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Florida Administrative Code (Last Updated: November 11, 2024) |
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69. Department of Financial Services |
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69L. Division of Workers' Compensation |
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69L-5. Rules For Self-Insurers Under The Workers' Compensation Act |
1(1) It shall be the sole responsibility of Current Self-Insurers and Former Self-Insurers to provide for competent persons to service their self-insurance program in the areas of claims adjusting, safety engineering and loss control. This shall be done through either the use of their own employees, who are determined by the Department to have experience in these areas, or by contracting with a Qualified Servicing Entity approved by the Department to provide these services. A list of Qualified Servicing Entities may be obtained by contacting the Department at:
89Department of Financial Services
93Division of Workers’ Compensation
97Bureau of Monitoring and Audit/Self-Insurance
102200 East Gaines Street
106Tallahassee, Florida 32399-4224
109(2) Current Self-Insurers and Former Self-Insurers choosing to use their own employees to provide these services must obtain prior approval from the Department and shall submit Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09, as incorporated by reference, within thirty (30) days of a change in servicing arrangement and at least every three (3) years thereafter. Resumes of employees with experience in these areas must be provided for approval.
179(3) Current Self-Insurers and Former Self-Insurers contracting with a Qualified Servicing Entity must submit a completed Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09, within thirty (30) days of entering into a servicing contract. 214For expiring contracts renewed with the same Qualified Servicing Entity, a completed Form DFS-F2-SI-19 must be submitted within thirty (30) days after the expiration date of the contract being renewed. For contracts that are continuous or have terms greater than three (3) years, Form DFS-F2-SI-19 must be submitted no later than three (3) years and thirty (30) days from the date of submission of the prior Form DFS-F2-SI-19.
282(a) For Governmental Entities, Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09, shall be obtained from and submitted to the:
303Department of Financial Services
307Division of Workers’ Compensation
311Bureau of Monitoring and Audit/Self-Insurance
316200 East Gaines Street
320Tallahassee, Florida 32399-4224
323(b) For FSIGA Members, Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09, shall be obtained from and submitted to the:
344Florida Self-Insurers Guaranty Association, Inc.
3491427 E. Piedmont Dr., 2nd Floor
355Tallahassee, Florida 32308
358(4) Failure to submit the required Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09, shall constitute good cause for revocation of the self-insurance authorization in addition to civil penalties specified in Rule 39169L-5.217, 392F.A.C.
393(5) In the event that self-insured claims are transferred to a new Qualified Servicing Entity or the self-insurer assumes responsibility for provision of these services in-house, the previous Qualified Servicing Entity shall provide an accounting of all claims files and claims data sufficiently detailed to permit the new Qualified Servicing Entity or the self-insurer to establish accurate claims, reserving, and accounting data.
455Rulemaking Authority 457440.38(1), 458(2), (3), 460440.385(6), 461440.525(2), 462440.591 FS. 464Law Implemented 466440.38(1), 467(2), (3), 469440.385(1), 470(3), (6), 472440.525 FS. 474History–New 3-9-10, Amended 1-29-13.
