyright 2020, Elsevier Inc.; the CPT®
				Assistant 2020, American Medical Association, Copyright 2019; and the ICD-10-CM
				2020: The Complete Official Codebook, American Medical Association, Copyright
				2019, Optum 360, LLC, are incorporated by reference as part of this rule. A
				copy of the American Medical Association reference materials may be obtained
				from the American Medical Association's website at
https://commerce.ama-assn.org/store/
.
				A copy of the CDT reference material may be obtained from the American Dental
				Association's website at
https://www.ada.org/en/publications/ada-catalog
.
(3) Posting the copyrighted materials in
				subsection (2) above and the HCP RM on the Internet would constitute a
				violation of federal copyright law. These materials are available for public
				inspection and examination, but may not be copied, during normal business hours
				at:
(a) the Florida Department of Financial
				Services, Division of Workers' Compensation, Bureau of Monitoring and Audit,
				1579 Summit Lake Drive, Tallahassee, Florida 32317, or
(b) the Florida Department of State, R.A.
				Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. In
				addition, the HCP RM may be obtained via the Department's Division of Workers'
				Compensation website at
https://www.myfloridacfo.com/Division/wc/
.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.100 - Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)

Current through Reg. 50, No. 138; July 16, 2024
(1) The Florida
				Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASC
				RM), 2020 Edition, effective 07/23 is incorporated herein by reference. The
				policy, procedures, principles, and standards in the ASC RM supplement the
				requirements and responsibilities established throughout rule Chapter 69L-7,
				F.A.C., Workers' Compensation Medical Reimbursement and Utilization
				Review.
(2) The ASC RM refers to a
				number of procedure codes and modifiers that are consistent with the Current
				Procedural Terminology (CPT®), developed and
				published by the American Medical Association. When a service or procedure is
				performed that does not have a code listed in the ASC RM, the Ambulatory
				Surgical Center shall refer to the Current Procedural Terminology
				(CPT®), 2020 Professional Edition, Copyright
				2019, American Medical Association, which is incorporated herein by reference.
				The CPT® Assistant 2020, American Medical
				Association, Copyright 2019; the ICD-10-CM 2020: The Complete Official
				Codebook, American Medical Association, Copyright 2019, Optum 360, LLC; and the
				ICD-10-PCS 2020: The Complete Official Codebook, American Medical Association,
				Copyright 2019 Optum 360, LLC are also incorporated herein by reference. A copy
				of these reference materials may be obtained from the American Medical
				Association's website at
https://commerce.ama-assn.org/store/
.
(3) The National Uniform Billing Committee
				(NUBC), Official UB-04 Data Specifications Manual 2021, version 15.00, July
				2020, American Hospital Association, is incorporated herein by reference. A
				copy of this manual can be obtained from the National Uniform Billing
				Committee's website at
https://www.nubc.org/
.
(4) The CDT 2020, Dental Procedure Codes,
				Copyright 2020, American Dental Association, is incorporated herein by
				reference, for dental D codes. A copy of the CDT reference material may be
				obtained from the American Dental Association's website at
http://www.ada.org/en/publications/ada-catalog
.
(5) The Department has determined that
				posting the publications referenced in subsections (1), (2), (3) and (4) on the
				Internet for purposes of public examination and inspection would constitute a
				violation of federal copyright law. These copyrighted materials may be viewed,
				during regular business hours, at the offices of:
1. Division of Workers' Compensation, Bureau
				of Monitoring and Audit, 1579 Summit Lake Drive, Tallahassee, Florida 32317;
				or
2. The Florida Administrative
				Code and Register, R.A. Gray Building, 500 South Bronough Street, Tallahassee,
				Florida 32399-0250.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.501 - Florida Workers' Compensation Reimbursement Manual for Hospitals

