Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-56 - ELECTRONIC DATA INTERCHANGE (EDI) REQUIREMENTS FOR PROOF OF COVERAGE AND CLAIMS (NON-MEDICAL) › Section 69L-56.4011 - First Report of Injury or Illness: Claim Administrator's Responsibility to Record and Report Accidents

Current through Reg. 50, No. 138; July 16, 2024
(1) A
				claim administrator shall record all industrial injuries and diseases as
				follows:
(a) Upon receipt of a Form
				DFS-F2-DWC-1, as adopted in Rule
				 69L-3.025, F.A.C., the claim
				administrator shall legibly date stamp the form in the "Received by
				Claims-handling Entity" box. Upon notification of the injury by any other
				means, the claim administrator shall record the earliest date of notification
				in the file and on the Form DFS-F2-DWC-1.
(b) If the employer notifies the claim
				administrator of the injury by telephone or electronic data interchange, the
				claim administrator shall produce and mail to the employee and employer a paper
				copy of Form DFS-F2-DWC-1, as adopted in Rule
				 69L-3.025, F.A.C., within 3
				business days of the claim administrator's knowledge of the injury. However, if
				the claim administrator is electronically sending the first report of injury
				information required in Rule
				 69L-56.4011, F.A.C., Form IA-1,
				Workers Compensation - First Report of Injury or Illness, 
				©IAIABC 2002, as adopted in Rule
				 69L-3.025, F.A.C., may be sent
				to the employee and employer.
(c)
				The claim administrator shall make reasonable efforts to confirm that the
				following information on the Form DFS-F2-DWC-1 is correct:
1. Employee's name.
2. Social security number or other
				identifying number pursuant to paragraph
				 69L-3.003(3)(b),
				F.A.C.
3. Employee's mailing
				address.
4. Employee's telephone
				number (if provided by the employee or employer).
5. Date (mm-dd-yy or mm-dd-ccyy) and time of
				accident.
6. Occupation of the
				employee.
7. Location of the
				accident.
8. Description of the
				accident, including the cause and nature of the injury, and part(s) of the body
				affected.
(d) The claim
				administrator shall complete the "Claims-handling Entity Information" section
				of Form DFS-F2-DWC-1 as follows:
1. "Insurer
				Code #".
2. "Service Co/TPA Code
				#", if applicable.
3. The "Insurer
				Name" and the "Claims-handling Entity Name, Address, & Telephone" as
				applicable. When a "Service Co/TPA" is adjusting claims for an insurer, the
				name, address and telephone number of the "Service Co/TPA" in addition to the
				name of the insurer shall be given. The telephone number provided shall enable
				a caller to readily contact the office handling the claim.
4. "Claims-handling Entity File #".
5. Indicate the status of the case by marking
				the appropriate box: "Denied Case", "Indemnity Only Denied Case," "Medical Only
				Which Became Lost Time Case," or "Lost Time Case." In addition, the following
				information is required:
a. "Denied Case":
				When the liability for the claim is being totally denied, Form DFS-F2-DWC-12,
				as adopted in Rule  69L-3.025, F.A.C., shall be
				filed with the Division at the same time as the Form DFS-F2-DWC-1 pursuant to
				rule  69L-56.4012, F.A.C.
b. "Indemnity Only Denied Case": When only
				indemnity benefits are being denied, a Form DFS-F2-DWC-12 shall be filed with
				the Division at the same time as the Form DFS-F2-DWC-1, pursuant to Rule
				 69L-56.4012, F.A.C.
c. "Medical Only Which Became Lost Time
				Case":
(I) Delayed disability cases: The
				fields for "First Date of Disability," "Date First Payment Mailed," "AWW,"
				"Comp Rate," "Employee's 8th Day of Disability," the "Entity's Knowledge of the
				8th Day of Disability" and the type of initial benefit paid shall be provided,
				except as indicated in sub-subparagraph (1)(d)5.f. of this rule.
(II) IB Only Cases: The "Date First Payment
				Mailed," "AWW," "Comp Rate," the type of initial benefit paid identified as
				"I.B."
(III) Settlement Only Cases:
				The "Date First Payment Mailed", the type of initial benefit paid identified,
				as "Settlement Only" shall be provided.
d. "Lost Time Cases": The "First Date of
				Disability," "Date First Payment Mailed," "AWW," "Comp Rate" and the type of
				initial benefit paid shall be provided except as indicated in sub-subparagraph
				(1)(d)5.f. of this rule.
e. "Full
				Salary End Date." If the employer paid full salary in lieu of compensation and
				the claim administrator has knowledge of the day the employer discontinued
				paying full salary, the "Full Salary In Lieu of Comp" box is to be checked
				"Yes" and the "Full Salary End Date" field on the DFS-F2-DWC-1 must be
				completed when the DFS-F2-DWC-1 is filed.
f. Exceptions to sub-subparagraphs (1)(d)5.c.
				and d. of this rule. The following data fields are not required for the filing
				of Form DFS-F2-DWC-1:
(I) If the employer is
				continuing full salary in lieu of compensation, the "Date First Payment
				Mailed," "AWW," and "Comp Rate" are not required.
(II) If a compensable volunteer has a lost
				time case, "Date First Payment Mailed," "AWW," and "Comp Rate" are not required
				unless the compensable volunteer meets statutory requirements to be paid for
				concurrent employment.
(III) If the
				employee's death is compensable and the employee has no known dependents, the
				"Date First Payment Mailed" is not
				required.
(e) The claim administrator shall report to
				the Division the "Employee's Class Code" based on the National Council on
				Compensation Insurance (NCCI) classification system (Scopes Manual), and the
				"Employers' NAICS Code" based on the North American Industrial Classification
				System (NAICS). The information shall be reported on Form DFS-F2-DWC-1 if the
				information is available at the time of filing with the Division. If either
				code is not available at time of filing, this information shall be filed on
				Form DFS-F2-DWC-4 pursuant to subsection
				 69L-56.404(14),
				F.A.C.
(f) If the initial payment
				of compensation was not timely paid in accordance with Section
				 440.20, F.S., the claim
				administrator shall also report the following information, where applicable:
1. "Penalty Amount Paid in 1st Payment";
				and,
2. The "Interest Amount Paid
				in 1st Payment."