69H-2.008: Other Forms Adopted
PURPOSE AND EFFECT: The Division of Risk Management adjusts claims for employees, volunteers, and other covered persons per Chapter 284, F.S. Currently, the Authorization to Release form DFS-D0-1407 does not state the reason for the requested medical records. This amendment will add a sentence to the form that explicitly states that the medical authorization release concerns a workers’ compensation claim. The additional language is needed for the Division to obtain crucial medical records and to ultimately perform its statutory authority to adjust and settle workers’ compensation claims for those covered persons under Section 284.31, F.S.
SUBJECT AREA TO BE ADDRESSED: Form DFS-D0-1407 for requesting information from workers’ compensation claimants and liability claimants.
SPECIFIC AUTHORITY: 284.17, 284.39 FS.
LAW IMPLEMENTED: 284.30, 284.40, 284.41 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: Tuesday, August 10, 2010, 9:30 a.m.
PLACE: 116 Larson Building, 200 East Gaines Street, Tallahassee, Florida
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: George Rozes, (850)413-4754 or George.Rozes@myfloridacfo.com. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: George Rozes, Senior Management Analyst II, Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-0336, (850)413-4754
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
69H-2.008 Other Forms Adopted.
(1) The following forms are hereby adopted and incorporated by reference. These forms shall be used to aid the Division in the performance of its administrative duties by securing pertinent facts and information on claims filed against the Fund, as the circumstances of particular cases may require.
(a) through (e) No change.
(f) DFS-D0-1407, “Medical Authorization”, rev. 2/10 11/05;
(g) through (i) No change.
(2) No change.
Rulemaking Authority 284.17, 284.39 FS. Law Implemented 284.30, 284.40, 284.41 FS. History–New 1-7-92, Amended 6-28-01, Formerly 4H-2.008, Amended 7-4-04, 5-4-05, 10-5-09,_________.