Current through Reg. 50, No. 138; July 16, 2024
(1) The Florida Workers' Compensation
				Reimbursement Manual for Hospitals, (Hospital RM), 2020 Edition, effective
				06/23, is incorporated herein by reference The policy, procedures, principles
				and standards in the Hospital RM supplement the requirements and
				responsibilities established throughout rule Chapter 69L-7, F.A.C. Workers'
				Compensation Medical Reimbursement and Utilization Review.
(2) The Current Procedural Terminology
				(CPT®), 2020 Professional Edition, Copyright 2019, American Medical
				Association; the CPT® Assistant 2020, American Medical Association,
				Copyright 2019; the ICD-10-CM 2020: The Complete Official Codebook, American
				Medical Association, Copyright 2019, Optum 360, LLC; the ICD-10-PCS 2020: The
				Complete Official Codebook, American Medical Association, Copyright 2019, Optum
				360, LLC; the 2020 HCPCS Level II Professional Edition, American Medical
				Association, Copyright 2020, Elsevier Inc.; and the CDT 2020, Dental Procedure
				Codes, Copyright 2020, American Dental Association, are incorporated herein by
				reference. A copy of the American Medical Association's reference materials may
				be obtained from the American Medical Association's website at
https://commerce.ama-assn.org/store/ui
.
				A copy of the CDT reference material may be obtained from the American Dental
				Association's website at
https://www.ada.org/en/publications/ada-catalog.
(3) The National Uniform Billing Committee
				(NUBC), Official UB-04 Data Specifications Manual 2021, version 15.00, July
				2020, American Hospital Association, is incorporated herein by reference. A
				copy of this manual can be obtained from the National Uniform Billing
				Committee's website at
https://www.nubc.org/
.
(4) The Florida Workers' Compensation Health
				Care Provider Reimbursement Manual (HCP RM), incorporated by reference into
				Rules  69L-7.020, and
				 69L-7.100 through 69L-7.550,
				F.A.C. which inform Health Care Providers and Insurers of their respective
				responsibilities in the billing, filing, reporting and review of worker's
				compensation medical claims, are recognized for use in conjunction with the
				Hospital RM.
(5) The Department has
				determined that posting the documents referenced in subsections (1), (2), and
				(3) on the Internet for purposes of public examination and inspection would
				constitute a violation of federal copyright law. These copyrighted materials
				may be viewed, during regular business hours, at the offices of:
1. Division of Workers' Compensation, Bureau
				of Monitoring and Audit, 1579 Summit Lake Drive, Tallahassee, Florida 32317;
				or
2. The Florida Administrative
				Code and Register, R.A. Gray Building, 500 South Bronough Street, Tallahassee,
				Florida 32399-0250.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.601 - Copying Charges for Medical Records

Current through Reg. 50, No. 138; July 16, 2024
Health care providers and health care facilities shall upon
				  demand furnish an injured employee or his attorney a copy of his office chart,
				  records and reports. The health care provider or health care facility
				  furnishing the records may charge the employee for copying the records up to
				  $.50 per page or the actual direct cost to the health care provider or health
				  care facility for x-rays, microfilm, or other non-paper
				  records.
Rulemaking Authority
					 440.13(4)(c)
					 FS. (1988 Supp.). Law Implemented
					 440.13(4)(b)
					 FS. (1988 Supp.).
New 11-14-89, Formerly 38F-7.601,
					 4L-7.601.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.602 - Florida Workers' Compensation Medical Services Billing, Filing and Reporting Rule (Transferred)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.13(4),
					 440.15(3)(b), (d),
					 (f),
					 440.185(5),
					 440.20(6)(b),
					 440.525(2),
					 440.591,
					 440.593(5) FS.
					 Law Implemented  440.09,
					  440.13(2)(a), (3), (4), (6), (11), (12), (14),
					 (16),
					  440.15(3)(b), (d), (f),
					 (5),
					  440.185(5),
					 (9),
					  440.20(6),
					  440.525(2),
					  440.593 FS.
New 1-23-95, Formerly 38F-7.602, 4L-7.602, Amended 7-4-04,
					 10-20-05, 6-25-06, 3-8-07, 1-12-10, 10-23-12, 11-6-13, Transferred to
					  69L-7.710.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.604 - Permanent Impairment

