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A bill to be entitled |
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An act relating to workers' compensation; amending s. |
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440.02, F.S.; revising and repealing definitions; amending |
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s. 440.05, F.S.; revising requirements relating to |
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submitting notice of election of exemption; providing that |
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an officer of a corporation who elects exemption may not |
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recover benefits and is not considered an employee for |
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purposes of determining premiums; amending s. 440.06, |
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F.S.; revising provisions relating to failure to secure |
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compensation; amending s. 440.077, F.S.; providing that a |
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corporate officer electing to be exempt may not receive |
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benefits under ch. 440, F.S.; amending s. 440.09, F.S.; |
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clarifying provisions relating to compensation for |
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subsequent injuries; providing definitions; revising |
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provisions relating to drug testing; amending s. 440.10, |
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F.S.; revising provisions relating to contractors and |
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subcontractors with regard to liability for compensation; |
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requiring subcontractors to provide evidence of workers' |
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compensation coverage or proof of exemption to a |
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contractor; deleting provisions relating to independent |
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contractors; amending s. 440.1025, F.S.; revising |
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requirements relating to workplace safety programs; |
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amending s. 440.105, F.S.; increasing criminal penalties |
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for certain violations of workers’ compensation compliance |
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requirements; amending s. 440.1051, F.S.; increasing |
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criminal penalty for false reports; amending s. 440.107, |
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F.S.; providing additional powers to the Department of |
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Insurance relating to compliance and enforcement; |
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providing penalties; amending s. 440.11, F.S.; revising |
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employer and safety consultant immunity from liability |
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provisions; amending s. 440.13, F.S.; requiring the Agency |
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for Health Care Administration to ensure establishment of |
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practice parameters for physician medical services; |
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revising provisions that provide for reimbursement |
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allowances; requiring revision of specified reimbursement |
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schedules; providing timetable for revision of schedules |
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of maximum reimbursement allowances; revising certain |
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reimbursement allowances; revising procedure for |
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determination of fee-for-service and hospital per-diem |
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schedules; amending s. 440.134, F.S.; revising provisions |
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relating to managed care arrangements; revising a |
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definition; amending s. 440.14, F.S.; revising provisions |
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relating to calculation of average weekly wage for injured |
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employees; amending s. 440.15, F.S.; providing additional |
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limitations on compensation for permanent total |
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disability; increasing payment schedule for impairment |
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benefits and providing for partial reduction under certain |
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circumstances; amending s. 440.16, F.S.; increasing the |
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limits on the amount of certain benefits paid as |
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compensation for death; amending s. 440.192, F.S.; |
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requiring a petition for benefits to include all claims |
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which are ripe, due, and owing; amending s. 440.25, F.S.; |
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revising procedures for mediation and hearings; amending |
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s. 440.34, F.S.; revising provisions relating to the award |
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of attorney's fees; amending s. 440.38, F.S.; providing |
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requirement for employers with coverage provided by |
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insurers from outside the state; amending s. 440.381, |
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F.S.; providing criminal penalty for unlawful |
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applications; amending s. 627.311, F.S.; providing for an |
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additional subplan within the joint underwriting plan for |
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workers’ compensation insurance; providing for rates, |
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surcharges, and assessments; limiting assessment powers; |
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amending s. 921.0022, F.S.; revising the offense severity |
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ranking chart to reflect changes in penalties under the |
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act; requiring a report to the Legislature from the |
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Department of Financial Services regarding provisions of |
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law relating to enforcement; providing effective dates. |
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Be It Enacted by the Legislature of the State of Florida: |
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Section 1. Subsections (15), (41, and (42) of section |
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440.02, Florida Statutes, are amended to read: |
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440.02 Definitions.--When used in this chapter, unless the |
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context clearly requires otherwise, the following terms shall |
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have the following meanings: |
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(15)(a) "Employee" means any person engaged in any |
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employment under any appointment or contract of hire or |
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apprenticeship, express or implied, oral or written, whether |
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lawfully or unlawfully employed, and includes, but is not |
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limited to, aliens and minors. |
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(b) "Employee" includes any person who is an officer of a |
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corporation and who performs services for remuneration for such |
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corporation within this state, whether or not such services are |
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continuous. |
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1. Any officer of a corporation may elect to be exempt |
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from this chapter by filing written notice of the election with |
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the department as provided in s. 440.05. |
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2. As to officers of a corporation who are actively |
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engaged in the construction industry, no more than three |
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officers may elect to be exempt from this chapter by filing |
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written notice of the election with the department as provided |
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in s. 440.05. However, any exemption obtained by a corporate |
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officer of a corporation actively engaged in the construction |
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industry is not applicable with respect to any commercial |
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building project estimated to be valued at $250,000 or greater. |
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3. An officer of a corporation who elects to be exempt |
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from this chapter by filing a written notice of the election |
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with the department as provided in s. 440.05 is not an employee. |
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Services are presumed to have been rendered to the corporation |
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if the officer is compensated by other than dividends upon |
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shares of stock of the corporation which the officer owns. |
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(c)1."Employee" includes a sole proprietor or a partner |
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who devotes full time to the proprietorship or partnership and, |
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except as provided in this paragraph, elects to be included in |
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the definition of employee by filing notice thereof as provided |
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in s. 440.05. Partners or sole proprietors actively engaged in |
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the construction industry are considered employees unless they |
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elect to be excluded from the definition of employee by filing |
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written notice of the election with the department as provided |
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in s. 440.05. However, no more than three partners in a |
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partnership that is actively engaged in the construction |
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industry may elect to be excluded. A sole proprietor or partner |
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who is actively engaged in the construction industry and who |
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elects to be exempt from this chapter by filing a written notice |
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of the election with the department as provided in s. 440.05 is |
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not an employee. For purposes of this chapter, an independent |
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contractor is an employee unless he or she meets all of the |
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conditions set forth in subparagraph (d)1. |
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2. Notwithstanding the provisions of subparagraph 1., the |
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term "employee" includes a sole proprietor or partner actively |
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engaged in the construction industry with respect to any |
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commercial building project estimated to be valued at $250,000 |
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or greater. Any exemption obtained is not applicable, with |
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respect to work performed at such a commercial building project.
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(d) "Employee" does not include: |
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1. An independent contractor, if: |
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a. The independent contractor maintains a separate |
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business with his or her own work facility, truck, equipment, |
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materials, or similar accommodations; |
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b. The independent contractor holds or has applied for a |
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federal employer identification number, unless the independent |
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contractor is a sole proprietor who is not required to obtain a |
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federal employer identification number under state or federal |
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requirements; |
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c. The independent contractor performs or agrees to |
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perform specific services or work for specific amounts of money |
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and controls the means of performing the services or work; |
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d. The independent contractor incurs the principal |
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expenses related to the service or work that he or she performs |
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or agrees to perform; |
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e. The independent contractor is responsible for the |
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satisfactory completion of work or services that he or she |
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performs or agrees to perform and is or could be held liable for |
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a failure to complete the work or services; |
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f. The independent contractor receives compensation for |
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work or services performed for a commission or on a per-job or |
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competitive-bid basis and not on any other basis; |
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g. The independent contractor may realize a profit or |
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suffer a loss in connection with performing work or services; |
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h. The independent contractor has continuing or recurring |
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business liabilities or obligations; and |
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i. The success or failure of the independent contractor's |
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business depends on the relationship of business receipts to |
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expenditures. |
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However, the determination as to whether an individual included |
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in the Standard Industrial Classification Manual of 1987, |
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Industry Numbers 0711, 0721, 0722, 0751, 0761, 0762, 0781, 0782, |
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0783, 0811, 0831, 0851, 2411, 2421, 2435, 2436, 2448, or 2449, |
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or a newspaper delivery person, is an independent contractor is |
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governed not by the criteria in this paragraph but by common-law |
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principles, giving due consideration to the business activity of |
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the individual. Notwithstanding the provisions of this paragraph |
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or any other provision of this chapter, with respect to any |
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commercial building project estimated to be valued at $250,000 |
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or greater, a person who is actively engaged in the construction |
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industry is not an independent contractor and is either an |
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employer or an employee who may not be exempt from the coverage |
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requirements of this chapter.
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2. A real estate salesperson or agent, if that person |
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agrees, in writing, to perform for remuneration solely by way of |
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commission. |
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3. Bands, orchestras, and musical and theatrical |
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performers, including disk jockeys, performing in licensed |
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premises as defined in chapter 562, if a written contract |
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evidencing an independent contractor relationship is entered |
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into before the commencement of such entertainment. |
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4. An owner-operator of a motor vehicle who transports |
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property under a written contract with a motor carrier which |
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evidences a relationship by which the owner-operator assumes the |
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responsibility of an employer for the performance of the |
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contract, if the owner-operator is required to furnish the |
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necessary motor vehicle equipment and all costs incidental to |
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the performance of the contract, including, but not limited to, |
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fuel, taxes, licenses, repairs, and hired help; and the owner- |
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operator is paid a commission for transportation service and is |
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not paid by the hour or on some other time-measured basis. |
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5. A person whose employment is both casual and not in the |
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course of the trade, business, profession, or occupation of the |
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employer. |
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6. A volunteer, except a volunteer worker for the state or |
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a county, municipality, or other governmental entity. A person |
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who does not receive monetary remuneration for services is |
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presumed to be a volunteer unless there is substantial evidence |
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that a valuable consideration was intended by both employer and |
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employee. For purposes of this chapter, the term "volunteer" |
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includes, but is not limited to: |
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a. Persons who serve in private nonprofit agencies and who |
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receive no compensation other than expenses in an amount less |
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than or equivalent to the standard mileage and per-diem expenses |
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provided to salaried employees in the same agency or, if such |
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agency does not have salaried employees who receive mileage and |
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per diem, then such volunteers who receive no compensation other |
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than expenses in an amount less than or equivalent to the |
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customary mileage and per diem paid to salaried workers in the |
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community as determined by the department; and |
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b. Volunteers participating in federal programs |
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established under Pub. L. No. 93-113. |
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7. Any officer of a corporation who elects to be exempt |
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from this chapter. |
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8. A sole proprietor or officer of a corporation who |
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actively engages in the construction industry, and a partner in |
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a partnership that is actively engaged in the construction |
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industry, who elects to be exempt from the provisions of this |
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chapter. Such sole proprietor, officer, or partner is not an |
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employee for any reason until the notice of revocation of |
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election filed pursuant to s. 440.05 is effective. |
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9. An exercise rider who does not work for a single horse |
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farm or breeder, and who is compensated for riding on a case-by- |
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case basis, provided a written contract is entered into prior to |
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the commencement of such activity which evidences that an |
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employee/employer relationship does not exist. |
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10. A taxicab, limousine, or other passenger vehicle-for- |
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hire driver who operates said vehicles pursuant to a written |
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agreement with a company which provides any dispatch, marketing, |
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insurance, communications, or other services under which the |
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driver and any fees or charges paid by the driver to the company |
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for such services are not conditioned upon, or expressed as a |
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proportion of, fare revenues. |
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11. A person who performs services as a sports official |
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for an entity sponsoring an interscholastic sports event or for |
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a public entity or private, nonprofit organization that sponsors |
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an amateur sports event. For purposes of this subparagraph, such |
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a person is an independent contractor. For purposes of this |
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subparagraph, the term "sports official" means any person who is |
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a neutral participant in a sports event, including, but not |
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limited to, umpires, referees, judges, linespersons, |
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scorekeepers, or timekeepers. This subparagraph does not apply |
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to any person employed by a district school board who serves as |
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a sports official as required by the employing school board or |
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who serves as a sports official as part of his or her |
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responsibilities during normal school hours. |
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(41) "Commercial building" means any building or structure |
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intended for commercial or industrial use, or any building or |
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structure intended for multifamily use of more than four |
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dwelling units, as well as any accessory use structures |
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constructed in conjunction with the principal structure. The |
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term, "commercial building," does not include the conversion of |
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any existing residential building to a commercial building.
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(42) "Residential building" means any building or |
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structure intended for residential use containing four or fewer |
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dwelling units and any structures intended as an accessory use |
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to the residential structure.
