2A-2.002. Victim Compensation Claims  


Effective on Wednesday, December 11, 2019
  • 1(1) Application. An application for victim compensation should be mailed to the Office of the Attorney General, Bureau of Victim Compensation, PL-01, The Capitol, Tallahassee, FL 32399-1050 or faxed to (850)414-6197 or (850)414-5779; or emailed to VCIntake@myfloridalegal.com, 38or submitted via the department’s web-portal 44located at https://vanext.myfloridalegal.com/47. The application entitled BVC100 Bureau of Victim Compensation Claim Form is incorporated in subsection 2A-2.017(1), F.A.C. 64The application must include the following information:

    71(a) Name, date of birth, mailing address, telephone number, if any, where victim/applicant can be reached during the day, email address, if any, for the victim/applicant to receive correspondence.

    100(b) Optional demographic data for federal statistical purposes, including race/ethnicity, gender, and national origin.

    114(c) A statement indicating if victim is disabled or deceased as a result of the crime.

    130(d) Agency name, name of agency representative, mailing address, telephone number, and email address for the person or agency assisting the victim/applicant with the victim compensation claim.

    157(e) Current occupation information including the 163name, mailing address, telephone number, and email address for the victim’s employer(s), if the victim was employed at the time of the crime.

    186(f) Applicants submitting an application on behalf of an incompetent adult must have their application signature witnessed by a notary public whose commission is current on the date the signature is captured.

    218(g) For loss of support, the name(s) and date(s) of birth of the deceased victim or intervenor’s:

    2351. Surviving spouse,

    2382. Dependent parent, sibling, or child(ren), or

    2453. Other person who was dependent on the decedent for his or her principal support.

    260(h) 261Insurance information, including the company (carrier) name, mailing address, telephone number, email address, and policy number, and explanation or statement of benefits for the following:

    2861. State and federal programs (e.g., Medicare, Champus, Erisa, Medicaid),

    2962. Homeowner’s, automobile, and medical insurance,

    3023. Health maintenance organization,

    3064. Funeral or burial insurance, and,

    3125. Disability and/or wage replacement coverage.

    318(i) Name, mailing address, telephone number, fax number, and email address of the attorney who is (or will be) handling civil litigation that has been (or will be) filed as a result of the crime.

    353(j) Crime information:

    3561. Date of occurrence and type of crime,

    3642. Date reported to proper authorities,

    3703. Whether crime was reported within 120 hours after the occurrence,

    3814. Official name of the agency to which crime was reported,

    3925. Law enforcement report number,

    3976. Name of the law enforcement officer assigned to the case; and,

    4097. Name of offender and status in the criminal justice system, including court case number.

    424(k) Statements asserting serious financial hardship, authorizing release of information, and acknowledging repayment requirements and subrogation obligations.

    441(l) Printed name and signature of the adult who is filing the claim.

    454(m) 455The following persons can file a claim:

    4621. Victim or intervenor,

    4662. Surviving spouse, parent, step-parent, adult child or sibling of a deceased victim,

    4793. Guardian applying on behalf of a minor victim, incompetent person, surviving minor child of a deceased victim, or surviving minor sibling of a deceased victim.

    5054. Relative applying on behalf of a deceased victim when there is no other source for payment of funeral expenses;

    5255. Non-relative applying for funeral benefits 531on behalf of a deceased victim when no family member is available to pay for funeral expenses, or

    5496. Other person applying for loss of support benefit 558who was dependent for his or her principal support upon a deceased victim or intervenor.

    5737. Mitigating or special circumstances, pursuant to Section 581960.065(3), 582Florida Statutes, only exist when an eligible minor victim, who cannot otherwise apply on their own behalf, has no qualified applicant available to apply on the minor victim’s behalf. In such cases, payments will only be made to treatment providers and no funds shall be paid directly or indirectly to the applicant.

    634(2) Documentation.

    636(a) The victim/applicant has the ultimate responsibility to provide information and documentation needed to support eligibility and benefits payment.

    655(b) The victim/applicant must provide updated address and contact information, which shall be considered the address of record. Failure to update this information will cause delays.

    681(c) When the claim is received, the victim/applicant shall provide specifically requested medical and financial information, if applicable.

    699(d) When an incomplete claim is received, the department will notify the victim/applicant at their address of record, or their email address, if provided, of the information needed for eligibility determination and benefits.