Current through Reg. 50, No. 138; July 16, 2024
(1) Determination
				of Physical Impairment Rating. The American Medical Association's Guide to the
				Evaluation of Permanent Impairment, 3rd Edition, (AMA Guide) (Copyright 1988 by
				the American Medical Association) is adopted as the schedule for determining
				the existence and degree of permanent impairment for all injuries prior to July
				1, 1990. For injuries occurring on or after July 1, 1990, but before the
				effective date of the Florida Impairment Rating Guide, the Minnesota Department
				of Labor and Industry Disability Schedule shall be used unless that schedule
				does not address an injury, in which case, the AMA Guide shall be used. For
				injuries occurring on or after its effective date, the Florida Impairment
				Rating Guide, which is adopted by reference as part of this rule, shall be
				used. The Florida Impairment Rating Guide shall also be known as the Florida
				Impairment Rating Schedule, which is the "uniform permanent impairment rating
				schedule" and the "uniform disability rating schedule" referenced in Section
				440.15(3)
				(a)2., F.S. The impairment rating must always be applied to the body as a
				whole.
(2) The 1996 Florida Uniform
				Permanent Impairment Rating Schedule is incorporated into this rule by
				reference and shall be used for injuries occurring on or after its effective
				date.
Rulemaking Authority 440.15(3),
					 440.591 FS. Law Implemented
					 440.15(3),
					 440.185,
					 440.20
					 FS.
New 10-30-79, Amended 11-5-81, 6-23-82, 6-12-84, Formerly
					 38F-3.17, Amended 4-11-90, 1-30-91, 6-21-93, 11-8-94, 6-15-95, 1-8-97, Formerly
					 38F-3.017, Formerly 37F-7.604, 4L-7.604.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.720 - Forms Incorporated by Reference for Medical Billing, Filing and Reporting

Current through Reg. 50, No. 138; July 16, 2024
(1) The following
				forms, including form completion instructions, are incorporated for use with
				rules adopted under this rule chapter.
(a)
				Form DFS-F5-DWC-9/CMS-1500 Health Insurance Claim Form, Rev. 02/12; Completion
				Instructions for Form DFS-F5-DWC-9 are comprised of three sets.
1. Form DFS-F5-DWC-9-A,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06186
,
				Completion Instructions for Physicians and Recognized Practitioners, Rev.
				01/01/2015;
2. Form DFS-F5-DWC-9-B,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06187
,
				Completion Instructions for Work Hardening and Pain Management Programs, Rev.
				01/01/2015;
3. Form DFS-F5-DWC-9-C,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06188
,
				Completion Instructions for Ambulatory Surgical Centers, Rev. 01/01/2015 (only
				for dates of services prior to July 8, 2010);
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-8 - SELECTED MATERIALS INCORPORATED BY REFERENCE › Section 69L-8.071 - Materials for use with the Florida Workers' Compensation Health Care Provider Reimbursement Manual

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				following materials are incorporated by reference:
(a) Rule
				 69L-7.710, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06181
;
(b) Rule
				 69L-7.720, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06182
;
(c) Rule
				 69L-7.730, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06183
;
(d) Rule
				 69L-7.740, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06184
;
(e) The CPT®
				2016 Current Procedural Terminology Professional Edition, Copyright 2015,
				American Medical Association;
(f)
				The CDT 2016, Dental Procedure Codes, Copyright 2015, American Dental
				Association;
(g) The 2016 HCPCS
				Level II Professional Edition, American Medical Association, Copyright 2016,
				Elsevier Saunders;
(h) The 2016
				ICD-10-CM: The Complete Official Codebook, American Medical Association,
				Copyright 2015, Optum 360, LLC; and,
(i) The 2016
				CPT® Assistant, Copyright American Medical
				Association.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-8 - SELECTED MATERIALS INCORPORATED BY REFERENCE › Section 69L-8.072 - Materials for use with the Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers