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Section 2. Effective January 1, 2004, subsections (8), |
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(15), (16), and (38) of section 440.02, Florida Statutes, as |
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amended by this act, are amended to read: |
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440.02 Definitions.--When used in this chapter, unless the |
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context clearly requires otherwise, the following terms shall |
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have the following meanings: |
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(8) "Construction industry" means for-profit activities |
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involving the carrying out ofany building, clearing, filling, |
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excavation, or substantial improvement in the size or use of any |
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structure or the appearance of any land. When appropriate to the |
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context, "construction" refers to the act of construction or the |
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result of construction. However, "construction" doesshallnot |
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mean a homeowner'slandowner'sact of construction or the result |
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of a construction upon his or her own premises, provided such |
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premises are not intended to be sold,or resold, or leased by |
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the owner within 1 year after the commencement of construction. |
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The division may, by rule, establish standard industrial |
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classification codes and definitions thereof which meet the |
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criteria of the term “construction industry” as set forth in |
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this section. |
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(15)(a) "Employee" means any person who receives |
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remuneration from an employer for the performance of any work or |
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service, whether byengaged in any employment under any |
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appointment or contract forofhire or apprenticeship, express |
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or implied, oral or written, whether lawfully or unlawfully |
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employed, and includes, but is not limited to, aliens and |
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minors. |
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(b) "Employee" includes any person who is an officer of a |
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corporation and who performs services for remuneration for such |
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corporation within this state, whether or not such services are |
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continuous. |
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1. Any officer of a corporation may elect to be exempt |
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from this chapter by filing written notice of the election with |
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the department as provided in s. 440.05. |
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2. As to officers of a corporation who are actively |
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engaged in the construction industry, no more than three |
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officers of a corporation or of any group of affiliated |
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corporationsmay elect to be exempt from this chapter by filing |
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written notice of the election with the department as provided |
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in s. 440.05. Officers must be shareholders, each owning at |
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least 10 percent of the stock of such corporation and listed as |
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an officer of such corporation with the Division of Corporations |
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of the Department of State, in order to elect exemptions under |
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this chapter. For purposes of this subparagraph, the term |
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“affiliated” means and includes one or more corporations or |
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entities, any one of which is a corporation engaged in the |
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construction industry, under the same or substantially the same |
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control of a group of business entities which are connected or |
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associated so that one entity controls or has the power to |
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control each of the other business entities. The term |
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“affiliated” includes the officers, directors, executives, |
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shareholders active in management, employees, and agents of the |
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affiliated corporation. The ownership by one business entity of |
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a controlling interest in another business entity or a pooling |
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of equipment or income among business entities shall be prima |
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facie evidence that one business is affiliated with the other. |
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3. An officer of a corporation who elects to be exempt |
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from this chapter by filing a written notice of the election |
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with the department as provided in s. 440.05 is not an employee. |
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Services are presumed to have been rendered to the corporation |
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if the officer is compensated by other than dividends upon |
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shares of stock of the corporation which the officer owns. |
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(c) "Employee" includes: |
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1. A sole proprietor or a partner who is not engaged in |
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the construction industry,devotes full time to the |
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proprietorship or partnership, and, except as provided in this |
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paragraph,elects to be included in the definition of employee |
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by filing notice thereof as provided in s. 440.05. Partners or |
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sole proprietors actively engaged in the construction industry |
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are considered employees unless they elect to be excluded from |
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the definition of employee by filing written notice of the |
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election with the department as provided in s. 440.05. However, |
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no more than three partners in a partnership that is actively |
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engaged in the construction industry may elect to be excluded. A |
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sole proprietor or partner who is actively engaged in the |
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construction industry and who elects to be exempt from this |
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chapter by filing a written notice of the election with the |
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department as provided in s. 440.05 is not an employee. For |
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purposes of this chapter, an independent contractor is an |
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employee unless he or she meets all of the conditions set forth |
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in subparagraph (d)1. |
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2. All persons who are being paid by a construction |
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contractor as a subcontractor, unless the subcontractor has |
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validly elected an exemption as permitted by this chapter, or |
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has otherwise secured the payment of compensation coverage as a |
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subcontractor, consistent with s. 440.10, for work performed by |
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or as a subcontractor.
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3. An independent contractor working or performing |
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services in the construction industry.
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4. A sole proprietor who engages in the construction |
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industry and a partner or partnership that is engaged in the |
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construction industry. |
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(d) "Employee" does not include: |
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1. An independent contractor who is not engaged in the |
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construction industry., if: |
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351
|
a. In order to meet the definition of independent |
|
352
|
contractor, at least four of the following criteria must be met: |
|
353
|
(I) The independent contractor maintains a separate |
|
354
|
business with his or her own work facility, truck, equipment, |
|
355
|
materials, or similar accommodations;
|
|
356
|
(II) The independent contractor holds or has applied for a |
|
357
|
federal employer identification number, unless the independent |
|
358
|
contractor is a sole proprietor who is not required to obtain a |
|
359
|
federal employer identification number under state or federal |
|
360
|
regulations;
|
|
361
|
(III) The independent contractor receives compensation for |
|
362
|
services rendered or work performed and such compensation is |
|
363
|
paid to a business rather than to an individual;
|
|
364
|
(IV) The independent contractor holds one or more bank |
|
365
|
accounts in the name of the business entity for purposes of |
|
366
|
paying business expenses or other expenses related to services |
|
367
|
rendered or work performed for compensation;
|
|
368
|
(V) The independent contractor performs work or is able to |
|
369
|
perform work for any entity in addition to or besides the |
|
370
|
employer at his or her own election without the necessity of |
|
371
|
completing an employment application or process; or
|
|
372
|
(VI) The independent contractor receives compensation for |
|
373
|
work or services rendered on a competitive-bid basis or |
|
374
|
completion of a task or a set of tasks as defined by a |
|
375
|
contractual agreement, unless such contractual agreement |
|
376
|
expressly states that an employment relationship exists.The |
|
377
|
independent contractor maintains a separate business with his or |
|
378
|
her own work facility, truck, equipment, materials, or similar |
|
379
|
accommodations; |
|
380
|
b. If four of the above criteria do not exist, an |
|
381
|
individual may still be presumed to be an independent contractor |
|
382
|
and not an employee based on full consideration of the nature of |
|
383
|
the individual situation with regard to satisfying any of the |
|
384
|
following conditions: |
|
385
|
(I) The independent contractor performs or agrees to |
|
386
|
perform specific services or work for a specific amount of money |
|
387
|
and controls the means of performing the services or work;
|
|
388
|
(II) The independent contractor incurs the principal |
|
389
|
expenses related to the service or work that he or she performs |
|
390
|
or agrees to perform;
|
|
391
|
(III) The independent contractor is responsible for the |
|
392
|
satisfactory completion of the work or services that he or she |
|
393
|
performs or agrees to perform;
|
|
394
|
(IV) The independent contractor receives compensation for |
|
395
|
work or services performed for a commission or on a per-job |
|
396
|
basis and not on any other basis;
|
|
397
|
(V) The independent contractor may realize a profit or |
|
398
|
suffer a loss in connection with performing work or services;
|
|
399
|
(VI) The independent contractor has continuing or |
|
400
|
recurring business liabilities or obligations; and
|
|
401
|
(VII) The success or failure of the independent |
|
402
|
contractor’s business depends on the relationship of business |
|
403
|
receipts to expenditures.The independent contractor holds or |
|
404
|
has applied for a federal employer identification number, unless |
|
405
|
the independent contractor is a sole proprietor who is not |
|
406
|
required to obtain a federal employer identification number |
|
407
|
under state or federal requirements; |
|
408
|
c. Notwithstanding anything to the contrary in this |
|
409
|
subparagraph, an individual claiming to be an independent |
|
410
|
contractor has the burden of proving that he or she is an |
|
411
|
independent contractor for purposes of this act.The independent |
|
412
|
contractor performs or agrees to perform specific services or |
|
413
|
work for specific amounts of money and controls the means of |
|
414
|
performing the services or work;
|
|
415
|
d. The independent contractor incurs the principal |
|
416
|
expenses related to the service or work that he or she performs |
|
417
|
or agrees to perform;
|
|
418
|
e. The independent contractor is responsible for the |
|
419
|
satisfactory completion of work or services that he or she |
|
420
|
performs or agrees to perform and is or could be held liable for |
|
421
|
a failure to complete the work or services;
|
|
422
|
f. The independent contractor receives compensation for |
|
423
|
work or services performed for a commission or on a per-job or |
|
424
|
competitive-bid basis and not on any other basis;
|
|
425
|
g. The independent contractor may realize a profit or |
|
426
|
suffer a loss in connection with performing work or services;
|
|
427
|
h. The independent contractor has continuing or recurring |
|
428
|
business liabilities or obligations; and
|
|
429
|
i. The success or failure of the independent contractor's |
|
430
|
business depends on the relationship of business receipts to |
|
431
|
expenditures.
|
|
432
|
|
|
433
|
However, the determination as to whether an individual included |
|
434
|
in the Standard Industrial Classification Manual of 1987, |
|
435
|
Industry Numbers 0711, 0721, 0722, 0751, 0761, 0762, 0781, 0782, |
|
436
|
0783, 0811, 0831, 0851, 2411, 2421, 2435, 2436, 2448, or 2449, |
|
437
|
or a newspaper delivery person, is an independent contractor is |
|
438
|
governed not by the criteria in this paragraph but by common-law |
|
439
|
principles, giving due consideration to the business activity of |
|
440
|
the individual. |
|
441
|
2. A real estate salesperson or agent, if that person |
|
442
|
agrees, in writing, to perform for remuneration solely by way of |
|
443
|
commission. |
|
444
|
3. Bands, orchestras, and musical and theatrical |
|
445
|
performers, including disk jockeys, performing in licensed |
|
446
|
premises as defined in chapter 562, if a written contract |
|
447
|
evidencing an independent contractor relationship is entered |
|
448
|
into before the commencement of such entertainment. |
|
449
|
4. An owner-operator of a motor vehicle who transports |
|
450
|
property under a written contract with a motor carrier which |
|
451
|
evidences a relationship by which the owner-operator assumes the |
|
452
|
responsibility of an employer for the performance of the |
|
453
|
contract, if the owner-operator is required to furnish the |
|
454
|
necessary motor vehicle equipment and all costs incidental to |
|
455
|
the performance of the contract, including, but not limited to, |
|
456
|
fuel, taxes, licenses, repairs, and hired help; and the owner- |
|
457
|
operator is paid a commission for transportation service and is |
|
458
|
not paid by the hour or on some other time-measured basis. |
|
459
|
5. A person whose employment is both casual and not in the |
|
460
|
course of the trade, business, profession, or occupation of the |
|
461
|
employer. |
|
462
|
6. A volunteer, except a volunteer worker for the state or |
|
463
|
a county, municipality, or other governmental entity. A person |
|
464
|
who does not receive monetary remuneration for services is |
|
465
|
presumed to be a volunteer unless there is substantial evidence |
|
466
|
that a valuable consideration was intended by both employer and |
|
467
|
employee. For purposes of this chapter, the term "volunteer" |
|
468
|
includes, but is not limited to: |
|
469
|
a. Persons who serve in private nonprofit agencies and who |
|
470
|
receive no compensation other than expenses in an amount less |
|
471
|
than or equivalent to the standard mileage and per diem expenses |
|
472
|
provided to salaried employees in the same agency or, if such |
|
473
|
agency does not have salaried employees who receive mileage and |
|
474
|
per diem, then such volunteers who receive no compensation other |
|
475
|
than expenses in an amount less than or equivalent to the |
|
476
|
customary mileage and per diem paid to salaried workers in the |
|
477
|
community as determined by the department; and |
|
478
|
b. Volunteers participating in federal programs |
|
479
|
established under Pub. L. No. 93-113. |
|
480
|
7. Unless otherwise prohibited by this chapter,any |
|
481
|
officer of a corporation who elects to be exempt from this |
|
482
|
chapter. |
|
483
|
8. Ana sole proprietor or officer of a corporation who |
|
484
|
actively engages in the construction industry, and a partner in |
|
485
|
a partnership that is activelyengaged in the construction |
|
486
|
industry,who elects to be exempt from the provisions of this |
|
487
|
chapter, as otherwise permitted by this chapter. Such sole |
|
488
|
proprietor, officer, or partneris not an employee for any |
|
489
|
reason until the notice of revocation of election filed pursuant |
|
490
|
to s. 440.05 is effective. |
|
491
|
9. An exercise rider who does not work for a single horse |
|
492
|
farm or breeder, and who is compensated for riding on a case-by- |
|
493
|
case basis, provided a written contract is entered into prior to |
|
494
|
the commencement of such activity which evidences that an |
|
495
|
employee/employer relationship does not exist. |
|
496
|
10. A taxicab, limousine, or other passenger vehicle-for- |
|
497
|
hire driver who operates said vehicles pursuant to a written |
|
498
|
agreement with a company which provides any dispatch, marketing, |
|
499
|
insurance, communications, or other services under which the |
|
500
|
driver and any fees or charges paid by the driver to the company |
|
501
|
for such services are not conditioned upon, or expressed as a |
|
502
|
proportion of, fare revenues. |
|
503
|
11. A person who performs services as a sports official |
|
504
|
for an entity sponsoring an interscholastic sports event or for |
|
505
|
a public entity or private, nonprofit organization that sponsors |
|
506
|
an amateur sports event. For purposes of this subparagraph, such |
|
507
|
a person is an independent contractor. For purposes of this |
|
508
|
subparagraph, the term "sports official" means any person who is |
|
509
|
a neutral participant in a sports event, including, but not |
|
510
|
limited to, umpires, referees, judges, linespersons, |
|
511
|
scorekeepers, or timekeepers. This subparagraph does not apply |
|
512
|
to any person employed by a district school board who serves as |
|
513
|
a sports official as required by the employing school board or |
|
514
|
who serves as a sports official as part of his or her |
|
515
|
responsibilities during normal school hours. |
|
516
|
12. Medicaid-enrolled clients under chapter 393 who are |
|
517
|
excluded from the definition of employment under s. |
|
518
|
443.036(21)(d)5. and served by Adult Day Training Services under |
|
519
|
the Home and Community-Based Medicaid Waiver program in a |
|
520
|
sheltered workshop setting licensed by the United States |
|
521
|
Department of Labor for the purpose of training and earning less |
|
522
|
than the federal hourly minimum wage.