    732(e) Required information:

    7351. Completed, signed, and dated application.

    7412. Report from proper authorities, or form BVC430 Law Enforcement Information Reporting Form, which is incorporated in subsection 2A-2.017(9), F.A.C., documenting that:

    763a. A compensable crime occurred,

    768b. The victim did not contribute to the infliction of his or her injury or death,

    784c. The victim did not act unlawfully; and,

    792d. The crime was reported to the proper authorities within the required timeframe in which the incident was known to have occurred.

    8143. Proof of crime-related expenses (includes itemized bills from treatment providers).

    8254. Proof of third-party payments such as insurance, restitution, judgments or settlements (e.g., copy of insurance explanation of benefits, settlement agreements, court documents for restitution and judgments), if applicable.

    8545. Proof of time missed from work as verified in writing by the treating physician and the 871human resources director or other authorized human resources supervisor, employee administrative services supervisor, chief financial officer, chief executive officer, president, or owner.

    8936. Proof of the disability incurred as a result of the crime as verified in writing by the treating physician, if applicable.

    915(3) Reporting Time. For crimes occurring before October 1, 2019, the crime must be reported to the proper authority within 72 hours after the crime is known to have occurred. For crimes occurring on or after October 1, 2019, the crime must be reported to the proper authority within 120 hours after the crime is known to have occurred. When the crime was reported to the proper authorities beyond the reporting requirement, the victim/applicant must provide an explanation for the late reporting which demonstrates good cause for the delay. Alternatively, BVC103 Reporting Time Explanation Form, which is incorporated in subsection 2A-2.017(11), F.A.C., may be used by the victim/applicant in lieu of submitting other written good cause explanation.

    1032(a) Good cause is demonstrated when the record shows the victim/applicant was unaware that a crime had occurred; the victim believed that the proper authorities had already been notified; the victim was not in the vicinity to report the incident to the proper authorities in the manner in which the proper authorities directed; there was no knowledge that a crime was committed prior to reporting the incident to the proper authorities; when the victim/applicant was not emotionally, mentally, or physically able to report the incident; when the victim/applicant believed that the proper authorities had been contacted and a report was filed; when the victim is/was a minor at the time of the incident; when the victim/applicant expressed feelings of shame, remorse, or embarrassment which prevented them from contacting the proper authorities; fear of retaliation or retribution by the offender, the offender’s family, or the offender’s acquaintances which was communicated to the proper authorities; or when a language or cultural barrier precludes effective communication with the proper authorities.

    1199(4) Filing Time. 1202For crimes occurring before October 1, 2019, applications must be received within one year after the crime; 1219the crime related death of the victim or intervenor; the date the death of the victim or intervenor is determined to be the result of a crime 1246or within two years with good cause 1253shown1254. For crimes occurring on or after October 1, 2019, applications must be received within three years after the crime; 1274the crime related death of the victim or intervenor; the date the death of the victim or intervenor is determined to be the result of a crime 1301or within five years with good cause 1308shown. 1309When a claim is received later than the filing time required, the victim/applicant must provide an explanation for the late filing which demonstrates good cause for the delay. 1337Alternatively, BVC102 Filing Time Explanation Form, which is incorporated in subsection 2A-2.017(10), F.A.C., may be used by the victim/applicant in lieu of submitting other written explanation.

    1363(a) Good cause is demonstrated when the record shows the victim/applicant was pursuing other means of recourse; when the victim/applicant was not emotionally, mentally, or physically able to file the claim; when the victim/applicant was unaware that a compensation program exists; 1404or when a language or cultural barrier hinders the access needed to timely file the claim1420.

    1421(b) For crimes occuring before October 1, 2019, 1429a victim who was under the age of 18 at the time of crime has one year or two years with good cause shown after turning 18 years of age for the department to receive their application. For crimes occurring on or after October 1, 2019, a victim who was under the age of 18 at the time of the crime has three years or five years with good cause shown after turning 18 years of age for the department to receive their application.

    1513(c) No explanation is acceptable for claims filed more than two years after the occurrence of the crime, unless Section 1533960.07(2)(b) 1534or (c), 1536960.07(3) 1537or 1538960.07(4), F.S., 1540applies.

    1541(5) Penalty Assessments.

    1544(a) An establishment of non-cooperation must be based on information obtained in writing from a proper authority. If an arrest has been made and the criminal case is at the prosecution stage, the assessment of non-cooperation must be based on information obtained from the assistant state attorney. If the case is open at the local law enforcement agency, the assessment of non-cooperation must be based on information obtained from the law enforcement agency.