Current through Reg. 50, No. 138; July 16, 2024
(1) The following materials are incorporated
				by reference:
(a) Rule
				 69L-7.710, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06181
;
(b) Rule
				 69L-7.720, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06182
;
(c) Rule
				 69L-7.730, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06183
;
(d) Rule
				 69L-7.740, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06184
;
(e) The CPT®
				2015 Current Procedural Terminology Professional Edition, Copyright 2014,
				American Medical Association;
(f)
				The CDT 2015, Dental Procedure Codes Copyright 2014, American Dental
				Association;
(g) The 2015 ICD-9-CM
				Professional Edition for Hospitals, Volumes 1, 2 & 3, American Medical
				Association, Copyright 2015;
(h)
				The 2015 ICD-9-CM Professional Edition for Physicians, Volumes 1 & 2,
				American Medical Association, Copyright 2015;
(i) The 2015
				CPT® Assistant, Copyright American Medical
				Association;
(j) National Uniform
				Billing Committee Official UB-04 Data Specifications Manual 2016, version
				10.00, July 2015, as adopted by the National Uniform Billing Committee. A copy
				of this manual can be obtained from the National Uniform Billing Committee web
				site:
http://www.nubc.org/subscriber/
;
(k) The 2015 ICD-10-CM: The Complete Official
				Draft Codebook, American Medical Association, Copyright 2014, OptumInsight,
				Inc.; and,
(l) The 2015 ICD-10-PCS:
				The Complete Official Draft Codebook, American Medical Association, Copyright
				2014, OptumInsight, Inc.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-8 - SELECTED MATERIALS INCORPORATED BY REFERENCE › Section 69L-8.073 - Materials for use with the Florida Workers' Compensation Hospital Reimbursement Manual

Current through Reg. 50, No. 138; July 16, 2024
(1) The following
				materials are incorporated by reference:
(a)
				Rule  69L-7.710, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06181
;
(b) Rule
				 69L-7.720, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06182
;
(c) Rule
				 69L-7.730, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06183
;
(d) Rule
				 69L-7.740, F.A.C.,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06184
;
(e) The 2015 ICD-9-CM Professional Edition
				for Hospitals, Volumes 1, 2 & 3, Copyright 2015, American Medical
				Association;
(f) The 2015
				ICD-10-CM: The Complete Official Draft Codebook, American Medical Association,
				Copyright 2014, OptumInsight, Inc.;
(g) The 2015 ICD-10-PCS: The Complete
				Official Draft Codebook, American Medical Association, Copyright 2014,
				OptumInsight, Inc.;
(h) The
				CPT® 2015 Current Procedural Terminology
				Professional Edition, Copyright 2014, American Medical Association;
(i) The CDT 2015, Dental Procedure Codes,
				Copyright 2014, American Dental Association;
(j) The "2015 HCPCS Level II Professional
				Edition", American Medical Association, Copyright 2015, Elsevier
				Saunders;
(k) The 2015 ICD-9-CM
				Professional Edition for Physicians, Volumes 1 & 2, American Medical
				Association, Copyright 2015; and,
(l) The 2015
				CPT® Assistant, Copyright American Medical
				Association.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-8 - SELECTED MATERIALS INCORPORATED BY REFERENCE › Section 69L-8.074 - Materials for use throughout Rule Chapter 69L-7, F.A.C