|
|
523
|
(16)(a)"Employer" means the state and all political |
|
524
|
subdivisions thereof, all public and quasi-public corporations |
|
525
|
therein, every person carrying on any employment, and the legal |
|
526
|
representative of a deceased person or the receiver or trustees |
|
527
|
of any person. If the employer is a corporation, parties in |
|
528
|
actual control of the corporation, including, but not limited |
|
529
|
to, the president, officers who exercise broad corporate powers, |
|
530
|
directors, and all shareholders who directly or indirectly own a |
|
531
|
controlling interest in the corporation, are considered the |
|
532
|
employer for the purposes of ss. 440.105 and 440.106. |
|
533
|
(b) A landowner shall not be considered the employer of |
|
534
|
persons hired by the homeowner to carry out construction on the |
|
535
|
homeowner’s own premises if those premises are not intended for |
|
536
|
immediate sale or resale. |
|
537
|
(c) Facilities serving individuals under subparagraph |
|
538
|
(15)(d)12. shall be considered agents of the Agency for Health |
|
539
|
Care Administration as it relates to providing Adult Day |
|
540
|
Training Services under the Home and Community-Based Medicaid |
|
541
|
Waiver program and not employers or third parties for the |
|
542
|
purpose of limiting or denying Medicaid benefits. |
|
543
|
(38) "Catastrophic injury" means a permanent impairment |
|
544
|
constituted by: |
|
545
|
(a) Spinal cord injury involving severe paralysis of an |
|
546
|
arm, a leg, or the trunk; |
|
547
|
(b) Amputation of an arm, a hand, a foot, or a leg |
|
548
|
involving the effective loss of use of that appendage; |
|
549
|
(c) Severe brain or closed-head injury as evidenced by: |
|
550
|
1. Severe sensory or motor disturbances; |
|
551
|
2. Severe communication disturbances; |
|
552
|
3. Severe complex integrated disturbances of cerebral |
|
553
|
function; |
|
554
|
4. Severe episodic neurological disorders; or |
|
555
|
5. Other severe brain and closed-head injury conditions at |
|
556
|
least as severe in nature as any condition provided in |
|
557
|
subparagraphs 1.-4.; |
|
558
|
(d) Second-degree or third-degree burns of 25 percent or |
|
559
|
more of the total body surface or third-degree burns of 5 |
|
560
|
percent or more to the face and hands; or |
|
561
|
(e) Total or industrial blindness; or |
|
562
|
(f) Any other injury that would otherwise qualify under |
|
563
|
this chapter of a nature and severity that would qualify an |
|
564
|
employee to receive disability income benefits under Title II or |
|
565
|
supplemental security income benefits under Title XVI of the |
|
566
|
federal Social Security Act as the Social Security Act existed |
|
567
|
on July 1, 1992, without regard to any time limitations provided |
|
568
|
under that act. |
|
569
|
Section 3. Effective January 1, 2004, subsections (3), |
|
570
|
(6), (10), and (13) of section 440.05, Florida Statutes, are |
|
571
|
amended, and subsection (14) is added to said section, to read: |
|
572
|
440.05 Election of exemption; revocation of election; |
|
573
|
notice; certification.-- |
|
574
|
(3) Each sole proprietor, partner, orofficer of a |
|
575
|
corporation who is activelyengaged in the construction industry |
|
576
|
and who elects an exemption from this chapter or who, after |
|
577
|
electing such exemption, revokes that exemption, must mail a |
|
578
|
written notice to such effect to the department on a form |
|
579
|
prescribed by the department. The notice of election to be |
|
580
|
exempt from the provisions of this chapter must be notarized and |
|
581
|
under oath. The notice of election to be exempt which is |
|
582
|
submitted to the department by the sole proprietor, partner, or |
|
583
|
officer of a corporation who is allowed to claim an exemption as |
|
584
|
provided by this chaptermust list the name, federal tax |
|
585
|
identification number, social security number, all certified or |
|
586
|
registered licenses issued pursuant to chapter 489 held by the |
|
587
|
person seeking the exemption, a copy of relevant documentation |
|
588
|
as to employment status filed with the Internal Revenue Service |
|
589
|
as specified by the department, a copy of the relevant |
|
590
|
occupational license in the primary jurisdiction of the |
|
591
|
business, and, for corporate officers and partners,the |
|
592
|
registration number of the corporation or partnershipfiled with |
|
593
|
the Division of Corporations of the Department of State along |
|
594
|
with a copy of the stock certificate evidencing the required |
|
595
|
ownership under this chapter. The notice of election to be |
|
596
|
exempt must identify each sole proprietorship, partnership, or |
|
597
|
corporation that employs the person electing the exemption and |
|
598
|
must list the social security number or federal tax |
|
599
|
identification number of each such employer and the additional |
|
600
|
documentation required by this section. In addition, the notice |
|
601
|
of election to be exempt must provide that the sole proprietor, |
|
602
|
partner, orofficer electing an exemption is not entitled to |
|
603
|
benefits under this chapter, must provide that the election does |
|
604
|
not exceed exemption limits for officers and partnerships |
|
605
|
provided in s. 440.02, and must certify that any employees of |
|
606
|
the corporation whosesole proprietor, partner, or officer |
|
607
|
electselectingan exemption are covered by workers' |
|
608
|
compensation insurance. Upon receipt of the notice of the |
|
609
|
election to be exempt, receipt of all application fees, and a |
|
610
|
determination by the department that the notice meets the |
|
611
|
requirements of this subsection, the department shall issue a |
|
612
|
certification of the election to the sole proprietor, partner, |
|
613
|
orofficer, unless the department determines that the |
|
614
|
information contained in the notice is invalid. The department |
|
615
|
shall revoke a certificate of election to be exempt from |
|
616
|
coverage upon a determination by the department that the person |
|
617
|
does not meet the requirements for exemption or that the |
|
618
|
information contained in the notice of election to be exempt is |
|
619
|
invalid. The certificate of election must list the namenamesof |
|
620
|
the sole proprietorship, partnership, orcorporation listed in |
|
621
|
the request for exemption. A new certificate of election must be |
|
622
|
obtained each time the person is employed by a new sole |
|
623
|
proprietorship, partnership, or differentcorporation that is |
|
624
|
not listed on the certificate of election. A copy of the |
|
625
|
certificate of election must be sent to each workers' |
|
626
|
compensation carrier identified in the request for exemption. |
|
627
|
Upon filing a notice of revocation of election, ana sole |
|
628
|
proprietor, partner, or officer who is a subcontractor or an |
|
629
|
officer of a corporate subcontractormust notify her or his |
|
630
|
contractor. Upon revocation of a certificate of election of |
|
631
|
exemption by the department, the department shall notify the |
|
632
|
workers' compensation carriers identified in the request for |
|
633
|
exemption. |
|
634
|
(6) A construction industry certificate of election to be |
|
635
|
exempt which is issued in accordance with this section shall be |
|
636
|
valid for 2 years after the effective date stated thereon. Both |
|
637
|
the effective date and the expiration date must be listed on the |
|
638
|
face of the certificate by the department. The construction |
|
639
|
industry certificate must expire at midnight, 2 years from its |
|
640
|
issue date, as noted on the face of the exemption certificate. |
|
641
|
Any person who has received from the division a construction |
|
642
|
industry certificate of election to be exempt which is in effect |
|
643
|
on December 31, 1998, shall file a new notice of election to be |
|
644
|
exempt by the last day in his or her birth month following |
|
645
|
December 1, 1998. A construction industry certificate of |
|
646
|
election to be exempt may be revoked before its expiration by |
|
647
|
the sole proprietor, partner, orofficer for whom it was issued |
|
648
|
or by the department for the reasons stated in this section. At |
|
649
|
least 60 days prior to the expiration date of a construction |
|
650
|
industry certificate of exemption issued after December 1, 1998, |
|
651
|
the department shall send notice of the expiration date and an |
|
652
|
application for renewal to the certificateholder at the address |
|
653
|
on the certificate. |
|
654
|
(10) Each sole proprietor, partner, orofficer of a |
|
655
|
corporation who is actively engaged in the construction industry |
|
656
|
and who elects an exemption from this chapter shall maintain |
|
657
|
business records as specified by the division by rule, which |
|
658
|
rules must include the provision that any corporation with |
|
659
|
exempt officers and any partnership activelyengaged in the |
|
660
|
construction industry with exempt partnersmust maintain written |
|
661
|
statements of those exempted persons affirmatively acknowledging |
|
662
|
each such individual's exempt status. |
|
663
|
(13) Any corporate officer permitted by this chapter to |
|
664
|
claimclaiming an exemption under this sectionmust be listed on |
|
665
|
the records of this state's Secretary of State, Division of |
|
666
|
Corporations, as a corporate officer. If the person who claims |
|
667
|
an exemption as a corporate officer is not so listed on the |
|
668
|
records of the Secretary of State, the individual must provide |
|
669
|
to the division, upon request by the division, a notarized |
|
670
|
affidavit stating that the individual is a bona fide officer of |
|
671
|
the corporation and stating the date his or her appointment or |
|
672
|
election as a corporate officer became or will become effective. |
|
673
|
The statement must be signed under oath by both the officer and |
|
674
|
the president or chief operating officer of the corporation and |
|
675
|
must be notarized.The division shall issue a stop-work order |
|
676
|
under s. 440.107(1) to any corporation who employs a person who |
|
677
|
claims to be exempt as a corporate officer but who fails or |
|
678
|
refuses to produce the documents required under this subsection |
|
679
|
to the division within 3 business days after the request is |
|
680
|
made. |
|
681
|
(14) An officer of a corporation who elects exemption from |
|
682
|
this chapter by filing a certificate of election under this |
|
683
|
section may not recover benefits or compensation under this |
|
684
|
chapter. For purposes of determining the appropriate premium for |
|
685
|
workers' compensation coverage, carriers may not consider any |
|
686
|
officer of a corporation who validly meets the requirements of |
|
687
|
this section to be an employee. |
|
688
|
Section 4. Section 440.06, Florida Statutes, is amended to |
|
689
|
read: |
|
690
|
440.06 Failure to secure compensation; effect.--Every |
|
691
|
employer who fails to secure the payment of compensation, as |
|
692
|
provided in s. 440.10, by failing to meet the requirements of |
|
693
|
under this chapter as provided ins. 440.38 may not, in any suit |
|
694
|
brought against him or her by an employee subject to this |
|
695
|
chapter to recover damages for injury or death, defend such a |
|
696
|
suit on the grounds that the injury was caused by the negligence |
|
697
|
of a fellow servant, that the employee assumed the risk of his |
|
698
|
or her employment, or that the injury was due to the comparative |
|
699
|
negligence of the employee. |
|
700
|
Section 5. Effective January 1, 2004, section 440.077, |
|
701
|
Florida Statutes, is amended to read: |
|
702
|
440.077 When a corporatesole proprietor, partner, or |
|
703
|
officer rejects chapter, effect.--AnA sole proprietor, partner, |
|
704
|
or officer of a corporation who is permitted to elect an |
|
705
|
exemption under this chapteractively engaged in the |
|
706
|
construction industryand who elects to be exempt from the |
|
707
|
provisions of this chapter may not recover benefits under this |
|
708
|
chapter. |
|
709
|
Section 6. Subsection (1) of section 440.09, Florida |
|
710
|
Statutes, is amended, and paragraph (e) is added to subsection |
|
711
|
(7) of said section, to read: |
|
712
|
440.09 Coverage.-- |
|
713
|
(1) The employer mustshallpay compensation or furnish |
|
714
|
benefits required by this chapter if the employee suffers an |
|
715
|
accidental compensableinjury or death arising out of work |
|
716
|
performed in the course and the scope of employment. The injury, |
|
717
|
its occupational cause, and any resulting manifestations or |
|
718
|
disability mustshallbe established to a reasonable degree of |
|
719
|
medical certainty, based onand by objective relevantmedical |
|
720
|
findings, and the compensable accident must be the major |
|
721
|
contributing cause of any resulting injuries. For purposes of |
|
722
|
this section, “major contributing cause” means the cause which |
|
723
|
is more than 50 percent responsible for the injury as compared |
|
724
|
to all other causes combined for which treatment or benefits are |
|
725
|
sought. In cases involving occupational disease or repetitive |
|
726
|
exposure, both causation and sufficient exposure to support |
|
727
|
causation must be proven by clear and convincing evidence. Pain |
|
728
|
or other subjective complaints alone, in the absence of |
|
729
|
objective relevant medical findings are not compensable. For |
|
730
|
purposes of this section, “objective relevant medical findings” |
|
731
|
are those objective findings that correlate to the subjective |
|
732
|
complaints of the injured employee and are confirmed by physical |
|
733
|
examination findings or diagnostic testing. Establishment of the |
|
734
|
causal relationship between a compensable accident and injuries |
|
735
|
for conditions that are not readily observable must be by |
|
736
|
medical evidence only, as demonstrated by physical examination |
|
737
|
findings or diagnostic testing. Major contributing cause must be |
|
738
|
demonstrated by medical evidence only.Mental or nervous |
|
739
|
injuries occurring as a manifestation of an injury compensable |
|
740
|
under this section shall be demonstrated by clear and convincing |
|
741
|
evidence. |
|
742
|
(a) This chapter does not require any compensation or |
|
743
|
benefits for any subsequent injury the employee suffers as a |
|
744
|
result of an original injury arising out of and in the course of |
|
745
|
employment unless the original injury is the major contributing |
|
746
|
cause of the subsequent injury. Major contributing cause must be |
|
747
|
demonstrated by medical evidence only.
