69L-24.003. Definitions

The following definitions shall apply in the rule chapter:

(1) “Action” – an event or events leading to the commission of a violation.

(2) “Audit” – a process whereby the practices of regulated entities are examined to verify compliance with chapter 440 and other applicable Florida Statutes and Administrative Rules. The term “audit” is synonymous with the term “examination.”

(3) “Batch” – a group of data records that is created and evaluated by CPS from manually or electronically submitted data received by the Department.

(4) “Centralized Performance System (CPS)” – a system that evaluates payment and filing data submitted to the Department.

(5) “Department” – the Florida Department of Financial Services.

(6) “Department Rules” – any and all rules adopted by the Department of Financial Services in its administration of chapter 440, F.S., that apply to insurers or other regulated entities.

(7) “Division” – the Division of Workers’ Compensation within the Florida Department of Financial Services.

(8) “Examination” – a process whereby the practices of regulated entities are examined to verify compliance with chapter 440, F.S., and Department Rules. The term “examination” is synonymous with the term “audit.”

(9) “F.A.C.” – Florida Administrative Code.

(10) “F.S.” – Florida Statutes.

(11) “Form DFS-F2-DWC-1” – Form DFS-F2-DWC-1 (First Report of Injury or Illness), effective 03/2009, or an electronic equivalent as required in rule 69L-56.301, F.A.C.

(12) “Investigation” – a Department review that is conducted to verify compliance with chapter 440, F.S., and Department Rules.

(13) “Pattern or Practice” – a repeated or customary act(s) of non-compliance with any single provision of Chapter 440, F.S. or Department Rules on an individual claim or on multiple claims.

(14) “Regulated Entity” – any insurer as defined in section 440.02(38), F.S., employer, service company, servicing agent, third-party administrator, claims handling entity, self-serviced self-insured employer or fund, submitter of forms or data on behalf of an insurer, or managing general agent that is responsible for handling or adjusting claims, or fulfilling an insurer’s responsibility to transmit workers’ compensation data to the Department.

(15) “Violation” – any finding of non-compliance with chapter 440, F.S. or Department Rules.

Rulemaking Authority 440.13(11),440.185(10), 440.20(6), 440.525(4), 440.591, 440.593(5) FS. Law Implemented 440.13(11), 440.185, 440.20(6), (8), 440.525, 440.593 FS. History–New 1-12-10.