Florida Regulations 69L-3.003 4

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§ Procedures for Filing Documents

(1) The carrier shall ensure that all parts of all documents filed with the Division pursuant to this chapter are complete and legible. These documents shalI be filed with the Division of Workers' Compensation, 2728 Centerview Drive, Suite 220, Forrest Building, Tallahassee, Florida 32399-0685, except as otherwise indicated. If a document is not complete and legible, the Division will return it to the carrier's address as provided for correction or completion.

(2) Carriers or employers shall respond to any written request for information by the Division no later than 14 days after receiving the request, except as otherwise provided in Title 38F, F.A.C.

(3) Instructions on or pertaining to forms which are promulgated under this chapter are also rules under this chapter. Forms must be completed according to instructions. Entities completing forms must include the Division assigned Carrier or Service Co/TPA Code #, where required.

(4) The carrier, where required, shall include on every document it submits to the Division the following information:

(a) the employee's name.

(b) the employee's social security number. If the employee does not have a social security number because the employee is an alien, the carrier shall instead use the number on the employee's Arrival and Departure card (Form 1-94) or Alien Registration Receipt card (Form 1-151). If the carrier is unable to ascertain the numbers, it shall send a written request to the Information Management Unit of the Division at the address in subsection (1) to obtain a temporary internal file number until one of the above identifying numbers is obtained.

(c) the month, date and year of the employee's accident, in the following order:


The Division shall return to the carrier any document on which the appropriate identification does not appear, and shall notify the carrier of its error or omission. The carrier shall make the correction and resubmit the document to the Division. The filing date of the document is the date the Division receives the corrected document. If the carrier reports an incorrect employee name, social security number or date of accident, it shall send an LES Form DWC-4, or electronic alternative pursuant to Rule 38F- 3.0091(1 6),F.A.C. All subsequent filings must reflect the corrected information.

(5) A carrier shall supply each employer to which it provides coverage a supply of LES Form DWC-1, , First Report of Injury or Illness, unless an alternative electronic reporting arrangement is in place, and LES Form DWC-Ia, Wage Statement. The carrier name, address and telephone number must be pre-printed or pre-stamped on each such form. As required by these rules, the carrier shall supply to employees LES Form DWC-40, Statement of Quarterly Earnings for Supplemental Income Benefits for dates of accident on or after 1 / 1/94, and LES Form DWC-3, Request for Wage Loss/Temporary Partial Benefits, for dates of accident prior to 1/1/94.

(6) Computer-generated versions of any form promulgated under this rule must appear in substantial conformity with the printed form in design, layout, field size and content. Computer-generated forms must contain all data elements required by the printed form. If the Division finds that the computer-generated form is not sufficiently similar to the printed form, if it faiIs to contain all data elements, or if it is unclear or confusing, the Division will return the form to the carrier and notify the carrier of the deficiency. The carrier shall make the correction and resubmit a corrected form to the Division. The filing date of the form is the date the Division receives the corrected form.

(7) A carrier wishing to use alternative electronic reporting methods, or to alter any existing approved alternative electronic reporting methods, must submit a written proposal to the Director of the Workers' Compensation, who will review the proposal to ensure compliance with applicable statutes and rules, and compatibility with the Division's systems. The Director shall inform the carrier in writing of the Division's determination. After the carrier has received written approval of its proposal, it may send documents to the Division according to the method set out in its proposal.

(8) Only those documents required by this or previous editions of Title 3 8F, F.A.C., shall be maintained in the Division's files.

(9) Any person or entity failing to timely send documents promulgated under this chapter is subject to civil penalties assessed by the Division according to the provisions of Rule Chapter 38F-24, F.A.C.