Florida Regulations 69L-10.007

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§ 69L-10.007 Notice of Claim.

A Notice of Claim for reimbursement from the SDTF shall be filed with the SDTF, Division of Worker's Compensation, 200 East Gaines Street, Tallahassee, FL 32399-4223. The Notice of Claim may be filed by letter form and shall include the following:

(1) Name and social security number of the employee;

(2) The name and address of the employer;

(3) The date of the accident;

(4) The name and address of the insurance carrier, self-insurance fund or employer on whose behalf the claim is made.

Specific Authority 440.49(2)(g) FS. Law Implemented 440.49(2) FS. History-New 4-19-92, Amended 8-18-93, Formerly 38F-10.007, 4L-10.007.