    1617(b) 1618Upon establishment of non-cooperation, the victim/applicant shall submit an explanation for same to the department. BVC104 Non-Cooperation Explanation Form, which is incorporated in subsection 2A-2.017(12), F.A.C., may be used for this purpose. 1650Non cooperation is established when a proper authority informs the department in writing that the victim:

    16661. Failed to appear when requested by law enforcement or after proper notice from the state attorney,

    16832. Failed to testify or assist in the investigation and prosecution,

    16943. Gave false or misleading information regarding the crime without recanting, or

    17064. Aided the offender in his or her defense.

    1715(c) Contributory misconduct is based on information in writing from 1725a proper authority that the victim’s conduct contributed to his or her injury or death.

    1740(d) Penalty assessments, if imposed, will be applied only to payments made directly to the victim or applicant at the rate of 25 percent of the amount otherwise payable.

    1769(e) A penalty assessment of more than 25 percent will result in the denial of benefits.

    1785(6) Benefits.

    1787(a) Collateral sources must be exhausted before the amount of any compensable benefit is determined, except loss of support and catastrophic disability.

    1809(b) Disability benefits are available for eligible victims who suffered a permanent disability as a result of the crime.

    18281. The disability allowance is calculated at $250.00 per percentage point for disability ratings of one through ten percent, and $500.00 per percentage point for disability ratings of eleven percent and above.

    18602. Pre-existing disability is not compensable.

    1866(c) 1867Wage loss benefits:

    18701. Available to eligible victims/applicants who missed time from work because they are unable to work as a result of the injuries sustained as a result of the crime. Wage loss benefits are also available to the victim’s parent, when he or she misses time from work to provide immediate care to the minor victim.

    19252. Lost wages will be paid at 66.667 percent based on the victim/applicant’s actual gross average weekly wage or maximum gross average weekly wage provided by the Department of Financial Services for Workers’ Compensation Benefits. In no case may the wage loss payment exceed the maximum gross average weekly wage (“GAWW”) established by the Department of Financial Services.

    19833. The victim or applicant must have been gainfully employed or accruing reemployment assistance benefits at the time of the crime.

    20044. The following is needed to calculate wage loss benefits:

    2014a. Earnings statement(s); documentation from the employer; most recent federal income tax documentation (if self-employed); unemployment compensation (reemployment assistance) benefits statement; or a BVC405 Victim Compensation Wage Loss Employment Report, which is incorporated in subsection 2A-2.017(14), F.A.C.

    2051b. Statement from treating physician.

    20565. When the victim was not employed at the time of the crime but was receiving unemployment compensation (reemployment assistance) benefits, and because of the crime injuries the victim is not able to work or actively seek employment and is thereby no longer eligible to receive unemployment compensation benefits, the payment for lost wages will be based on the victim’s non-discounted unemployment compensation benefit amount.

    2121(d) 2122Loss of support benefits are available to eligible dependents of a deceased victim or intervenor who was employed, was receiving reemployment assistance, or had applied for and would have been eligible for unemployment compensation benefits (reemployment assistance), at the time of the crime. Benefits for loss of support are calculated by determining the earnings lost for a period of three years.  The gross average weekly wage is multiplied by 52 weeks then multiplied by 3 years, to equal the total loss of support benefit up to to the maximum benefit amount in the Schedule of Benefits listed below. Persons eligible for this benefit are:

    22261. Surviving spouse,

    22292. Dependent parent, sibling, and child(ren); and,

    22363. A person who was dependent for his or her principal support on the deceased victim.

    2252(e) 2253Funeral/burial expenses are compensable and may be paid to the service provider or reimbursed to the applicant when the applicant has already paid the bill. The applicant must be identified on the funeral contract as the party who paid the funeral expenses or the party responsible for the unpaid funeral expense. 2304Funeral/burial expenses are considered expenses associated with the funeral, services that constitute a funeral, transporting the deceased victim’s remains, burying, entombing, internment, cremation, procession, wake, or memorial ceremony held in honor or observation of the deceased and any other expenses which are not otherwise listed but are directly related to a funeral/memorial ceremony or the care of the decedent. With exception to religious practices, food, beverages, and expenses associated with social events are not compensable.