Current through Reg. 50, No. 138; July 16, 2024
(1) The following materials are incorporated
				by reference:
(a) The HCPCS Level II
				Professional Edition, as adopted in rules
				 69L-8.071 and
				 69L-8.073, F.A.C.
(b) The Current Procedural Terminology
				(CPT®), as adopted in rules
				 69L-8.071,  69L-8.072 and
				 69L-8.073, F.A.C.
(c) The CDT, Dental Procedure Codes, as
				adopted in rules  69L-8.071,
				 69L-8.072 and
				 69L-8.073, F.A.C.
(d) The ICD-9-CM Professional Edition for
				Physicians, Volumes 1 & 2, as adopted in rules
				 69L-8.072 and
				 69L-8.073, F.A.C.
(e) The ICD-9-CM Professional Edition for
				Hospitals, as adopted in rules  69L-8.072 and
				 69L-8.073, F.A.C.
(f) The American Medical Association's Guide
				to the Evaluation of Permanent Impairment, as adopted in rule
				 69L-7.604, F.A.C.
(g) The Minnesota Department of Labor and
				Industry Disability Schedule, as adopted in rule
				 69L-7.604, F.A.C.
(h) The Florida Impairment Rating Guide, as
				adopted in rule  69L-7.604, F.A.C.
(i) The 1996 Florida Uniform Permanent
				Impairment Rating Schedule, as adopted in rule
				 69L-7.604, F.A.C.
(j) The National Uniform Billing Committee,
				Official UB-04 Data Specifications Manual 2017, version 11.00, July 2016, as
				adopted by the National Uniform Billing Committee. (A copy of this manual can
				be obtained from the National Uniform Billing Committee website at
http://www.nubc.org/subscriber/
.)
(k) The Florida Medical EDI Implementation
				Guide,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06185
(MEIG), 2015. (The Florida Medical EDI Implementation Guide (MEIG), 2015, that
				can be obtained from the DFS/DWC website at
http://www.myfloridacfo.com/Division/WC/EDI/Med_EDI.htm
.)
(l) The ICD-10-CM: The Complete Official
				Codebook, American Medical Association, as adopted in rules
				 69L-8.071,
				 69L-8.072, and
				 69L-8.073, F.A.C.
(m) The ICD-10-PCS: The Complete Official
				Codebook, American Medical Association, as adopted in rules
				 69L-8.072, and
				 69L-8.073, F.A.C.
(n) The CPT®
				Assistant, Copyright American Medical Association, as adopted in rules
				 69L-8.071,
				 69L-8.072, and
				 69L-8.073,
				F.A.C.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-9 - DRUG TESTING RULE › Section 69L-9.015 - Drug Testing Criteria (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					  440.09(7),
					  440.101,
					  440.102 (10) FS.
					 Law Implemented 440.09(7),
					 440.101,
					 440.102,
					  627.0915 FS.
New 4-30-96, Formerly 38F-9.015, 4L-9.015, Repealed
					 12-12-11.
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-10.006 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) Claimant - an insurance carrier,
				self-insurance fund, or employer seeking reimbursement from the SDTF.
(2) Representative - a person representing a
				claimant such as an attorney or a service organization.
(3) Notice of Claim - The document[s]
				submitted by a claimant that places the SDTF on notice of the claim.
(4) Proof of Claim - The document[s]
				submitted by a claimant that includes a completely filled out DFS-F1-SDF-1
				(rev. 3-09) with all required documents attached to fully support the
				claim.
Rulemaking Authority
					 440.49(2),
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 4-19-92, Amended 8-18-93, Formerly 38F-10.006,
					 4L-10.006, Amended 3-16-09.
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-10.0065 - Filing; Facsimile Transmissions

Current through Reg. 50, No. 138; July 16, 2024
(1)
				All claims, notices, legal documents, forms, affidavits, reimbursement
				requests, and documentation shall be submitted by mail or in person at the
				Tallahassee office of the SDTF. The filing date shall be the date
				received.
(2) Documentation which
				is requested by the SDTF subsequent to receipt of the notice of claim and proof
				of claim may be submitted by facsimile transmission, provided there is a prior
				agreement between the sender and the SDTF regarding such specific transmission.
				The Fund will make the determination based on the urgency and volume of the
				transmission. All such facsimile transmissions shall be completed between the
				hours of 8:00 a.m. and 5:00 p.m. (EST) or (EDT).
(3) Any document which is required to be
				submitted by mail or in person may not be submitted by facsimile transmission
				and will not be accepted or effective until proper service is completed as set
				out in subsection (1).
Rulemaking Authority
					 440.49(7)(g),
					 440.591 FS. Law Implemented
					 440.49(7)
					 FS.
New 8-18-93, Formerly 38F-10.0065,
					 4L-10.0065.
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-10.007 - Notice of Claim