|
|
748
|
(b) If an injury arising out of and in the course of |
|
749
|
employment combines with a preexisting disease or condition to |
|
750
|
cause or prolong disability or need for treatment, the employer |
|
751
|
must pay compensation or benefits required by this chapter only |
|
752
|
to the extent that the injury arising out of and in the course |
|
753
|
of employment is and remains more than 50 percent responsible |
|
754
|
for the injury as compared to all other causes combined and |
|
755
|
thereafter remainsthe major contributing cause of the |
|
756
|
disability or need for treatment. Major contributing cause must |
|
757
|
be demonstrated by medical evidence only.
|
|
758
|
(c) Death resulting from an operation by a surgeon |
|
759
|
furnished by the employer for the cure of hernia as required in |
|
760
|
s. 440.15(6) shall for the purpose of this chapter be considered |
|
761
|
to be a death resulting from the accident causing the hernia. |
|
762
|
(d) If an accident happens while the employee is employed |
|
763
|
elsewhere than in this state, which would entitle the employee |
|
764
|
or his or her dependents to compensation if it had happened in |
|
765
|
this state, the employee or his or her dependents are entitled |
|
766
|
to compensation if the contract of employment was made in this |
|
767
|
state, or the employment was principally localized in this |
|
768
|
state. However, if an employee receives compensation or damages |
|
769
|
under the laws of any other state, the total compensation for |
|
770
|
the injury may not be greater than is provided in this chapter. |
|
771
|
(7) |
|
772
|
(e) As a part of rebutting any presumptions under |
|
773
|
paragraph (b), the injured worker must prove the actual |
|
774
|
quantitative amounts of the drug or its metabolites as measured |
|
775
|
on the initial and confirmation post-accident drug tests of the |
|
776
|
injured worker’s urine sample and provide additional evidence |
|
777
|
regarding the absence of drug influence other than the worker’s |
|
778
|
denial of being under the influence of a drug. No drug test |
|
779
|
conducted on a urine sample shall be rejected as to its results |
|
780
|
or the presumption imposed under paragraph (b) on the basis of |
|
781
|
urine being bodily fluid tested.
|
|
782
|
Section 7. Effective January 1, 2004, subsection (1) of |
|
783
|
section 440.10, Florida Statutes, is amended to read: |
|
784
|
440.10 Liability for compensation.-- |
|
785
|
(1)(a) Every employer coming within the provisions of this |
|
786
|
chapter, including any brought within the chapter by waiver of |
|
787
|
exclusion or of exemption,shall be liable for, and shall |
|
788
|
secure, the payment to his or her employees, or any physician, |
|
789
|
surgeon, or pharmacist providing services under the provisions |
|
790
|
of s. 440.13, of the compensation payable under ss. 440.13, |
|
791
|
440.15, and 440.16. Any contractor or subcontractor who engages |
|
792
|
in any public or private construction in the state shall secure |
|
793
|
and maintain compensation for his or her employees under this |
|
794
|
chapter as provided in s. 440.38. |
|
795
|
(b) In case a contractor sublets any part or parts of his |
|
796
|
or her contract work to a subcontractor or subcontractors, all |
|
797
|
of the employees of such contractor and subcontractor or |
|
798
|
subcontractors engaged on such contract work shall be deemed to |
|
799
|
be employed in one and the same business or establishment; and |
|
800
|
the contractor shall be liable for, and shall secure, the |
|
801
|
payment of compensation to all such employees, except to |
|
802
|
employees of a subcontractor who has secured such payment. |
|
803
|
(c) A contractor shallmayrequire a subcontractor to |
|
804
|
provide evidence of workers' compensation insurance or a copy of |
|
805
|
his or her certificate of election. A subcontractor that is a |
|
806
|
corporation and that has an officer who electselectingto be |
|
807
|
exempt as permitted under this chaptera sole proprietor, |
|
808
|
partner, or officer of a corporationshall provide a copy of his |
|
809
|
or her certificate of exemptionelectionto the contractor. |
|
810
|
(d)1. If a contractor becomes liable for the payment of |
|
811
|
compensation to the employees of a subcontractor who has failed |
|
812
|
to secure such payment in violation of s. 440.38, the contractor |
|
813
|
or other third-party payor shall be entitled to recover from the |
|
814
|
subcontractor all benefits paid or payable plus interest unless |
|
815
|
the contractor and subcontractor have agreed in writing that the |
|
816
|
contractor will provide coverage. |
|
817
|
2. If a contractor or third-party payor becomes liable for |
|
818
|
the payment of compensation to the corporate officeremployeeof |
|
819
|
a subcontractor who is activelyengaged in the construction |
|
820
|
industry and has elected to be exempt from the provisions of |
|
821
|
this chapter, but whose election is invalid, the contractor or |
|
822
|
third-party payor may recover from the claimant, partnership,or |
|
823
|
corporation all benefits paid or payable plus interest, unless |
|
824
|
the contractor and the subcontractor have agreed in writing that |
|
825
|
the contractor will provide coverage. |
|
826
|
(e) A subcontractor providing services in conjunction with |
|
827
|
a contractor on the same project or contract workis not liable |
|
828
|
for the payment of compensation to the employees of another |
|
829
|
subcontractor or the contractor on such contract work and is not |
|
830
|
protected by the exclusiveness-of-liability provisions of s. |
|
831
|
440.11 from anyaction at law or in admiralty on account of |
|
832
|
injury to anof such employee of another subcontractor, or of |
|
833
|
the contractor, provided that:
|
|
834
|
1. The subcontractor has secured workers’ compensation |
|
835
|
insurance for its employees or the contractor has secured such |
|
836
|
insurance on behalf of the subcontractor and its employees in |
|
837
|
accordance with paragraph (b). |
|
838
|
2. The subcontractor’s own culpable negligence was not the |
|
839
|
major contributing cause of the injury. |
|
840
|
(f) If an employer fails to secure compensation as |
|
841
|
required by this chapter, the department shallmayassess |
|
842
|
against the employer a penalty not to exceed $5,000 for each |
|
843
|
employee of that employer who is classified by the employer as |
|
844
|
an independent contractor but who is found by the department to |
|
845
|
not meet the criteria for an independent contractor that are set |
|
846
|
forth in s. 440.02. The division shall adopt rules to administer |
|
847
|
the provisions of this paragraph. |
|
848
|
(g) For purposes of this section, a person is conclusively |
|
849
|
presumed to be an independent contractor if:
|
|
850
|
1. The independent contractor provides the general |
|
851
|
contractor with an affidavit stating that he or she meets all |
|
852
|
the requirements of s. 440.02; and
|
|
853
|
2. The independent contractor provides the general |
|
854
|
contractor with a valid certificate of workers' compensation |
|
855
|
insurance or a valid certificate of exemption issued by the |
|
856
|
department.
|
|
857
|
|
|
858
|
A sole proprietor, partner, or officer of a corporation who |
|
859
|
elects exemption from this chapter by filing a certificate of |
|
860
|
election under s. 440.05 may not recover benefits or |
|
861
|
compensation under this chapter. An independent contractor who |
|
862
|
provides the general contractor with both an affidavit stating |
|
863
|
that he or she meets the requirements of s. 440.02 and a |
|
864
|
certificate of exemption is not an employee under s. 440.02 and |
|
865
|
may not recover benefits under this chapter. For purposes of |
|
866
|
determining the appropriate premium for workers' compensation |
|
867
|
coverage, carriers may not consider any person who meets the |
|
868
|
requirements of this paragraph to be an employee.
|
|
869
|
Section 8. Section 440.1025, Florida Statutes, is amended |
|
870
|
to read: |
|
871
|
440.1025 Consideration of publicEmployer workplace safety |
|
872
|
program in rate-setting; program requirements; rulemaking.— |
|
873
|
(1) For a public or privateemployer to be eligible for |
|
874
|
receipt of specific identifiable consideration under s. 627.0915 |
|
875
|
for a workplace safety program in the setting of rates, the |
|
876
|
publicemployer must have a workplace safety program. At a |
|
877
|
minimum, the program must include a written safety policy and |
|
878
|
safety rules, and make provision for safety inspections, |
|
879
|
preventative maintenance, safety training, first-aid, accident |
|
880
|
investigation, and necessary recordkeeping. For purposes of this |
|
881
|
section, "public employer" means any agency within state, |
|
882
|
county, or municipal government employing individuals for |
|
883
|
salary, wages, or other remuneration.The division may |
|
884
|
promulgate rules for insurers to utilize in determining public |
|
885
|
employer compliance with the requirements of this section. |
|
886
|
(2) The division shall publicize on the Internet, and |
|
887
|
shall encourage insurers to publicize, the availability of free |
|
888
|
safety consultation services and safety program resources.