    2379(f) 2380Mental health treatment (inpatient and outpatient) expenses;

    23871. Compensable when the treatment is directly related to the crime and when such services are rendered by a person qualified to provide mental health counseling pursuant to Chapter 458, 490 or 491, F.S., and when such treatment is rendered within the timeframes established on the Schedule of Benefits.

    24362. 2437Inpatient mental health care is limited to acute, crisis stabilization up to seven days.

    24513. 2452Minors who saw or heard the crime incident and who suffered a psychological or psychiatric injury as a result of the crime, but were not physically injured, may receive mental health care, when the law enforcement report reflects that the minor was present at the crime scene.

    24994. Minors younger than 18 years of age who were the victim of a felony or misdemeanor offense of child abuse that resulted in a mental injury, as defined in Section 2530827.03, F.S., 2532but who were not physically injured, are eligible for mental health treatment benefits.

    25455. Persons who suffered a psychological or psychiatric injury as a direct result of a forcible felony may receive mental health care, when the law enforcement report identifies the individual as a victim of the crime. This is the only benefit available to adult victims who did not suffer a physical injury or death.

    25996. A surviving spouse, parent, step-parent, child or sibling of a deceased victim may receive mental health grief counseling. When more than one applicant applies, each adult applicant shall be eligible for benefits up to the maximum benefit amount on the Schedule of Benefits, not to exceed $10,000.00 per claim.

    26507. When a minor receiving mental health treatment care reaches the age of 18, the maximum adult benefit level applies. If that benefit amount has already been paid, no further mental health or grief counseling benefits are available.

    26888. Out-of-pocket reimbursement to the victim/applicant for payment to mental health service providers is payable at 100 percent, not to exceed total benefit limits, except when the offender would be unjustly enriched directly or indirectly. In that event, reimbursement is not compensable.

    27309. 2731Reimbursement for transportation costs to mental health treatment 2739appointments requires the submission of an itemized bill by the treating provider and a reasonable estimate of the mileage between the victim/applicant’s residence. Rental car charges may be compensable for travel to another city for mental health treatment. A traveler who uses an indirect route for personal convenience must bear any extra costs; reimbursement for expenses shall be based only on such charges as would have been incurred by a usually-traveled route.

    2811(g) Medical/dental/non-medical remedial care treatment costs are compensable.

    28191. 2820Treatment expenses include any financial obligation or monetary outlay for crime-related medical or non-medical remedial care and other services necessary as a result of the crime for which the victim/applicant is responsible for payment.

    28542. 2855If the provider rejects payment in full from the department, the funds may be paid to the victim/applicant, who is then responsible for the bill.

    28803. Out-of-pocket reimbursement to the victim/applicant for payments to medical providers is payable at 100 percent, not to exceed total benefit limits, except when the offender would be unjustly enriched directly or indirectly. In that event, reimbursement is not compensable.

    29204. 2921Crime-related medical expenses of a deceased adult victim incurred prior to his or her death are compensable only when an eligible applicant is financially responsible for the expense.

    29495. Medically necessary equipment (e.g., wheelchairs, oxygen tanks and prosthetics) that are damaged during the crime. When the item was damaged during the crime, the law enforcement report must specifically identify what happened to the items.

    29856. 2986Reimbursement for transportation costs to medical/dental treatment appointments requires the submission of an itemized bill by the treating provider and a reasonable estimate of the mileage between the victim/applicant’s residence. Rental car charges may be compensable for travel to another city for medical/dental treatment. A traveler who uses an indirect route for personal convenience must bear any extra costs; reimbursement for expenses shall be based only on such charges as would have been incurred by a usually-traveled route.

    30647. Costs for interpreter services for eligible victims with (foreign) language barriers and/or hearing impairment which allows victims to receive assistance in obtaining benefits and medical or mental health treatment services. These costs are included in the respective maximum benefit amounts and must be identified on an itemized bill. This does not apply to interpreter costs incurred for court-related activities.

    3124(h) Crime scene cleanup costs for the removal and disposal of biohazardous and/or biochemical substances following a violent crime that occurs in the private residence or conveyance of the victim. These services must be performed by a government-authorized facility within seven days after law enforcement officially releases the scene as a site closed for investigation.

    3179(i) 3180When the maximum benefit amount has been reached, no further benefits are available, regardless of whether that occurs prior to or after the effective date of these rules.

