Division of Workers' Compensation

Division Fast Facts

• The Division will be offering R3 Claims EDI Training on April 27 & 28, 2010 in Tallahassee »
• In 2009, EDI filings to the Division increased significantly »

  The Division came closer to meeting its total EDI business environment for submission goal in 2009.

  The Claims Handling Entities and their designees electronically submitted 3,906,096 million medical bills, representing the combined group of physician, hospital, dental, pharmacy, and other healthcare providers’ bills, which the Division accepted into the Medical database. This figure represents 100% electronic filing.

  The Claims Handling Entities electronically submitted 426,174 Claim form filings, the combined group of the First Report of Injury/Illness, Claim Cost Report, Notice of Action/Change, Notice of Denial, and Change in Claims Administration, which the Division accepted into the Claims database. This figure represents 92% electronic filing.

  Insurer designees electronically submitted 726,374 Proof of Coverage filings, representing the combined group of certificates of insurance, endorsements, cancellations, and reinstatements, which the Division accepted into the Compliance database. This figure represents 100% electronic filing.

• Pursuant to section 440.107(11), F.S., the Division may initiate lien proceedings to collect any penalty due that has not been paid. In addition, the Department may refer any unpaid penalty that is due to a collection agency for the initiation of proceedings to collect the unpaid penalty.
• Reminder: The Division of Workers' Compensation, Bureau of Monitoring and Audit has completed a rewrite of rule 69L-24, F.A.C. Workers Compensation Insurers' Standards and Practices. The rule is effective January 12, 2010.
• The Bureau of Monitoring and Audit reviewed 37,488 claim files in 6 months, identifying $862,885 in benefit underpayments and penalties and interest due from insurers (and subsequently paid) to injured workers »

  During the first six months of the 2009-2010 fiscal year, the Division of Workers' Compensation, Bureau of Monitoring and Audit reviewed 37,488 claim files. As a result of these reviews, the Bureau's staff identified $862,885 in benefit underpayments and penalties and interest due from insurers (and subsequently paid) to injured workers.

• The "Employee Notification Letter" has been updated to reflect technical changes to Rule 69L-26.004, F.A.C. In accordance with 440.185(11), F.S., employers or carriers must provide this written notice to injured workers within three days of receiving notice of the injury »

  Technical changes to Rule 69L-26.004, F.A.C. include corrections in statutory citations, updates to Division web addresses, and the addition of an e-mail address for the Bureau of Employee Assistance and Ombudsman Office.

  The "Employee Notification Letter" is posted under Publications. Employers and carriers should begin using this letter on or before April 1, 2010.

  If you have questions regarding these technical changes to the rule, please contact Pam Macon at (850) 413-1708.

• The Division of Insurance Fraud, Bureau of Workers' Compensation Fraud and the Division of Workers' Compensation, Bureau of Compliance issued a Joint Report summarizing their respective efforts and activities in combating workers' compensation fraud and employer non-compliance for the period of July 1, 2008 through June 30, 2009.
• The Division has published its 2009 Annual Report, available in Publications and Manuals.