|
|
889
|
Section 9. Subsections (1), (2), (3), and (5) and |
|
890
|
paragraph (f) of subsection (4) of section 440.105, Florida |
|
891
|
Statutes, are amended to read: |
|
892
|
440.105 Prohibited activities; reports; penalties; |
|
893
|
limitations.-- |
|
894
|
(1)(a) Any insurance carrier, any individual self-insured, |
|
895
|
any commercial or group self-insurance fund, any professional |
|
896
|
practitioner licensed or regulated by the Department of Health |
|
897
|
Business and Professional Regulation, except as otherwise |
|
898
|
provided by law, any medical review committee as defined in s. |
|
899
|
766.101, any private medical review committee, and any insurer, |
|
900
|
agent, or other person licensed under the insurance code, or any |
|
901
|
employee thereof, having knowledge or who believes that a |
|
902
|
fraudulent act or any other act or practice which, upon |
|
903
|
conviction, constitutes a felony or misdemeanor under this |
|
904
|
chapter is being or has been committed shall send to the |
|
905
|
Division of Insurance Fraud, Bureau of Workers' Compensation |
|
906
|
Fraud, a report or information pertinent to such knowledge or |
|
907
|
belief and such additional information relative thereto as the |
|
908
|
bureau may require. The bureau shall review such information or |
|
909
|
reports and select such information or reports as, in its |
|
910
|
judgment, may require further investigation. It shall then cause |
|
911
|
an independent examination of the facts surrounding such |
|
912
|
information or report to be made to determine the extent, if |
|
913
|
any, to which a fraudulent act or any other act or practice |
|
914
|
which, upon conviction, constitutes a felony or a misdemeanor |
|
915
|
under this chapter is being committed. The bureau shall report |
|
916
|
any alleged violations of law which its investigations disclose |
|
917
|
to the appropriate licensing agency and state attorney or other |
|
918
|
prosecuting agency having jurisdiction with respect to any such |
|
919
|
violations of this chapter. If prosecution by the state attorney |
|
920
|
or other prosecuting agency having jurisdiction with respect to |
|
921
|
such violation is not begun within 60 days of the bureau's |
|
922
|
report, the state attorney or other prosecuting agency having |
|
923
|
jurisdiction with respect to such violation shall inform the |
|
924
|
bureau of the reasons for the lack of prosecution. |
|
925
|
(b) In the absence of fraud or bad faith, a person is not |
|
926
|
subject to civil liability for libel, slander, or any other |
|
927
|
relevant tort by virtue of filing reports, without malice, or |
|
928
|
furnishing other information, without malice, required by this |
|
929
|
section or required by the bureau, and no civil cause of action |
|
930
|
of any nature shall arise against such person: |
|
931
|
1. For any information relating to suspected fraudulent |
|
932
|
acts furnished to or received from law enforcement officials, |
|
933
|
their agents, or employees; |
|
934
|
2. For any information relating to suspected fraudulent |
|
935
|
acts furnished to or received from other persons subject to the |
|
936
|
provisions of this chapter; or |
|
937
|
3. For any such information relating to suspected |
|
938
|
fraudulent acts furnished in reports to the bureau, or the |
|
939
|
National Association of Insurance Commissioners. |
|
940
|
(2) Whoever violates any provision of this subsection |
|
941
|
commits a misdemeanor of the firstseconddegree, punishable as |
|
942
|
provided in s. 775.082 or s. 775.083. |
|
943
|
(a) It shall be unlawful for any employer to knowingly: |
|
944
|
1. Coerce or attempt to coerce, as a precondition to |
|
945
|
employment or otherwise, an employee to obtain a certificate of |
|
946
|
election of exemption pursuant to s. 440.05. |
|
947
|
2. Discharge or refuse to hire an employee or job |
|
948
|
applicant because the employee or applicant has filed a claim |
|
949
|
for benefits under this chapter. |
|
950
|
3. Discharge, discipline, or take any other adverse |
|
951
|
personnel action against any employee for disclosing information |
|
952
|
to the department or any law enforcement agency relating to any |
|
953
|
violation or suspected violation of any of the provisions of |
|
954
|
this chapter or rules promulgated hereunder. |
|
955
|
4. Violate a stop-work order issued by the department |
|
956
|
pursuant to s. 440.107. |
|
957
|
(b) It shall be unlawful for any insurance entity to |
|
958
|
revoke or cancel a workers' compensation insurance policy or |
|
959
|
membership because an employer has returned an employee to work |
|
960
|
or hired an employee who has filed a workers' compensation |
|
961
|
claim. |
|
962
|
(3) Whoever violates any provision of this subsection |
|
963
|
commits a felonymisdemeanor of the thirdfirstdegree, |
|
964
|
punishable as provided in s. 775.082,or s. 775.083, or s. |
|
965
|
775.084. |
|
966
|
(a) It shall be unlawful for any employer to knowingly |
|
967
|
fail to update applications for coverage as required by s. |
|
968
|
440.381(1) and department of Insurancerules, or to post notice |
|
969
|
of coverage pursuant to s. 440.40. |
|
970
|
(b) It is unlawful for any attorney or other person, in |
|
971
|
his or her individual capacity or in his or her capacity as a |
|
972
|
public or private employee, or for any firm, corporation, |
|
973
|
partnership, or association to receive any fee or other |
|
974
|
consideration or any gratuity from a person on account of |
|
975
|
services rendered for a person in connection with any |
|
976
|
proceedings arising under this chapter, unless such fee, |
|
977
|
consideration, or gratuity is approved by a judge of |
|
978
|
compensation claims or by the Deputy Chief Judge of Compensation |
|
979
|
Claims. |
|
980
|
(4) Whoever violates any provision of this subsection |
|
981
|
commits insurance fraud, punishable as provided in paragraph |
|
982
|
(f). |
|
983
|
(f) If the monetary valueamountof any claim or workers' |
|
984
|
compensation insurance premium involved in any violation of this |
|
985
|
subsection: |
|
986
|
1. Is less than $20,000, the offender commits a felony of |
|
987
|
the third degree, punishable as provided in s. 775.082, s. |
|
988
|
775.083, or s. 775.084. |
|
989
|
2. Is $20,000 or more, but less than $100,000, the |
|
990
|
offender commits a felony of the second degree, punishable as |
|
991
|
provided in s. 775.082, s. 775.083, or s. 775.084. |
|
992
|
3. Is $100,000 or more, the offender commits a felony of |
|
993
|
the first degree, punishable as provided in s. 775.082, s. |
|
994
|
775.083, or s. 775.084. |
|
995
|
(5) It shall be unlawful for any attorney or other person, |
|
996
|
in his or her individual capacity or in his or her capacity as a |
|
997
|
public or private employee or for any firm, corporation, |
|
998
|
partnership, or association, to unlawfully solicit any business |
|
999
|
in and about city or county hospitals, courts, or any public |
|
1000
|
institution or public place; in and about private hospitals or |
|
1001
|
sanitariums; in and about any private institution; or upon |
|
1002
|
private property of any character whatsoever for the purpose of |
|
1003
|
making workers' compensation claims. Whoever violates any |
|
1004
|
provision of this subsection commits a felony of the second |
|
1005
|
thirddegree, punishable as provided in s. 775.082, s. 775.083, |
|
1006
|
or s. 775.085. |
|
1007
|
Section 10. Subsection (3) of section 440.1051, Florida |
|
1008
|
Statutes, is amended to read: |
|
1009
|
440.1051 Fraud reports; civil immunity; criminal |
|
1010
|
penalties.-- |
|
1011
|
(3) A person who calls and, knowingly and falsely, reports |
|
1012
|
workers' compensation fraud or who, in violation of subsection |
|
1013
|
(2) retaliates against a person for making such report, commits |
|
1014
|
is guilty of a felonymisdemeanor of the thirdfirstdegree, |
|
1015
|
punishable as provided in s. 775.082,or s. 775.083, or 775.084 |
|
1016
|
both. |
|
1017
|
Section 11. Subsections (1), (3), (5), and (6) of section |
|
1018
|
440.107, Florida Statutes, are amended to read: |
|
1019
|
440.107 Department powers to enforce employer compliance |
|
1020
|
with coverage requirements.-- |
|
1021
|
(1) The Legislature finds that the failure of an employer |
|
1022
|
to comply with the workers' compensation coverage requirements |
|
1023
|
under this chapter poses an immediate danger to public health, |
|
1024
|
safety, and welfare. The Legislature authorizes The department |
|
1025
|
shalltosecure employer compliance with the workers' |
|
1026
|
compensation coverage requirements under this chapterand |
|
1027
|
authorizes the department to conduct investigations for the |
|
1028
|
purpose of ensuring employer compliance. |
|
1029
|
(3) In addition to any other powers provided by this |
|
1030
|
chapter, the department is authorized to:
|
|
1031
|
(a) Conduct investigations for the purpose of ensuring |
|
1032
|
employer compliance;
|
|
1033
|
(b) Enter and inspect any place of business at any |
|
1034
|
reasonable time for the purpose of investigating employer |
|
1035
|
compliance;
|
|
1036
|
(c) Examine and copy business records;
|
|
1037
|
(d)In discharging its duties, the department may |
|
1038
|
Administer oaths and affirmations;, |
|
1039
|
(e) Certify to official acts;, |
|
1040
|
(f) Issue and servesubpoenas to compel the attendance of |
|
1041
|
witnesses orand the production of business records,books, |
|
1042
|
papers, correspondence, memoranda, and other records deemed |
|
1043
|
necessary by the department as evidence in order to ensure |
|
1044
|
proper compliance with the coverage provisions of this chapter; |
|
1045
|
(g) Issue stop-work orders, penalty assessment orders, and |
|
1046
|
any other orders necessary for the administration of this |
|
1047
|
chapter;
|
|
1048
|
(h) Enforce the terms of a stop-work order;
|
|
1049
|
(i) Levy and pursue actions to recover penalties; and
|
|
1050
|
(j) Seek injunctions and other appropriate relief. |
|
1051
|
(5)(a)Whenever the department determines that an employer |
|
1052
|
who is required to secure the payment to his or her employees of |
|
1053
|
the compensation provided for by this chapter has failed to do |
|
1054
|
so, has materially understated or concealed payroll, has |
|
1055
|
materially misrepresented or concealed an employee’s duties so |
|
1056
|
as to avoid proper classification of the employee for premium |
|
1057
|
calculations, or has materially misrepresented or concealed |
|
1058
|
information pertinent to the computation and application of an |
|
1059
|
experience rating modification factor, such failure, |
|
1060
|
understatement, concealment, or misrepresentation shall subject |
|
1061
|
the employer to the sanctions set forth in this section and |
|
1062
|
shall be deemed an immediate serious danger to public health, |
|
1063
|
safety, or welfare sufficient to justify service by the |
|
1064
|
department of a stop-work order on the employer, requiring the |
|
1065
|
cessation of all business operations at the place of employment |
|
1066
|
or job site. If the division makes such a determination, the |
|
1067
|
division shall issue a stop-work order within 72 hours. The |
|
1068
|
order shall take effect upon the date of service upon the |
|
1069
|
employer and shall remain in effect until the department issues |
|
1070
|
an order releasing the stop-work order upon the finding that the |
|
1071
|
employer has come into compliance with the coverage requirements |
|
1072
|
of this chapter and paid any penalty assessed under this |
|
1073
|
section, unless the employer provides evidence satisfactory to |
|
1074
|
the department of having secured any necessary insurance or |
|
1075
|
self-insurance and pays a civil penalty to the department, to be |
|
1076
|
deposited by the department into the Workers' Compensation |
|
1077
|
Administration Trust Fund, in the amount of $100 per day for |
|
1078
|
each day the employer was not in compliance with this chapter. |
|
1079
|
The issuance of a stop-work order pursuant to this subsection |
|
1080
|
shall have no effect upon an employer’s or carrier’s duty to |
|
1081
|
provide benefits under this chapter, or the employer’s and |
|
1082
|
carrier’s rights under this chapter, including exclusive remedy.
|
|
1083
|
(b) Stop-work orders and penalty assessment orders issued |
|
1084
|
under this subsection against a corporation, partnership, or |
|
1085
|
sole proprietorship shall be in effect against any successor |
|
1086
|
corporation or business entity that has one or more of the same |
|
1087
|
principals or officers as the corporation or partnership against |
|
1088
|
which the stop-work order was issued and which is engaged in the |
|
1089
|
same or a related enterprise.
|
|
1090
|
(c) The department shall assess a penalty of $1,000 per |
|
1091
|
day against an employer for each day that the employer conducts |
|
1092
|
business operations that are in violation of a stop-work order. |
|
1093
|
(6) In addition to the issuance of a stop-work order and |
|
1094
|
any other penalties provided for in this chapter,the department |
|
1095
|
may file a complaint in the circuit court in and for Leon County |
|
1096
|
to enjoin any employer, who has failed to secure the payment of |
|
1097
|
workers’compensation as required by this chapter, from |
|
1098
|
employing individuals and from conducting business until the |
|
1099
|
employer presents evidence satisfactory to the department of |
|
1100
|
having secured the payment of workers’for compensation as |
|
1101
|
required by this chapter and pays any administrative fine ora |
|
1102
|
civil penalty assessed or owedto the department, to be |
|
1103
|
deposited by the department into the Workers' Compensation |
|
1104
|
Administration Trust Fund, in the amount of $100 per day for |
|
1105
|
each day the employer was not in compliance with this chapter. |
|
1106
|
Section 12. Subsections (1) and (3) of section 440.11, |
|
1107
|
Florida Statutes, are amended to read: |
|
1108
|
440.11 Exclusiveness of liability.-- |
|
1109
|
(1) The liability of an employer prescribed in s. 440.10 |
|
1110
|
shall be exclusive and in place of all other liability, |
|
1111
|
including vicarious liability,of such employer to any third- |
|
1112
|
party tortfeasor and to the employee, the legal representative |
|
1113
|
thereof, husband or wife, parents, dependents, next of kin, and |
|
1114
|
anyone otherwise entitled to recover damages from such employer |
|
1115
|
at law or in admiralty on account of such injury or death, |
|
1116
|
except as follows:that |
|
1117
|
(a)If an employer fails to secure payment of compensation |
|
1118
|
as required by this chapter, an injured employee, or the legal |
|
1119
|
representative thereof in case death results from the injury, |
|
1120
|
may elect to claim compensation under this chapter or to |
|
1121
|
maintain an action at law or in admiralty for damages on account |
|
1122
|
of such injury or death. In such action the defendant may not |
|
1123
|
plead as a defense that the injury was caused by negligence of a |
|
1124
|
fellow employee, that the employee assumed the risk of the |
|
1125
|
employment, or that the injury was due to the comparative |
|
1126
|
negligence of the employee. |
|
1127
|
(b) When an employer commits an intentional tort that |
|
1128
|
causes the injury or death of the employee. For purposes of this |
|
1129
|
exception, an employer’s actions shall be deemed to constitute |
|
1130
|
an intentional tort and not an accident only when the employee |
|
1131
|
proves, by clear and convincing evidence, that:
|
|
1132
|
1. The employer deliberately intended to injure the |
|
1133
|
employee; or |
|
1134
|
2. The employer engaged in conduct that the employer knew, |
|
1135
|
based on prior similar accidents or on explicit warnings |
|
1136
|
specifically identifying a known danger, was certain to result |
|
1137
|
in injury or death to the employee, and the employee was not |
|
1138
|
aware of the risk because the danger was not apparent and the |
|
1139
|
employer deliberately concealed or misrepresented the danger so |
|
1140
|
as to prevent the employee from exercising informed judgment |
|
1141
|
about whether to perform the work.