    3208(7) Documentation Requirements –

    3212(a) The victim/applicant shall provide documentation needed to support a determination of eligibility for benefits under this rule. Failure to provide the requested information will cause delays and result in denial of the claim.

    3246(b) A claim for compensation must include the type of benefits requested and the following:

    32611. Personal identification information for applicant and victim, if different,

    32712. Full legal name, date of birth, social security or other government-issued identification number (if applicable), and relationship to victim,

    32913. Mailing address, including city, state and zip code where department correspondence can be received, which shall be the address of record,

    33134. Email address, if any, and telephone number, if any, where victim/applicant can be reached during the day; and,

    33325. Indication of whether victim was disabled before the crime occurred.

    33436. Referral information, if applicable:

    3348a. Name of person who assisted victim/applicant in completing the application,

    3359b. Name of organization assisting the victim/applicant;

    3366c. Organization’s mailing address, including city, state and zip code,

    3376d. Email address, if any, and telephone number, if any, for person assisting victim/applicant.

    33907. Employment information, if applicable:

    3395a. Supervisor’s name and title,

    3400b. Legal name of company or business,

    3407c. Employer’s mailing address, including city, state and zip code; and,

    3418d. Supervisor’s email address, if any, and telephone number, if any.

    34298. An individual federal income tax return with W-2 or schedule C attachments, as appropriate.

    34449. Insurance and other third party payer information:

    3452a. Name of insured,

    3456b. Type of policy and policy number,

    3463c. Name of insurance company; and,

    3469d. Insurance company’s mailing address, including city, state and zip code.

    348010. Crime information:

    3483a. Date of crime,

    3487b. Date crime was reported to the law enforcement or other proper authority and report number,

    3503c. Name of law enforcement agency where crime was reported,

    3513d. Type of crime,

    3517e. Name of law enforcement officer,

    3523f. Name of offender,

    3527g. Offender’s status,

    3530h. Name of assistant state attorney handling case; and,

    3539i. Court case number.

    354311. Affirmative statement signed by victim/applicant that the information provided is true and correct to the best of his or her knowledge.

    356512. A contractual agreement signed by the victim/applicant or attorney to:

    3576a. Reimburse the department according to the provisions of Section 3586960.16, F.S.,

    3588b. Authorize release of information pursuant to Sections 3596960.05(2)(k), 3597(l), (m) and (n), F.S.; and,

    3603c. Affirm whether the victim wants to invoke confidentiality pursuant to Section 3615119.071, F.S.

    3617(c) Acceptable documentation for proof that a compensable crime occurred shall include:

    36291. A law enforcement report that affirms a crime occurred, regardless of whether an offender can be identified,

    36472. An affidavit charging an individual with a crime filed by law enforcement,

    36603. An information charging an individual with a crime filed by a state attorney,

    36744. An indictment by a grand jury,

    36815. A written communication from any Federal Law Enforcement agency,

    36916. A cybercrime investigator may certify a crime for purposes of Section 3703960.197, F.S., 3705or

    37067. A completed form BVC430 Law Enforcement Information Reporting Form which is incorporated in subsection 2A-2.017(9), F.A.C.

    3723(d) When there is an original law enforcement report showing a compensable crime occurred, the claim should be determined eligible, without regard to the offense to which the offender eventually pled or was convicted of, provided the remaining eligibility criteria are met.

    3765(e) Itemized bills must be submitted before payment to a provider or reimbursement to the victim/applicant can be considered pursuant to Sections 3787960.13, 3788960.197 3789and 3790960.28, F.S. 3792The itemized bill (invoice) should be prepared using industry standard forms (e.g., CMS-1450, 1500, J400), or on the provider’s letterhead and must include the following information:

    38181. Service provider/facility’s name, street address, city, state and zip code, email address, and telephone number (including area code),

    38372. Organization/treatment facility’s mailing address,

    38423. Federal tax identification number,

    38474. Beginning and ending date(s) of service,

    38545. Name and address of individual being billed for services rendered,

    38656. Revenue code, description of service, CPT or equivalent code, service date, service units, and total charges,

    38827. Diagnosis code, diagnosis, or nature of injury; and,

    38918. First and last name of attending medical professional and license number.

    3903(f) Acceptable documentation for crime-related wage loss:

    39101. Documentation from the employer signed by the company’s human resources director or other authorized human resources supervisor, employee administrative services supervisor, chief financial officer, chief executive officer, president, or owner which specifies the following:

    3945a. Victim/applicant’s name,

    3948b. Job title,

    3951c. Date hired,

    3954d. Date terminated, if applicable,

    3959e. Dates missed from work as a result of the crime,

    3970f. Average number of hours the victim/applicant worked per week,

    3980g. Total number of hours missed from work as a result of the crime,

    3994h. Hourly wage or average weekly wage (rate of pay),

    4004i. Company name, address, and telephone number; and,

    4012j. Supervisor’s name and telephone number, if applicable.