Current through Reg. 50, No. 138; July 16, 2024
A Notice of Claim for reimbursement from the SDTF shall be
				  filed with the SDTF, Division of Worker's Compensation, 200 East Gaines Street,
				  Tallahassee, FL 32399-4223. The Notice of Claim may be filed by letter form and
				  shall include the following:
(1) Name
				and social security number of the employee;
(2) The name and address of the
				employer;
(3) The date of the
				accident;
(4) The name and address
				of the insurance carrier, self-insurance fund or employer on whose behalf the
				claim is made.
Rulemaking Authority
					 440.49(7)(a)
					 FS. Law Implemented 440.49(7)
					 FS.
New 4-19-92, Amended 8-18-93, Formerly 38F-10.007,
					 4L-10.007.
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-10.009 - Claimant's Representatives

Current through Reg. 50, No. 138; July 16, 2024
A Notice of Claim shall be filed by a claimant or its
				  representative. Once a claimant is represented before the SDTF by an attorney
				  or other representative, and then a substitute representative is employed by
				  the claimant, the substitute representative must file, in letter form, a
				  substitution of representation, with notice to the former
				  representative.
Rulemaking Authority
					 440.49(7)(a)
					 FS. Law Implemented 440.49(7)
					 FS.
New 4-19-92, Formerly 38F-10.009,
					 4L-10.009.
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-10.011 - Informed Conclusion of Pre-existing Conditions for Proof of Claim

Current through Reg. 50, No. 138; July 16, 2024
(1) Statements submitted to meet the proof
				requirement of this rule section and Section
				 440.49(6)(a),
				F.S., shall be by deposition, as authorized by Section
				 440.30, F.S., or by an original
				affidavit.
(2) Except as provided
				in Section  440.49(6)(a),
				F.S., the claimant shall submit the sworn statement of the employer showing
				that the employer had reached an informed conclusion prior to the occurrence of
				the subsequent injury or occupational disease that the employee's pre-existing
				condition was permanent and was, or was likely to be, a hindrance or obstacle
				to employment. The employer's statement must fully explain the factual
				conditions under which the informed conclusion was made and further fully
				explain how the employer believed the pre-existing permanent condition was, or
				was likely to be, a hindrance or an obstacle to employment. The claimant shall
				support this statement with appropriate documentation, when possible.
(3) For those conditions or instances
				specified in Section  440.49(6)(a),
				F.S., giving rise to the conclusive presumption, the claimant shall submit the
				sworn statement of the employer showing that the employer had knowledge of the
				condition prior to the occurrence of the subsequent injury or occupational
				disease. The claimant shall support this statement with all available
				documentation.
(4) Affidavits filed
				pursuant to this section shall include the following statement: "Under penalty
				of perjury, I declare that I have read the foregoing; that the facts as alleged
				are true, to the best of my knowledge and belief; and that a representative of
				the Special Disability Trust Fund is authorized to contact me to confirm the
				truthfulness of this statement." The affidavit will also include the address
				and telephone number of the affiant. This requirement shall apply to affidavits
				or depositions taken after July 19, 1992. Before any contact is made with any
				person who has made a sworn knowledge statement by affidavit or deposition, the
				SDTF shall first provide notice to the claimant's counsel of record that
				contact is desired.
Rulemaking Authority
					 440.30,
					 440.49(6)(a),
					 440.591 FS. Law Implemented
					 440.49(2),
					 440.30
					 FS.
New 4-19-92, Amended 8-18-93, Formerly 38F-10.011,
					 4L-10.011.
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-10.012 - Review of Proof of Claim