|
|
1142
|
|
|
1143
|
The same immunities from liability enjoyed by an employer shall |
|
1144
|
extend as well to each employee of the employer when such |
|
1145
|
employee is acting in furtherance of the employer's business and |
|
1146
|
the injured employee is entitled to receive benefits under this |
|
1147
|
chapter. Such fellow-employee immunities shall not be applicable |
|
1148
|
to an employee who acts, with respect to a fellow employee, with |
|
1149
|
willful and wanton disregard or unprovoked physical aggression |
|
1150
|
or with gross negligence when such acts result in injury or |
|
1151
|
death or such acts proximately cause such injury or death, nor |
|
1152
|
shall such immunities be applicable to employees of the same |
|
1153
|
employer when each is operating in the furtherance of the |
|
1154
|
employer's business but they are assigned primarily to unrelated |
|
1155
|
works within private or public employment. The same immunity |
|
1156
|
provisions enjoyed by an employer shall also apply to any sole |
|
1157
|
proprietor, partner, corporate officer or director, supervisor, |
|
1158
|
or other person who in the course and scope of his or her duties |
|
1159
|
acts in a managerial or policymaking capacity and the conduct |
|
1160
|
which caused the alleged injury arose within the course and |
|
1161
|
scope of said managerial or policymaking duties and was not a |
|
1162
|
violation of a law, whether or not a violation was charged, for |
|
1163
|
which the maximum penalty which may be imposed does not exceed |
|
1164
|
60 days' imprisonment as set forth in s. 775.082. The immunity |
|
1165
|
from liability provided in this subsection extends to county |
|
1166
|
governments with respect to employees of county constitutional |
|
1167
|
officers whose offices are funded by the board of county |
|
1168
|
commissioners. |
|
1169
|
(3) An employer's workers' compensation carrier, service |
|
1170
|
agent, or safety consultant shall not be liable as a third-party |
|
1171
|
tortfeasor to employees of the employer or employees of its |
|
1172
|
subcontractors for assisting the employer and its |
|
1173
|
subcontractors, if any,in carrying out the employer's rights |
|
1174
|
and responsibilities under this chapter by furnishing any safety |
|
1175
|
inspection, safety consultative service, or other safety service |
|
1176
|
incidental to the workers' compensation or employers' liability |
|
1177
|
coverage or to the workers' compensation or employer's liability |
|
1178
|
servicing contract. Without limitation, a safety consultant may |
|
1179
|
include an owner, as defined in chapter 713, or an owner’s |
|
1180
|
related, affiliated, or subsidiary companies and the employees |
|
1181
|
of each.The exclusion from liability under this subsection |
|
1182
|
shall not apply in any case in which injury or death is |
|
1183
|
proximately caused by the willful and unprovoked physical |
|
1184
|
aggression, or by the negligent operation of a motor vehicle, by |
|
1185
|
employees, officers, or directors of the employer's workers' |
|
1186
|
compensation carrier, service agent, or safety consultant. |
|
1187
|
Section 13. Paragraph (m) of subsection (1), subsection |
|
1188
|
(12), and paragraph (a) of subsection (15) of section 440.13, |
|
1189
|
Florida Statutes, are amended to read: |
|
1190
|
440.13 Medical services and supplies; penalty for |
|
1191
|
violations; limitations.-- |
|
1192
|
(1) DEFINITIONS.--As used in this section, the term: |
|
1193
|
(m) "Medically necessary" means any medical service or |
|
1194
|
medical supply which is used to identify or treat an illness or |
|
1195
|
injury, is appropriate to the patient's diagnosis and status of |
|
1196
|
recovery, and is consistent with the location of service, the |
|
1197
|
level of care provided, and applicable practice parameters. The |
|
1198
|
service should be widely accepted among practicing health care |
|
1199
|
providers, based on scientific criteria, and determined to be |
|
1200
|
reasonably safe. The service must not be of an experimental, |
|
1201
|
investigative, or research nature, except in those instances in |
|
1202
|
which prior approval of the Agency for Health Care |
|
1203
|
Administration has been obtained. The Agency for Health Care |
|
1204
|
Administration shall adopt rules providing for such approval on |
|
1205
|
a case-by-case basis when the service or supply is shown to have |
|
1206
|
significant benefits to the recovery and well-being of the |
|
1207
|
patient. The agency shall ensure that applicable practice |
|
1208
|
parameters are established under subsection (15) for physician |
|
1209
|
medical services, including, but not limited to, pain management |
|
1210
|
and psychiatric treatment. |
|
1211
|
(12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM |
|
1212
|
REIMBURSEMENT ALLOWANCES.-- |
|
1213
|
(a) A three-member panel is created, consisting of the |
|
1214
|
Insurance Commissioner, or the Insurance Commissioner's |
|
1215
|
designee, and two members to be appointed by the Governor, |
|
1216
|
subject to confirmation by the Senate, one member who, on |
|
1217
|
account of present or previous vocation, employment, or |
|
1218
|
affiliation, shall be classified as a representative of |
|
1219
|
employers, the other member who, on account of previous |
|
1220
|
vocation, employment, or affiliation, shall be classified as a |
|
1221
|
representative of employees. The panel shall determine statewide |
|
1222
|
schedules of maximum reimbursement allowances for medically |
|
1223
|
necessary treatment, care, and attendance provided by |
|
1224
|
physicians, hospitals, ambulatory surgical centers, work- |
|
1225
|
hardening programs, pain programs, and durable medical |
|
1226
|
equipment. The maximum reimbursement allowances for inpatient |
|
1227
|
hospital care shall be based on a schedule of per diem rates, to |
|
1228
|
be approved by the three-member panel no later than March 1, |
|
1229
|
1994, to be used in conjunction with a precertification manual |
|
1230
|
as determined by the agency. All compensable charges for |
|
1231
|
hospital outpatient care shall be reimbursed at 75 percent of |
|
1232
|
usual and customary charges, except as otherwise provided by |
|
1233
|
this subsection. Until the three-member panel approves a |
|
1234
|
schedule of per diem rates for inpatient hospital care and it |
|
1235
|
becomes effective, all compensable charges for hospital |
|
1236
|
inpatient care must be reimbursed at 75 percent of their usual |
|
1237
|
and customary charges. Annually, the three-member panel shall |
|
1238
|
adopt schedules of maximum reimbursement allowances for |
|
1239
|
physicians, hospital inpatient care, hospital outpatient care, |
|
1240
|
ambulatory surgical centers, work-hardening programs, and pain |
|
1241
|
programs. However, the maximum percentage of increase in the |
|
1242
|
individual reimbursement allowance may not exceed the percentage |
|
1243
|
of increase in the Consumer Price Index for the previous year. |
|
1244
|
An individual physician, hospital, ambulatory surgical center, |
|
1245
|
pain program, or work-hardening program shall be reimbursed |
|
1246
|
either the usual and customary charge for treatment, care, and |
|
1247
|
attendance, the agreed-upon contract price,or the maximum |
|
1248
|
reimbursement allowance in the appropriate schedule, whichever |
|
1249
|
is less. |
|
1250
|
(b) Maximum reimbursement for physicians, freestanding |
|
1251
|
ambulatory surgical centers, pain programs, and work-hardening |
|
1252
|
programs shall be equal to 100 percent of the reimbursement |
|
1253
|
allowed by Medicare for the services provided or the medical |
|
1254
|
reimbursement level adopted by the three-member panel as of |
|
1255
|
January 1, 2003, whichever is greater. Effective January 1, |
|
1256
|
2005, the maximum reimbursement for physicians, freestanding |
|
1257
|
ambulatory surgical centers, pain programs, and work-hardening |
|
1258
|
programs shall increase 5 percent per year for 5 consecutive |
|
1259
|
years unless the three-member panel determines that the 5- |
|
1260
|
percent annual increase would result in significant rate |
|
1261
|
increases for carriers. Maximum reimbursement for surgical |
|
1262
|
procedures shall be equal to 140 percent of the reimbursement |
|
1263
|
allowed by Medicare for the service provided or the medical |
|
1264
|
reimbursement level adopted by the three-member panel as of |
|
1265
|
January 1, 2003, whichever is greater. Effective January 1, |
|
1266
|
2005, the maximum reimbursement for surgical procedures shall |
|
1267
|
increase 5 percent per year for 5 consecutive years unless the |
|
1268
|
three-member panel determines that the 5-percent annual increase |
|
1269
|
would result in significant rate increases for carriers. Payment |
|
1270
|
for outpatient physical, occupational, and speech therapy |
|
1271
|
provided by hospitals shall be reduced to the schedule of |
|
1272
|
maximum reimbursement allowances for those services which |
|
1273
|
applies to nonhospital providers. Payments for scheduled |
|
1274
|
outpatient nonemergency radiological and clinical laboratory |
|
1275
|
services that are not provided in conjunction with a surgical |
|
1276
|
procedure shall be reduced to the maximum reimbursement |
|
1277
|
allowances for those services which applies to nonhospital |
|
1278
|
providers.
