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Workers Compensation Claims 69L-3, F.A.C. Forms Overview Fred Becknell - Insurance Administrator 850-413-1763.

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Presentation on theme: "Workers Compensation Claims 69L-3, F.A.C. Forms Overview Fred Becknell - Insurance Administrator 850-413-1763."— Presentation transcript:

1 Workers Compensation Claims 69L-3, F.A.C. Forms Overview Fred Becknell - Insurance Administrator

2 69L-3 WC Claims Forms Overview First major rewrite of the rule since November Each section containing forms updated. Removal of outdated forms. Revision of forms / new look.

3 Drafts of Rule 69L-3 and the incorporated forms are currently available on the Divisions Website. Updated drafts will be made available on the website. Sign up for the DWC e-Alert program for the quickest notification of rule making & other DWC activities.

4 New Definition 69L-3.002(3) Claims-handling Entity means any insurer, third-party administrator, servicing company, self-serviced self-insured employer or fund, or managing general agent and includes all claims office locations that will be responsible for adjusting and submitting workers compensation claims to the Division.

5 Required Fields on all Forms 69L-3.003(3) Employees name (First, middle, last) Employees social security number * Month, day and year of the accident (mm-dd-yy or mm-dd-ccyy) * Or Division assigned number

6 Required Fields on all Forms 69L Insurer Code # & Insurer Name Service Co/TPA Code # * Claims-handling Entity File # Claims-handling Entitys Name, Address & Telephone * If applicable

7 Required Fields on all Forms 69L-3.003(5) Sent to Division Date or The revised Sent to Division Date as applicable for forms returned to the claims- handling entity for correction. The document will be considered complete & in compliance with the rule when the corrected document is resent to the Division.

8 Injured Worker Informational Brochure 69L DFS-F2-DWC-60 (English version) & DFS-F2-DWC-61 (Spanish version) are now incorporated. The applicable brochure is to be sent within 3 business days after notification of the injury or illness, pursuant to Section (4), F.S.

9 Injured Worker Informational Brochure 69L DFS-F2-DWC-60 Important Workers Compensation Information For Floridas Workers DFS-F2-DWC-61 Informacion Importante De Seguro De Indemnizacion Por Accidentes De Trabajo Para Los Trabajadores De La Florida

10 Injured Worker Informational Brochure 69L With the promulgation of the rule, the DFS-F2-DWC-60 and DFS-F2-DWC-61 must be provided verbatim. Alternative formats will no longer be permissible.

11 Employer Informational Brochure 69L DFS-F2-DWC-65 (English version) & DFS-F2-DWC-66 (Spanish version) are now incorporated. The applicable brochure is to be mailed to the employer annually, pursuant to Section (4), F.S.

12 Employer Informational Brochure 69L With the promulgation of the rule, the DFS-F2-DWC-65 and DFS-F2-DWC-66 must be provided verbatim. Alternative formats will no longer be permissible.

13 Overview of Proposed Changes to Forms Form numbers are preceded with DFS-F2 per Departmental guidelines. For example: DWC-1 = DFS-F2-DWC-1. The Social Security Number field on all forms will be relocated to make it easier to redact pursuant to Statute 119, F.S.

14 Overview of Proposed Changes to Forms The 2002 North American Industrial Classification System (NAICS) Code is replacing the obsolete Standard Industrial Classification (SIC) Code.

15 DFS-F2-DWC-1

16 DFS-F2-DWC-1 / 69L First Report of Injury or Illness Major changes 1.Reporting of delayed disability cases 2.Reporting of penalties & paid to the employee 3.Filing requirements detailed 4.Reporting of Indemnity Only Denied Cases 5.Reporting of the insurers name

17 Claims-Handling Entity Information Pursuant to 69L (1)(d) – the claims-handling entity shall complete the Claims-handling Entity Information section on Form DFS-F2-DWC-1

18 Insurer Code # Service Co/TPA Code # Employees Class Code Employers NAICS Code Claims-Handling Entity File # Insurer Name Claims-Handling Entity Name, Address & Telephone

19 Reporting of Delayed Disability Cases 69L (1)(d)5.c.1 The claims-handling entity is to report: the Employees 8 th Day of Disability and the Claims-handling entitys Knowledge of the 8 th Day of Disability.

20 New fields on the DFS-F2-DWC-1 Employees 8 th Day of Disability Entitys Knowledge of 8 th Day of Disability

21 Reporting of Delayed Disability Cases 69L (1)(d)5.c.1 The alternative electronic format for reporting delayed disability cases electronically (EDI) will be presented by Linda Yon in the next presentation.

22 Reporting of Penalties & Interest 69L (1)(f) If the initial payment of compensation was not timely paid in accordance with Section , F.S., the claims-handling entity is to report the Penalty Amount Paid in 1 st Payment and the Interest Amount Paid in 1 st Payment.

