Claims Kit

Penalties for Late Reporting  440.185(8)

Any employer or carrier who fails or refuses to timely send any form, report, or notice is subject to an administrative fine by the department not to exceed $500 for each failure or refusal. 

However, any employer who fails to notify the carrier of the injury on the prescribed form or by letter within the 7 days required is liable for the administrative fine, which will be paid by the employer and not the carrier. 

Failure by the employer to timely file the notice does not relieve the carrier from liability for the administrative fine if it fails to comply with its duties to send the informational brochure or file required documents. 

Fines for untimely filing: 69L-24.006

• $100 for 1-7 days late
• $200 for 8-14 days late
• $300 for 15-21 days late
• $400 for 22-28 days late
• $500 for over 28 days late.

This applies to employer filing late with carrier and carrier filing late with Division.

Physician Selection   440.134  440.13(2)(c)

The employer/carrier/servicing agent has choice of physician. If medical care is provided through a managed care arrangement, the employee can choose a doctor from the list of physicians provided by the employer's managed care arrangement or insurance carrier.

The physician must be a "certified health care provider" certified by the Agency for Health Care Administration" (AHCA) 

Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident. The carrier must authorize a change of physician within five days after receiving the request.If the carrier fails to respond within five days, the employee may select the physician who is then deemed authorized. 

If the employee goes to a doctor other than one that is authorized, they may have to pay for their own medical bills except that that an employee may seek unauthorized care at the carriers expense if the carrier fails to provide care within a reasonable time after the care is requested. This applies only to initial treatment.

Posting Requirements  440.40  69L-6.007.

Every employer who has secured compensation under the provisions of this chapter will keep posted in a conspicuous place or places in and about her or his place or places of business typewritten or printed notices, in accordance with a form prescribed by the department, the following:

A notice stating that such employer has secured the payment of compensation in accordance with the provisions of this chapter.The notices will contain the name and address of the carrier, if any, with whom the employer has secured payment of compensation and the date of the expiration of the policy. The department may by rule prescribe the form of the notices and require carriers to provide the notices to policyholders.

(2) A notice stating: “Anti-Fraud Reward Program.—Rewards of up to $25,000 may be paid to persons providing information to the Department of Financial Services leading to the arrest and conviction of persons committing insurance fraud, including employers who illegally fail to obtain workers’ compensation coverage. Persons may report suspected fraud to the department . A person is not subject to civil liability for furnishing this information, if the person acts without malice, fraud, or bad faith.”

Upon issuance of an insurance policy or certificate of membership in a self-insurance fund or a renewal certificate thereof, the insurer or self-insurance servicing agent must electronically send the compensation notice to the employer or furnish the employer with a sufficient number of typewritten or printed compensation notices, commonly referred to as the “broken arm poster.”

Reporting of claim by Employer: .  440.185(2),

Within 7 days after knowledge of injury or death the employer will report the injury or death to the carrier and provide copy to employee or employee's estate. First Report of Injury or Illness form (DWC-1)

First-aid cases which are treated on site do not have to be reported as long as no medical charges were incurred and the employee is not disabled for more than seven days.

The employer must send the Wage Statement (DWC-1a) to the Carrier/Servicing Agent within 14 days of the employer's knowledge of a "lost time" or a "medical only to lost time case". The Carrier is to forward to the Division only upon request.