|
|
1279
|
(c)(b)As to reimbursement for a prescription medication, |
|
1280
|
the reimbursement amount for a prescription shall be the average |
|
1281
|
wholesale price times 1.2 plus $4.18 for the dispensing fee, |
|
1282
|
except where the carrier has contracted for a lower amount. Fees |
|
1283
|
for pharmaceuticals and pharmaceutical services shall be |
|
1284
|
reimbursable at the applicable fee schedule amount. Where the |
|
1285
|
employer or carrier has contracted for such services and the |
|
1286
|
employee elects to obtain them through a provider not a party to |
|
1287
|
the contract, the carrier shall reimburse at the schedule, |
|
1288
|
negotiated, or contract price, whichever is lower. |
|
1289
|
(d)(c)Reimbursement for all fees and other charges for |
|
1290
|
such treatment, care, and attendance, including treatment, care, |
|
1291
|
and attendance provided by any hospital or other health care |
|
1292
|
provider, ambulatory surgical center, work-hardening program, or |
|
1293
|
pain program, must not exceed the amounts provided by the |
|
1294
|
uniform schedule of maximum reimbursement allowances as |
|
1295
|
determined by the panel or as otherwise provided in this |
|
1296
|
section. This subsection also applies to independent medical |
|
1297
|
examinations performed by health care providers under this |
|
1298
|
chapter. Until the three-member panel approves a uniform |
|
1299
|
schedule of maximum reimbursement allowances and it becomes |
|
1300
|
effective, all compensable charges for treatment, care, and |
|
1301
|
attendance provided by physicians, ambulatory surgical centers, |
|
1302
|
work-hardening programs, or pain programs shall be reimbursed at |
|
1303
|
the lowest maximum reimbursement allowance across all 1992 |
|
1304
|
schedules of maximum reimbursement allowances for the services |
|
1305
|
provided regardless of the place of service. In determining the |
|
1306
|
uniform schedule, the panel shall first approve the data which |
|
1307
|
it finds representative of prevailing charges in the state for |
|
1308
|
similar treatment, care, and attendance of injured persons. Each |
|
1309
|
health care provider, health care facility, ambulatory surgical |
|
1310
|
center, work-hardening program, or pain program receiving |
|
1311
|
workers' compensation payments shall maintain records verifying |
|
1312
|
their usual charges. In establishing the uniform schedule of |
|
1313
|
maximum reimbursement allowances, the panel must consider: |
|
1314
|
1. The levels of reimbursement for similar treatment, |
|
1315
|
care, and attendance made by other health care programs or |
|
1316
|
third-party providers; |
|
1317
|
2. The impact upon cost to employers for providing a level |
|
1318
|
of reimbursement for treatment, care, and attendance which will |
|
1319
|
ensure the availability of treatment, care, and attendance |
|
1320
|
required by injured workers; |
|
1321
|
3. The financial impact of the reimbursement allowances |
|
1322
|
upon health care providers and health care facilities, including |
|
1323
|
trauma centers as defined in s. 395.4001, and its effect upon |
|
1324
|
their ability to make available to injured workers such |
|
1325
|
medically necessary remedial treatment, care, and attendance. |
|
1326
|
The uniform schedule of maximum reimbursement allowances must be |
|
1327
|
reasonable, must promote health care cost containment and |
|
1328
|
efficiency with respect to the workers' compensation health care |
|
1329
|
delivery system, and must be sufficient to ensure availability |
|
1330
|
of such medically necessary remedial treatment, care, and |
|
1331
|
attendance to injured workers; and |
|
1332
|
4. The most recent average maximum allowable rate of |
|
1333
|
increase for hospitals determined by the Health Care Board under |
|
1334
|
chapter 408. |
|
1335
|
(e)(d)In addition to establishing the uniform schedule of |
|
1336
|
maximum reimbursement allowances, the panel shall: |
|
1337
|
1. Take testimony, receive records, and collect data to |
|
1338
|
evaluate the adequacy of the workers' compensation fee schedule, |
|
1339
|
nationally recognized fee schedules and alternative methods of |
|
1340
|
reimbursement to certified health care providers and health care |
|
1341
|
facilities for inpatient and outpatient treatment and care. |
|
1342
|
2. Survey certified health care providers and health care |
|
1343
|
facilities to determine the availability and accessibility of |
|
1344
|
workers' compensation health care delivery systems for injured |
|
1345
|
workers. |
|
1346
|
3. Survey carriers to determine the estimated impact on |
|
1347
|
carrier costs and workers' compensation premium rates by |
|
1348
|
implementing changes to the carrier reimbursement schedule or |
|
1349
|
implementing alternative reimbursement methods. |
|
1350
|
4. Submit recommendations on or before January 1, 2003, |
|
1351
|
and biennially thereafter, to the President of the Senate and |
|
1352
|
the Speaker of the House of Representatives on methods to |
|
1353
|
improve the workers' compensation health care delivery system. |
|
1354
|
|
|
1355
|
The division shall provide data to the panel, including but not |
|
1356
|
limited to, utilization trends in the workers' compensation |
|
1357
|
health care delivery system. The division shall provide the |
|
1358
|
panel with an annual report regarding the resolution of medical |
|
1359
|
reimbursement disputes and any actions pursuant to s. 440.13(8). |
|
1360
|
The division shall provide administrative support and service to |
|
1361
|
the panel to the extent requested by the panel. |
|
1362
|
(15) PRACTICE PARAMETERS.-- |
|
1363
|
(a) The Agency for Health Care Administration, in |
|
1364
|
conjunction with the department and appropriate health |
|
1365
|
professional associations and health-related organizations shall |
|
1366
|
develop and shallmayadopt by rule scientifically sound |
|
1367
|
practice parameters for medical procedures relevant to workers' |
|
1368
|
compensation claimants. Practice parameters developed under this |
|
1369
|
section must focus on identifying effective remedial treatments |
|
1370
|
and promoting the appropriate utilization of health care |
|
1371
|
resources. Priority must be given to those procedures that |
|
1372
|
involve the greatest utilization of resources either because |
|
1373
|
they are the most costly or because they are the most frequently |
|
1374
|
performed. Practice parameters for treatment of the 10 top |
|
1375
|
procedures associated with workers' compensation injuries, |
|
1376
|
including the remedial treatment of lower-back injuries, pain |
|
1377
|
management, and psychiatry, must be developed by December 31, |
|
1378
|
20031994. |
|
1379
|
Section 14. Paragraph (i) of subsection (1) and subsection |
|
1380
|
(10) of section 440.134, Florida Statutes, are amended to read: |
|
1381
|
440.134 Workers' compensation managed care arrangement.-- |
|
1382
|
(1) As used in this section, the term: |
|
1383
|
(i) "Medical care coordinator" means a primary care |
|
1384
|
provider within a provider network who is responsible for |
|
1385
|
managing the medical care of an injured worker including |
|
1386
|
determining other health care providers and health care |
|
1387
|
facilities to which the injured employee will be referred for |
|
1388
|
evaluation or treatment. A medical care coordinator shall be a |
|
1389
|
physician licensed under chapter 458,oran osteopathic |
|
1390
|
physician licensed under chapter 459, a chiropractic physician |
|
1391
|
licensed under chapter 460, or a podiatric physician licensed |
|
1392
|
under chapter 461. |
|
1393
|
(10) Written procedures and methods for the management of |
|
1394
|
an injured worker's medical care by a medical care coordinator |
|
1395
|
including: |
|
1396
|
(a) Assignment of a medical care coordinator licensed |
|
1397
|
under chapter 458 or chapter 459 to manage care by physicians |
|
1398
|
licensed under chapter 458 or chapter 459, a medical care |
|
1399
|
coordinator licensed under chapter 460 to manage care by |
|
1400
|
physicians licensed under chapter 460, and a medical care |
|
1401
|
coordinator licensed under chapter 461 to manage care by |
|
1402
|
physicians licensed under chapter 461 upon request by an injured |
|
1403
|
employee for care by a physician licensed under chapter 458, |
|
1404
|
chapter 459, chapter 460, or chapter 461.
|
|
1405
|
(b)(a)The mechanism for assuring that covered employees |
|
1406
|
receive all initial covered services from a primary care |
|
1407
|
provider participating in the provider network, except for |
|
1408
|
emergency care. |
|
1409
|
(c)(b)The mechanism for assuring that all continuing |
|
1410
|
covered services be received from the same primary care provider |
|
1411
|
participating in the provider network that provided the initial |
|
1412
|
covered services, except when services from another provider are |
|
1413
|
authorized by the medical care coordinator pursuant to paragraph |
|
1414
|
(e)(d). |
|
1415
|
(d)(c)The policies and procedures for allowing an |
|
1416
|
employee one change to another provider within the same |
|
1417
|
specialty and provider network as the authorized treating |
|
1418
|
physician during the course of treatment for a work-related |
|
1419
|
injury, if a request is made to the medical care coordinator by |
|
1420
|
the employee; and requiring that special provision be made for |
|
1421
|
more than one such referral through the arrangement's grievance |
|
1422
|
procedures. |
|
1423
|
(e)(d)The process for assuring that all referrals |
|
1424
|
authorized by a medical care coordinator are made to the |
|
1425
|
participating network providers, unless medically necessary |
|
1426
|
treatment, care, and attendance are not available and accessible |
|
1427
|
to the injured worker in the provider network. |
|
1428
|
Section 15. Subsection (1) of section 440.14, Florida |
|
1429
|
Statutes, is amended to read: |
|
1430
|
440.14 Determination of pay.-- |
|
1431
|
(1) Except as otherwise provided in this chapter, the |
|
1432
|
average weekly wages of the injured employee on the date of the |
|
1433
|
accidentat the time of the injuryshall be taken as the basis |
|
1434
|
upon which to compute compensation and shall be determined, |
|
1435
|
subject to the limitations of s. 440.12(2), as follows: |
|
1436
|
(a) If the injured employee has worked in the employment |
|
1437
|
in which she or he was working on the date of the accidentat |
|
1438
|
the time of the injury, whether for the same or another |
|
1439
|
employer, during substantially the whole of 13 weeks immediately |
|
1440
|
preceding the accidentinjury, her or his average weekly wage |
|
1441
|
shall be one-thirteenth of the total amount of wages earned in |
|
1442
|
such employment during the 13 weeks. As used in this paragraph, |
|
1443
|
the term "substantially the whole of 13 weeks" means the |
|
1444
|
calendarshall be deemed to mean and refer to a constructive |
|
1445
|
period of 13 weeks as a whole, which shall be defined as the 13 |
|
1446
|
calendar weeks before the date of the accident, excluding the |
|
1447
|
week during which the accident occurred.a consecutive period of |
|
1448
|
91 days, andThe term "during substantially the whole of 13 |
|
1449
|
weeks" shall be deemed to mean during not less than 90 percent |
|
1450
|
of the total customary full-timehours of employment within such |
|
1451
|
period considered as a whole. |
|
1452
|
(b) If the injured employee has not worked in such |
|
1453
|
employment during substantially the whole of 13 weeks |
|
1454
|
immediately preceding the accidentinjury, the wages of a |
|
1455
|
similar employee in the same employment who has worked |
|
1456
|
substantially the whole of such 13 weeks shall be used in making |
|
1457
|
the determination under the preceding paragraph. |
|
1458
|
(c) If an employee is a seasonal worker and the foregoing |
|
1459
|
method cannot be fairly applied in determining the average |
|
1460
|
weekly wage, then the employee may use, instead of the 13 weeks |
|
1461
|
immediately preceding the accidentinjury, the calendar year or |
|
1462
|
the 52 weeks immediately preceding the accidentinjury. The |
|
1463
|
employee will have the burden of proving that this method will |
|
1464
|
be more reasonable and fairer than the method set forth in |
|
1465
|
paragraphs (a) and (b) and, further, must document prior |
|
1466
|
earnings with W-2 forms, written wage statements, or income tax |
|
1467
|
returns. The employer shall have 30 days following the receipt |
|
1468
|
of this written proof to adjust the compensation rate, including |
|
1469
|
the making of any additional payment due for prior weekly |
|
1470
|
payments, based on the lower rate compensation. |
|
1471
|
(d) If any of the foregoing methods cannot reasonably and |
|
1472
|
fairly be applied, the full-time weekly wages of the injured |
|
1473
|
employee shall be used, except as otherwise provided in |
|
1474
|
paragraph (e) or paragraph (f). |
|
1475
|
(e) If it is established that the injured employee was |
|
1476
|
under 22 years of age when the accident occurredinjuredand |
|
1477
|
that under normal conditions her or his wages should be expected |
|
1478
|
to increase during the period of disability, the fact may be |
|
1479
|
considered in arriving at her or his average weekly wages. |
|
1480
|
(f) If it is established that the injured employee was a |
|
1481
|
part-time worker on the date of the accidentat the time of the |
|
1482
|
injury, that she or he had adopted part-time employment as a |
|
1483
|
customary practice, and that under normal working conditions she |
|
1484
|
or he probably would have remained a part-time worker during the |
|
1485
|
period of disability, these factors shall be considered in |
|
1486
|
arriving at her or his average weekly wages. For the purpose of |
|
1487
|
this paragraph, the term "part-time worker" means an individual |
|
1488
|
who customarily works less than the full-time hours or full-time |
|
1489
|
workweek of a similar employee in the same employment. |
|
1490
|
(g) If compensation is due for a fractional part of the |
|
1491
|
week, the compensation for such fractional part shall be |
|
1492
|
determined by dividing the weekly compensation rate by the |
|
1493
|
number of days employed per week to compute the amount due for |
|
1494
|
each day. |
|
1495
|
Section 16. Paragraphs (b) and (f) of subsection (1), and |
|
1496
|
paragraph (a) of subsection (3) of section 440.15, Florida |
|
1497
|
Statutes, are amended to read: |
|
1498
|
440.15 Compensation for disability.--Compensation for |
|
1499
|
disability shall be paid to the employee, subject to the limits |
|
1500
|
provided in s. 440.12(2), as follows: |
|
1501
|
(1) PERMANENT TOTAL DISABILITY.-- |
|
1502
|
(b) Only A catastrophic injury as defined in s. 440.02(38) |
|
1503
|
shall, in the absence of conclusive proof of a substantial |
|
1504
|
earning capacity, constitute permanent total disability. In all |
|
1505
|