23 New fields on the DFS-F2-DWC-1 Penalty Amount Paid in 1 st Payment Interest Amount Paid in 1 st Payment

24 Reporting of Lost Time Cases 69L (2)(a) When disability is immediate and continuous for 8 or more days, the claims-handling entity shall send a completed Form DFS-F2-DWC-1 within 14 days after the claims- handling entitys knowledge of the injury or illness for the following

25 Reporting of Lost Time Cases 69L (2)(a) 1.Initial lost time cases 2.Full salary cases (employer paid for 8 or more days) 3.Death cases with/without dependents 4.Volunteers

26 Timely Reporting of Lost Time Cases By EDI 69L (1)(a) an electronic equivalent of a First Report of Injury or Illness will be considered timely filed with the Division when it is received by the Division on or before the 21st day after the carriers knowledge of the injury and is assigned an acknowledgement code of Transaction Accepted (TA).

27 3. Lost Time Case 1 st Day of Disability, Full Salary in lieu of comp? Full Salary End Date Date First Payment Mailed AWW / Comp Rate and the Disability Type

28 Reporting of Delayed Disability Cases 69L (2)(b) When disability is not immediate and continuous but result in 8 or more days of disability, the claims-handling entity shall send a completed Form DFS-F2-DWC-1 within 6 days after the claims-handling entitys knowledge of the eighth day of disability.

29 Timely Reporting of Delayed Disability Cases By EDI - 69L (1)(a) the electronic equivalent of a First Report of Injury or Illness will be considered timely filed with the Division when it is received by the Division on or before the 13th day after the carriers knowledge of the 8th day of disability and is assigned an acknowledgement code of Transaction Accepted (TA).

30 2. Medical Only Which Became Lost Time Case (Complete all Information in #3) 1 st Day of Disability, Full Salary in lieu of comp? Full Salary End Date Date First Payment Mailed AWW / Comp Rate and the Disability Type

31 Indemnity Only Denied Cases 69L (2)(g) For cases where the claims-handling entity denied only indemnity benefits and medical benefits are being provided: Box 1(b) Indemnity Only Denied Case is to be marked & Forms DFS-F2-DWC-1 and DFS-F2-DWC-12 are to be filed with the Division at the same time.

32 1(b) Indemnity Only Denied Case – DWC-12, Notice of Denial Attached Attach a DFS-F2-DWC-12 – pursuant to: 69L (1)(d) 5.b & 69L-3.012(3)

33 Summary of Key Elements The status of the case by marking the appropriate box on each DFS-F2-DWC-1 filed with the Division; Box 1(a)Denied Case Box 1(b)Indemnity Only Denied Case Box 2Medical Only which became Lost Time Case Box 3Lost Time Case

34 Key Elements - Continued For lost time cases include the following data as applicable: 1 st Day of Disability Full Salary in lieu of comp? Full Salary End Date Date First Payment Mailed AWW / Comp Rate and the Disability Type

35 Key Elements - Continued The claims-handling entity shall complete the Claims-handling Entity Information section Insurer Name Insurer Code # Claims-handling Entity Name, Address & Telephone Service Co/TPA Code # Claims-handling Entity File #

36 DFS-F2-DWC-4

37 DFS-F2-DWC-4 / 69L Notice of Action/Change File with the Division within 14 days of the claims-handling entitys knowledge of the action or change which it is reporting for lost time cases. Copies of the Form are to be mailed to the employee and employer at the same time.

38 DFS-F2-DWC-4 / 69L Notice of Action / Change Clarification of when the DFS-F2-DWC-4 is required to be filed with the Division and the applicable fields that are to be completed for each required filing. Complete the applicable fields and only use the Remarks Section to supplement the information reported.

39 DFS-F2-DWC-4 / 69L Incomplete Forms The filing of the form with only the Remarks Section completed will not constitute filing of the required information if the applicable field(s) are left blank.

40 DFS-F2-DWC-4 / 69L (8) New Required Filing Report a revised Start Date and the new Weekly Rate, when the payment of Impairment Income Benefits is changed due to the employees return to work or stopped earning at least the average weekly wage.

41 DFS-F2-DWC-4 / 69L Deleted Fields Initial Indemnity Started: Effective Date & Disability Type PI Benefits: Date Paid

42 DFS-F2-DWC-12

43 DFS-F2-DWC-12 / 69L Notice of Denial Copies of the Form are to be mailed to the employee, employer and any additional party requesting payment or authorization. Removal of the Lost Time Case and Medical Only Case Boxes.

44 DFS-F2-DWC-12 / 69L-3.012(3) Denial of Indemnity Only If the claims-handling entity initially denies only the indemnity benefits of a claim, it shall send Form DFS-F2-DWC- 12 to the Division within 14 days after notification of the injury, illness or death with a completed DFS-F2-DWC-1

45 DFS-F2-DWC-13

46 DFS-F2-DWC-13 / 69L Claims Cost Report Initial Report – file within 30 days after the 6 th month anniversary of the date of accident – no early filings accepted – unless filing as the final report. Annual Reports – file within 30 days after the annual anniversary of the date of accident – no early filings accepted – unless filing as the final report.

47 DFS-F2-DWC-13 / 69L Claims Cost Report All filings are to report the cumulative amounts of all applicable categories on the form. For acquired / take over claims – the insurer shall provide cumulative totals by specific claim cost type for all applicable data elements on each transferred case to the new claims-handling entity.

48 69L Forms No Longer Required The DFS-F2-DWC-48 Monthly Risk Class/SIC Code Report and the DFS-F2-DWC-51 Aggregate Defense Attorney Fee Report

49 69L Forms 90 days after the promulgation of the rule, only forms dated August 2004 will be accepted.

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