    40202. If the documentation requirements specified in subparagraph 1., above, cannot be obtained, the following documentation shall be accepted:

    4039a. The victim/applicant’s individual earnings statement(s) showing loss of dates and income from work as a result of the crime,

    4059b. Unemployment compensation (reemployment assistance) benefits statement,

    4066c. Federal income tax, or

    4071d. Documentation for the quarter or year immediately preceding the date of the crime (if self-employed).

    40873. Oral or electronic confirmation shall be obtained from the employer for the first forty hours of wage loss. Subsequent loss is compensable only upon receipt of written document requested herein.

    41184. Alternatively, BVC405 Victim Compensation Wage Loss Employment Report, which is incorporated in subsection 2A-2.017(14), F.A.C., may be submitted in lieu of other documentation.

    41425. Statement from treating physician including;

    4148a. Victim’s full name, date of birth, and other identifying information (e.g., social security number, patient account number),

    4166b. Type of injury, diagnostic code(s) for the injury,

    4175c. Dates victim was not able to work as a result of the crime,

    4189d. Physician’s name, mailing address, email address, telephone number, fax number, federal identification number, and medical license number; and,

    4208e. Physician’s signature and date signed.

    4214(g) Acceptable documentation for crime-related loss of support includes the following:

    42251. Income tax returns showing earnings for one to three years preceding the date of the crime. If the claim will exhaust the maximum allowable benefit using just the year prior to the date of the crime, then only one year of tax documentation is necessary. If not, two or three years of prior tax documents for the years preceding the date of the crime are required to calcualte the gross average weekly wage.

    42992. Reemployment assistance statements may be used in combination with tax documentation to calculate the gross average weekly wage.

    43183. Alternatively, the Victim Compensation Wage Loss Employment Report (BVC403), which is incorporated in subsection 2A-2.017, F.A.C., may be submitted to document earnings preceding the crime.

    4344(h) Proof of dependency is established based on:

    43521. The deceased victim’s federal income tax return,

    43602. Marriage certificate,

    43633. Birth or death certificate,

    43684. Copy of approval for Social Security Administration survivor benefits,

    43785. A court order for support, or

    43856. When establishing principal dependency, the applicant may provide actual documentation that joint expenses exceed the applicant’s income and that the expenses had been paid by the deceased. Acceptable documentation includes certified copies of financial records, leases, mortgages or other forms of mutual indebtedness for a minimum of one year preceding the occurrence of the crime.

    4441(i) Acceptable documentation for crime-related disability benefits includes an assessment in writing by a licensed physician which must document the disability rating in accordance with the American Medical Association’s Guide to Evaluation of Permanent Impairment or the Florida Permanent Impairment Rating Guide. Alternatively, a BVC409 Victim Compensation Treatment Disability Statement, which is incorporated in subsection 2A-2.017(8), F.A.C., may be submitted in lieu of other documentation. The documentation must include the following:

    45121. Victim’s full name, date of birth, and other identifying information (e.g., social security number),

    45272. Type of injury and diagnostic code(s),

    45343. Permanent whole body disability rating pursuant to Section 4543440.15(3)(b), F.S.,

    45454. Verification that the victim has reached maximum medical improvement, or that the percentage of disablity will not change after maximum medical improvement has been reached,

    45715. Guide used to assess the whole body permanent disability percentage,

    45826. Subsection of Section 4586960.03(1), F.S. 4588for which the victim qualifies for catastrophic losses, if applicable; and,

    45997. Attending physician’s name, mailing address, telephone number, federal identification number, medical license number which is signed and dated.