Current through Reg. 50, No. 138; July 16, 2024
The SDTF will not consider a claim ripe, or mature, for
				  review purposes, until a Proof of Claim is filed complete with all the
				  necessary documents required by DFS Form DFS-F1-SDF-1 (Rev. 3-09). If a Proof
				  of Claim is placed in line for review and it is discovered that certain
				  documents or required information have not been provided by the claimant, the
				  SDTF will advise the claimant in writing of the incomplete claim and will not
				  review the claim until the missing information or document has been supplied by
				  the claimant.
Rulemaking Authority
					 440.49(7),
					 440.591 FS. Law Implemented
					 440.49
					 FS.
New 4-19-92, Formerly 38F-10.012, 4L-10.012, Amended
					 3-16-09.
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-10.013 - Acknowledgements by SDTF

Current through Reg. 50, No. 138; July 16, 2024
The SDTF will only acknowledge in writing the filing of a
				  Notice of Claim and a Proof of Claim. Any claimant who wishes the SDTF to
				  acknowledge other documents must provide a self-addressed, stamped envelope and
				  a copy of the document for acknowledgement.
Rulemaking Authority
					 440.49(7)(g)
					 FS. Law Implemented 440.49(7)
					 FS.
New 4-19-92, Formerly 38F-10.013,
					 4L-10.013.
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-10.014 - Procedure for Accepting an Offer of Reimbursement

Current through Reg. 50, No. 138; July 16, 2024
Acceptance of an offer of reimbursement by the Fund must be
				  in writing and will be considered as acquiescing to all terms specified in the
				  offer without modification.
Rulemaking Authority
					 440.49(7)(g)
					 FS. Law Implemented 440.49(2)
					 FS.
New 4-19-92, Formerly 38F-10.014,
					 4L-10.014.
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-10.015 - Deemed Denial - 120 Day Time Period

Current through Reg. 50, No. 138; July 16, 2024
The 120 days that the SDTF has to accept a claim after it has
				  been filed begins to run at the time the SDTF receives a fully completed Proof
				  of Claim on DFS Form DFS-F1-SDF-1 (Rev. 3-09). Upon receipt of said form the
				  SDTF shall notify the claimant within twenty-one (21) days of receipt that said
				  form is complete and contains the required documents. If the form is complete
				  the 120 days begins to run. If it is not complete and the SDTF notifies the
				  claimant within the twenty-one (21) day period, then the 120 days from notice
				  of claim does not begin to run until the claimant submits all the required
				  documents necessary to support the claim.
Rulemaking Authority
					 440.49(7)(g),
					 440.591 FS. Law Implemented
					 440.49(7)
					 FS.
New 4-19-92, Formerly 38F-10.015, 4L-10.015, Amended
					 3-16-09.
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-10.0165 - On-site Audit Criteria (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49(7) FS.
					 Law Implemented 440.49(7)
					 FS.
New 12-8-98, Formerly 38F-10.0165, 4L-10.0165, Repealed
					 5-7-13.
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-10.017 - Reimbursement to Subsequent Employer (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 440.49(2)(k)
					 FS. Law Implemented 440.49(2)
					 FS.
New 4-19-92, Formerly 38F-10.017, 4L-10.017, Repealed
					 3-16-09.
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-10.018 - Attorneys' Fees, Costs, Penalties and Interest

Current through Reg. 50, No. 138; July 16, 2024
The SDTF will not reimburse any attorneys' fees, costs,
				  penalties, supplemental permanent total disability benefits or interest paid by
				  a carrier or a self insurance fund. Claimants shall disclose to the Special
				  Disability Trust Fund any attorneys' fees, costs, penalties and interest paid
				  in any settlement or in any claim to the SDTF whenever reimbursement is
				  claimed.
Rulemaking Authority
					 440.49(7)(g)
					 FS. Law Implemented 440.49(6)(b)
					 FS.
New 4-19-92, Formerly 38F-10.018,
					 4L-10.018.