31000150, 69H-2.004 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 31000150

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Risk Management

Chapter:

STATE RISK MANAGEMENT TRUST FUND, STATE CASUALTY CLAIMS

Overview

RULE:

69H-2.004	Certificate of Coverage
69H-2.008	Other Forms Adopted

PURPOSE:

The purpose of the change in 69H-2.004 Certificate of Coverage is to incorporate the language of rule 69H-2.002 Coverage Exclusion, which is being repealed (to consolidate and streamline the rule chapter). The purpose of the change in 69H-2.008 Other Forms Adopted is to add hyperlinks for forms DFS-D0-1404, “Lien disclosure Statement,” DFS-D0-1406, “Insurer’s Disclosure Statement Pursuant to Section 627.4137, F.S.,” and DFS-D0-1407, “Medical Authorization.” The change will further update forms DFS-D0-1404 and DFS-D0-1407 to include a more comprehensive “Purpose and Use Statement required by Section 119.071(5), Florida Statutes” as it relates to the disclosure of the claimant’s social security number. Additionally, the rulemaking authority in .004, and the laws implemented in .008 will be updated.

SUMMARY:

The rule changes will consolidate rules, add hyperlinks to three forms, and update two of those forms.

RULEMAKING AUTHORITY:

284.17, 284.311, 284.39 FS.

LAW:

284.30, 284.31, 284.40, 284.41, 627.4137 FS.

PRINT PUBLISH DATE:

6/11/2026 Vol. 52/113

COMMENTS:

From 6/11/2026 To 7/2/2026 (21 Days)

REFERENCE MATERIALS:

Ref-19348 DFS-D0-1406 - Insurer’s Disclosure Statement Pursuant to Section 627.4137, F.S.
Ref-19349 DFS-D0-1404 - Lien Disclosure Statement
Ref-19350 DFS-D0-1407 - Medical Authorization

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