    4618(j) Acceptable documentation for crime scene cleanup services includes an itemized bill which provides the following:

    46341. Service provider/facility’s name, street address, city, state and zip code, email address, and telephone number (including area code),

    46532. Federal tax identification number,

    46583. Date(s) of service,

    46624. Date of occurrence of crime incident for which services are provided,

    46745. Name and address of individual being billed for services rendered,

    46856. Description of service, service date, service units, and total charges; and,

    46977. Documentation must prove that services were performed within seven days from the crime incident, or be accompanied by documentation from law enforcement proving that services were performed within seven days after law enforcement released the scene as a site closed for investigation.

    4740(k) The schedule of benefits for claims timely filed pursuant to the Crimes Compensation Act, includes:

    4756BENEFIT TYPE

    4758Maximum Benefit Amount

    4761(up to)

    4763Timeframe Within Which Loss Must Be Incurred from Date of Crime (up to)

    4776Wage Loss

    4778$7,500.00 at a rate of

    478450%

    4785or GAWW

    4787one year

    4789Parental Wage Loss

    4792$7,500.00 at a rate of

    479850%

    4799or GAWW

    4801one year

    4803Loss of Support

    4806$12,500.00

    4808n/a

    4809Disability

    4810$7,500.00

    4812n/a

    4813Catastrophic Disability

    4815$25,000.00

    4817n/a

    4818Crime Scene Cleanup

    4821$1,000.00

    48237 days

    4825Medical/Dental Treatment

    4827$5,000.00 at a rate of

    483350%

    4834one year

    4836Mental Health Injured Minor (until age 18)

    4843$5,000.00 at a rate of

    484950%

    4850n/a

    4851Mental Health Inpatient Crisis Stabilization

    4856$5,000.00 at a rate of

    486250%

    48637 days

    4865Mental Health Injured Adult Victim

    4870$2,500.00 at a rate of

    487650%

    4877one year

    4879Mental Health Minor Witness

    4883$2,500.00 at a rate of

    488950%

    4890one year

    4892Mental Health Minor Victim Mental Injury (until age 18)

    4901$5,000.00 at a rate of

    490750%

    4908n/a

    4909Mental Health Adult or Minor Victim of Forcible Felony (non-injury)

    4919$5,000.00 at a rate of

    492550%

    4926one year

    4928Grief Counseling (surviving spouse, parent, step-parent, child, step-child, sibling, step-sibling, or other dependent of a deceased victim; combined total benefit cannot exceed $10,000.00 payout)

    4953$5,000.00

    4955($2,500.00 each adult applicant)

    4960at a rate of

    496450%

    4965one year

    4967Funeral/Burial

    4968$7,500.00

    4970n/a

    4971Property Loss

    4973$500.00

    4974date loss discovered

    4977Domestic Violence Relocation

    4980$1,000.00

    4982receipts submitted within 45 days

    4987Sexual Battery Relocation

    4990$1,000.00

    4992receipts submitted within 45 days

    4997Human Trafficking Relocation

    5000$1,000.00

    5002receipts submitted within 45 days

    5007Sexual Battery Forensic Examinations

    5011$500.00

    5012date of exam

    5015Emergency Responder Death Benefit

    5019$50,000.00

    5021n/a

    5022(l) Total benefits paid on a single claim cannot exceed $7,500.00 when the victim is not deceased, or catastrophically injured, $12,500.00 when the victim is deceased, $25,000.00 when the victim has sustained a catastrophic injury as defined in Section 5064960.03(1), F.S., 5066as a direct result of the crime, or $50,000 when an emergency responder was killed in the line of duty. Benefits paid to medical, mental health, or grief counseling treatment providers shall be paid at a rate of 50% or less depending on the availability of funds. Property loss cannot exceed $500.00 on any one claim, and a lifetime maximum of $1,000.00 on all claims. Benefits paid for relocation claims cannot exceed $1,000.00 on any one claim, and a lifetime maximum of $3,000.00 for the same relocation claim type.

    5159Rulemaking Authority 5161960.045(1), 5162960.13(9)(b) FS. 5164Law Implemented 5166960.065, 5167960.07, 5168960.12, 5169960.13, 5170960.15, 5171960.16, 5172960.17, 5173960.18, 5174960.195, 5175960.198 FS. 5177History–New 1-1-92, Amended 11-1-92, 9-13-94, 1-8-96, 6-25-96, 10-1-96, 9-24-97, 8-17-99, 2-3-00, 10-23-01, 5-13-03, 1-16-08, 7-1-10, 11-19-12, 10-1-14, 9-23-15, 2-29-16, 6-30-16, 10-29-17, 5-20-19, 9-1-19, 12-11-19.