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Division Director

Tanner Holloman

Assistant Director

Andrew Sabolic

Workers' Compensation
200 East Gaines Street
Tallahassee, FL 32399-0318
Workers' Compensation Claims
(800) 342-1741
Workers' Compensation Exemption/ Compliance
(850) 413-1609

Reimbursement Disputes

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The Medical Services Section is statutorily responsible for the resolution of reimbursement disputes arising from reimbursement paid for services rendered to Florida’s injured workers. The Florida Statutes provide the updated regulatory language effective July 1, 2013, for resolution of reimbursement disputes in Section 440.13(7):

  • Any health care provider, carrier, or employer who elects to contest the disallowance or adjustment of payment by a carrier …must, within 45 days after receipt of notice of disallowance or adjustment of payment, petition the department to resolve the dispute. The petitioner must serve a copy of the petition on the carrier and on all affected parties by certified mail. The petition must be accompanied by all documents and records that support the allegations contained in the petition. Failure of a petitioner to submit such documentation to the department results in dismissal of the petition.
  • The carrier must submit to the department within 30 days after receipt of the petition all documentation substantiating the carrier’s disallowance or adjustment. Failure of the carrier to timely submit such documentation to the department within 30 days constitutes a waiver of all objections to the petition

The Department adopted and is currently updating Rule Chapter 69L-31, Florida Administrative Code, to clarify the reimbursement dispute resolution process, the time frames and documentation that are required for a petition to be valid. Rule 69L-31.003, F.A.C. incorporates the Petition for Resolution of Reimbursement Dispute Form (DFS Form 3160-0023 PDF) (Petition), which must be submitted to the Medical Services Section when seeking resolution of a reimbursement dispute. All items on the petition form must be completed for the Petition to be valid and accepted by the Medical Services Section.

Rule 69L-31.004, F.A.C. incorporates the Carrier Response to Carrier Response to Petition for Resolution of Reimbursement Dispute Form (DFS Form 3160-0024 PDF) (Carrier Response), which is the only form accepted by the department upon which a carrier may submit its response to a Petition for Resolution of Reimbursement Dispute (Petition). Failure to submit a Carrier Response form results in the Carrier waiving all objections to the allegations in the Petition.