69L-3.025: Forms
PURPOSE AND EFFECT: Section 440.185(4), F.S., authorizes the Department to approve informational brochures that carriers are required to mail to injured employees and employers. The brochures are required to set forth in clear and understandable language an explanation of the rights, benefits, procedures for obtaining benefits and assistance, criminal penalties, and obligations of injured workers and their employers under the Florida Workers’ Compensation Law. Section 440.185(4), F.S., requires the carrier to mail the Department approved informational brochure to the injured employee within three (3) days after being informed by the employer or employee of an injury. Carriers are also required to annually mail the Department approved informational brochures to employers. The proposed amendment will adopt the updated English and Spanish versions of the workers’ compensation informational brochures that carriers are required to mail to employers and injured employees.
SUMMARY: Workers’ compensation informational brochures for employers and injured employees.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 440.15, 440.185, 440.20, 440.591 FS.
LAW IMPLEMENTED: 440.14(3), 440.15(1), (4), (9), (10), 440.185(4), (5), (10), 440.20(2), (3), 440.345, 440.35, 440.51(6), (9) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: October 11, 2010, 1:00 p.m.
PLACE: Room 104J, Hartman Building, 2012 Capital Circle S.E., 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: Pam Macon at (850)413-1708 or Pamela.Macon@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 IS: Pam Macon, Chief, Bureau of Employee Assistance, Division of Workers’ Compensation, 2012 Capital Circle S.E., Tallahassee, Florida 32399, (850)413-1708
THE FULL TEXT OF THE PROPOSED RULE IS:
69L-3.025 Forms.
(1) The following forms are to be used with this rule chapter and are hereby incorporated by reference:
(a) through (n) No change.
|
(o) |
Form DFS-F2-DWC-60 |
03/10 |
Important Workers’ Compensation Information for Florida’s Workers |
|
(p) |
Form DFS-F2-DWC-61 |
03/10 |
Informacion Importante De Seguro De Indemnizacion Por Accidentes De Trabajo Para Los Trabajadores De La Florida |
|
(q) |
Form DFS-F2-DWC-65 |
03/10 |
Important Workers’ Compensation Information for Florida’s Employers |
|
(r) |
Form DFS-F2-DWC-66 |
03/10 |
Informacion Importante Del Seguro De Indemnizacion Por Accidentes De Trabajo Para Los Empleadores De La Florida |
(2) The Division will not supply the forms promulgated under this chapter, but will make sample forms available on the Division’s web site: http://www.myfloridacfo.com/WC/. http://www.fldfs.com/wc.
(3) For a transitional period of 90 days from the effective date of this rule, an insurer or claims-handling entity may use forms identified and adopted in subsection 69L-3.025(1), F.A.C., or the corresponding form(s) in effect prior to the adoption of this rule. After the completion of the 90 day transitional period, only the forms adopted in this rule may be used.
Rulemaking Specific Authority 440.15, 440.185, 440.20, 440.591 FS. Law Implemented 440.14(3), 440.15(1), (4), (9), (10), 440.185(4), (5), (10), 440.20(2), (3), 440.345, 440.35, 440.51(6), (9) FS. History–New 4-11-90, Amended 1-30-91, 11-8-94, 11-11-96, 11-25-96, Formerly 38F-3.025, 4L-3.025, Amended 1-10-05, 3-16-09,_________.