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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 Request (SDF-2) Process

Our goal is to ensure that the process of filing a Reimbursement Request (SDF-2) is as straightforward as possible. Please note, however, that the outline below is not legal advice. The information provided is designed to assist you in the accurate and timely submission of the Reimbursement Request (SDF-2).

Note: If you have not yet filed a Proof of Claim (SDF-1) with the SDTF, please do so before proceeding.

 

What you need to know before preparing a Reimbursement Request (SDF-2):

If this is the first time a Reimbursement Request (SDF-2 PDF) has been filed on a claim, you should first verify that an offer on the claim has been extended by the SDTF, and has been accepted by the Employer/Carrier, as established in Florida Administrative Rule 69L-10.014.
 

Preparing a Reimbursement Request (SDF-2) for submittal:

Once it has been established that the claim is eligible to receive reimbursement from the SDTF for benefits paid, it’s time to begin preparing a Reimbursement Request (SDF-2) packet.

  1. Download and print a copy of the Reimbursement Request (SDF-2 PDF), which includes Payment Schedule Forms A-E, each designed to assist you in organizing the Reimbursement Request (SDF-2) categories.
  2. If a Reimbursement Request (SDF-2) has been filed on the claim in the past, review each category of the previous Reimbursement Request (SDF-2) in order to determine the last date for which benefits were claimed.
  3. Retrieve payment history from the Employer/Carrier (E/C), verifying payment of medical and/or indemnity benefits to the claimant or medical provider.
  4. Review indemnity payment history and calculate benefits from the beginning of the period being requested for reimbursement. Review file to determine if the compensation rate (C/R) has changed, and provide DWC-4’s or other information to verify the amount being paid.
  5. Retrieve all supporting documentation, including, but not limited to: medical bills, medical reports, Explanation of Benefits Forms (SDF-6 PDF), and/or other documentation verifying treatment was provided for the claimant’s compensable injury.
  6. Separate all documentation by category, placing each category in chronological order by date of service (oldest on top, newest on bottom), and verify that all documentation is entirely legible.
  7. Correlate each paid benefit with its corresponding payment history, and indicate on each medical bill the amount paid, as well as the date it was paid.
  8. An appropriate Payment Schedule Form should be completed for each category of benefits being requested for reimbursement. Fill out the Payment Schedule Forms using information from the supporting documentation, placing the information in chronological order by date of service.
  9. Total the benefits paid by the E/C for each category and insert the amounts in their appropriate category on the Reimbursement Request (SDF-2).
  10. Proceed by filling out the Reimbursement Request (SDF-2) form. Once all appropriate information has been entered, please sign and date the document at the bottom, preferably in blue ink.
  11. Organize the Reimbursement Request (SDF-2) packet, sending the Reimbursement Request (SDF-2), with an original signature, via mail to the address listed below:

 

Mailing Address

Special Disability Trust Fund
200 East Gaines Street
Tallahassee, Florida 32399-4223