other cases, no compensation shall be payable under paragraph |
|
1506
|
(a) if the employee is engaged in, or is physically capable of |
|
1507
|
engaging in, employment, including sheltered employment. In |
|
1508
|
order to obtain permanent total disability benefits, the |
|
1509
|
employee must establish that he or she is not able |
|
1510
|
uninterruptedly to engage in any employment, including part-time |
|
1511
|
sedentary employment or available sheltered employment within a |
|
1512
|
50-mile radius of the employee’s residence, due to his or her |
|
1513
|
physical limitation. “Sheltered employment” means work |
|
1514
|
unavailable in the open labor market that is offered to the |
|
1515
|
employee or which is actually performed by the employee as |
|
1516
|
offered by the employer in whose employment the injured worker |
|
1517
|
was engaged at the time of the accident. Such benefits shall be |
|
1518
|
payable until the employee reaches age 70, notwithstanding any |
|
1519
|
age limits. If the accident occurred on or after the employee |
|
1520
|
reaches age 65, benefits shall be payable during the continuance |
|
1521
|
of permanent total disability, not to exceed 5 years following |
|
1522
|
the determination of permanent total disability.Only claimants |
|
1523
|
with catastrophic injuries or who are incapable of engaging in |
|
1524
|
employment, including sheltered employment as described in this |
|
1525
|
paragraph,are eligible for permanent total benefits. In no |
|
1526
|
other case may permanent total disability be awarded. |
|
1527
|
(f)1. If permanent total disability results from injuries |
|
1528
|
that occurred subsequent to June 30, 1955, and for which the |
|
1529
|
liability of the employer for compensation has not been |
|
1530
|
discharged under s. 440.20(11), the injured employee shall |
|
1531
|
receive additional weekly compensation benefits equal to 5 |
|
1532
|
percent of her or his weekly compensation rate, as established |
|
1533
|
pursuant to the law in effect on the date of her or his injury, |
|
1534
|
multiplied by the number of calendar years since the date of |
|
1535
|
injury. The weekly compensation payable and the additional |
|
1536
|
benefits payable under this paragraph, when combined, may not |
|
1537
|
exceed the maximum weekly compensation rate in effect at the |
|
1538
|
time of payment as determined pursuant to s. 440.12(2). |
|
1539
|
Entitlement to These supplemental payments shall not be paid or |
|
1540
|
payable after the employee attainscease at age 62, regardless |
|
1541
|
of whether or notif the employee has applied for or is |
|
1542
|
ineligible to applyis eligiblefor social security benefits |
|
1543
|
under 42 U.S.C. ss. 402 and 423, whether or not the employee has |
|
1544
|
applied for such benefits. These supplemental benefits shall be |
|
1545
|
paid by the department out of the Workers' Compensation |
|
1546
|
Administration Trust Fund when the injury occurred subsequent to |
|
1547
|
June 30, 1955, and before July 1, 1984. These supplemental |
|
1548
|
benefits shall be paid by the employer when the injury occurred |
|
1549
|
on or after July 1, 1984. Supplemental benefits are not payable |
|
1550
|
for any period prior to October 1, 1974. |
|
1551
|
2.a. The department shall provide by rule for the periodic |
|
1552
|
reporting to the department of all earnings of any nature and |
|
1553
|
social security income by the injured employee entitled to or |
|
1554
|
claiming additional compensation under subparagraph 1. Neither |
|
1555
|
the department nor the employer or carrier shall make any |
|
1556
|
payment of those additional benefits provided by subparagraph 1. |
|
1557
|
for any period during which the employee willfully fails or |
|
1558
|
refuses to report upon request by the department in the manner |
|
1559
|
prescribed by such rules. |
|
1560
|
b. The department shall provide by rule for the periodic |
|
1561
|
reporting to the employer or carrier of all earnings of any |
|
1562
|
nature and social security income by the injured employee |
|
1563
|
entitled to or claiming benefits for permanent total disability. |
|
1564
|
The employer or carrier is not required to make any payment of |
|
1565
|
benefits for permanent total disability for any period during |
|
1566
|
which the employee willfully fails or refuses to report upon |
|
1567
|
request by the employer or carrier in the manner prescribed by |
|
1568
|
such rules or if any employee who is receiving permanent total |
|
1569
|
disability benefits refuses to apply for or cooperate with the |
|
1570
|
employer or carrier in applying for social security benefits. |
|
1571
|
3. When an injured employee receives a full or partial |
|
1572
|
lump-sum advance of the employee's permanent total disability |
|
1573
|
compensation benefits, the employee's benefits under this |
|
1574
|
paragraph shall be computed on the employee's weekly |
|
1575
|
compensation rate as reduced by the lump-sum advance. |
|
1576
|
(3) PERMANENT IMPAIRMENT AND WAGE-LOSS BENEFITS.-- |
|
1577
|
(a) Impairment benefits.-- |
|
1578
|
1. Once the employee has reached the date of maximum |
|
1579
|
medical improvement, impairment benefits are due and payable |
|
1580
|
within 20 days after the carrier has knowledge of the |
|
1581
|
impairment. |
|
1582
|
2. The three-member panel, in cooperation with the |
|
1583
|
department, shall establish and use a uniform permanent |
|
1584
|
impairment rating schedule. This schedule must be based on |
|
1585
|
medically or scientifically demonstrable findings as well as the |
|
1586
|
systems and criteria set forth in the American Medical |
|
1587
|
Association's Guides to the Evaluation of Permanent Impairment; |
|
1588
|
the Snellen Charts, published by American Medical Association |
|
1589
|
Committee for Eye Injuries; and the Minnesota Department of |
|
1590
|
Labor and Industry Disability Schedules. The schedule should be |
|
1591
|
based upon objective findings. The schedule shall be more |
|
1592
|
comprehensive than the AMA Guides to the Evaluation of Permanent |
|
1593
|
Impairment and shall expand the areas already addressed and |
|
1594
|
address additional areas not currently contained in the guides. |
|
1595
|
On August 1, 1979, and pending the adoption, by rule, of a |
|
1596
|
permanent schedule, Guides to the Evaluation of Permanent |
|
1597
|
Impairment, copyright 1977, 1971, 1988, by the American Medical |
|
1598
|
Association, shall be the temporary schedule and shall be used |
|
1599
|
for the purposes hereof. For injuries after July 1, 1990, |
|
1600
|
pending the adoption by rule of a uniform disability rating |
|
1601
|
agency schedule, the Minnesota Department of Labor and Industry |
|
1602
|
Disability Schedule shall be used unless that schedule does not |
|
1603
|
address an injury. In such case, the Guides to the Evaluation of |
|
1604
|
Permanent Impairment by the American Medical Association shall |
|
1605
|
be used. Determination of permanent impairment under this |
|
1606
|
schedule must be made by a physician licensed under chapter 458, |
|
1607
|
a doctor of osteopathic medicine licensed under chapters 458 and |
|
1608
|
459, a chiropractic physician licensed under chapter 460, a |
|
1609
|
podiatric physician licensed under chapter 461, an optometrist |
|
1610
|
licensed under chapter 463, or a dentist licensed under chapter |
|
1611
|
466, as appropriate considering the nature of the injury. No |
|
1612
|
other persons are authorized to render opinions regarding the |
|
1613
|
existence of or the extent of permanent impairment. |
|
1614
|
3. All impairment income benefits shall be based on an |
|
1615
|
impairment rating using the impairment schedule referred to in |
|
1616
|
subparagraph 2. Impairment income benefits are paid weekly at a |
|
1617
|
the rate equal toof 50 percent ofthe employee's average weekly |
|
1618
|
temporary total disability benefit not to exceed the maximum |
|
1619
|
weekly benefit under s. 440.12; provided, however, that such |
|
1620
|
benefits shall be reduced by 50 percent for each week in which |
|
1621
|
the employee has earned income equal to, or in excess of, the |
|
1622
|
employee’s average weekly wage. An employee's entitlement to |
|
1623
|
impairment income benefits begins the day after the employee |
|
1624
|
reaches maximum medical improvement or the expiration of |
|
1625
|
temporary benefits, whichever occurs earlier, and continues |
|
1626
|
until the earlier of: |
|
1627
|
a. The expiration of a period computed at the rate of 3 |
|
1628
|
weeks for each percentage point of impairment; or |
|
1629
|
b. The death of the employee. |
|
1630
|
4. After the employee has been certified by a doctor as |
|
1631
|
having reached maximum medical improvement or 6 weeks before the |
|
1632
|
expiration of temporary benefits, whichever occurs earlier, the |
|
1633
|
certifying doctor shall evaluate the condition of the employee |
|
1634
|
and assign an impairment rating, using the impairment schedule |
|
1635
|
referred to in subparagraph 2. Compensation is not payable for |
|
1636
|
the mental, psychological, or emotional injury arising out of |
|
1637
|
depression from being out of work. If the certification and |
|
1638
|
evaluation are performed by a doctor other than the employee's |
|
1639
|
treating doctor, the certification and evaluation must be |
|
1640
|
submitted to the treating doctor, and the treating doctor must |
|
1641
|
indicate agreement or disagreement with the certification and |
|
1642
|
evaluation. The certifying doctor shall issue a written report |
|
1643
|
to the department, the employee, and the carrier certifying that |
|
1644
|
maximum medical improvement has been reached, stating the |
|
1645
|
impairment rating, and providing any other information required |
|
1646
|
by the department by rule. If the employee has not been |
|
1647
|
certified as having reached maximum medical improvement before |
|
1648
|
the expiration of 102 weeks after the date temporary total |
|
1649
|
disability benefits begin to accrue, the carrier shall notify |
|
1650
|
the treating doctor of the requirements of this section. |
|
1651
|
5. The carrier shall pay the employee impairment income |
|
1652
|
benefits for a period based on the impairment rating. |
|
1653
|
6. The department may by rule specify forms and procedures |
|
1654
|
governing the method of payment of wage loss and impairment |
|
1655
|
benefits for dates of accidents before January 1, 1994, and for |
|
1656
|
dates of accidents on or after January 1, 1994. |
|
1657
|
Section 17. Subsections (1) and (7) of section 440.16, |
|
1658
|
Florida Statutes, are amended to read: |
|
1659
|
440.16 Compensation for death.-- |
|
1660
|
(1) If death results from the accident within 1 year |
|
1661
|
thereafter or follows continuous disability and results from the |
|
1662
|
accident within 5 years thereafter, the employer shall pay: |
|
1663
|
(a) Within 14 days after receiving the bill, actual |
|
1664
|
funeral expenses not to exceed $10,000$5,000. |
|
1665
|
(b) Compensation, in addition to the above, in the |
|
1666
|
following percentages of the average weekly wages to the |
|
1667
|
following persons entitled thereto on account of dependency upon |
|
1668
|
the deceased, and in the following order of preference, subject |
|
1669
|
to the limitation provided in subparagraph 2., but such |
|
1670
|
compensation shall be subject to the limits provided in s. |
|
1671
|
440.12(2), shall not exceed $200,000$100,000, and may be less |
|
1672
|
than, but shall not exceed, for all dependents or persons |
|
1673
|
entitled to compensation, 662/3 percent of the average wage: |
|
1674
|
1. To the spouse, if there is no child, 50 percent of the |
|
1675
|
average weekly wage, such compensation to cease upon the |
|
1676
|
spouse's death. |
|
1677
|
2. To the spouse, if there is a child or children, the |
|
1678
|
compensation payable under subparagraph 1. and, in addition, |
|
1679
|
162/3 percent on account of the child or children. However, when |
|
1680
|
the deceased is survived by a spouse and also a child or |
|
1681
|
children, whether such child or children are the product of the |
|
1682
|
union existing at the time of death or of a former marriage or |
|
1683
|
marriages, the judge of compensation claims may provide for the |
|
1684
|
payment of compensation in such manner as may appear to the |
|
1685
|
judge of compensation claims just and proper and for the best |
|
1686
|
interests of the respective parties and, in so doing, may |
|
1687
|
provide for the entire compensation to be paid exclusively to |
|
1688
|
the child or children; and, in the case of death of such spouse, |
|
1689
|
331/3 percent for each child. However, upon the surviving |
|
1690
|
spouse's remarriage, the spouse shall be entitled to a lump-sum |
|
1691
|
payment equal to 26 weeks of compensation at the rate of 50 |
|
1692
|
percent of the average weekly wage as provided in s. 440.12(2), |
|
1693
|
unless the $200,000$100,000limit provided in this paragraph is |
|
1694
|
exceeded, in which case the surviving spouse shall receive a |
|
1695
|
lump-sum payment equal to the remaining available benefits in |
|
1696
|
lieu of any further indemnity benefits. In no case shall a |
|
1697
|
surviving spouse's acceptance of a lump-sum payment affect |
|
1698
|
payment of death benefits to other dependents. |
|
1699
|
3. To the child or children, if there is no spouse, 331/3 |
|
1700
|
percent for each child. |
|
1701
|
4. To the parents, 25 percent to each, such compensation |
|
1702
|
to be paid during the continuance of dependency. |
|
1703
|
5. To the brothers, sisters, and grandchildren, 15 percent |
|
1704
|
for each brother, sister, or grandchild. |
|
1705
|
(c) To the surviving spouse, payment of postsecondary |
|
1706
|
student fees for instruction at any area technical center |
|
1707
|
established under s. 1001.44 for up to 1,800 classroom hours or |
|
1708
|
payment of student fees at any community college established |
|
1709
|
under part III of chapter 1004 for up to 80 semester hours. The |
|
1710
|
spouse of a deceased state employee shall be entitled to a full |
|
1711
|
waiver of such fees as provided in ss. 1009.22 and 1009.23 in |
|
1712
|
lieu of the payment of such fees. The benefits provided for in |
|
1713
|
this paragraph shall be in addition to other benefits provided |
|
1714
|
for in this section and shall terminate 7 years after the death |
|
1715
|
of the deceased employee, or when the total payment in eligible |
|
1716
|
compensation under paragraph (b) has been received. To qualify |
|
1717
|
for the educational benefit under this paragraph, the spouse |
|
1718
|
shall be required to meet and maintain the regular admission |
|
1719
|
requirements of, and be registered at, such area technical |
|
1720
|
center or community college, and make satisfactory academic |
|
1721
|
progress as defined by the educational institution in which the |
|
1722
|
student is enrolled. |
|
1723
|
(7) Compensation under this chapter to aliens not |
|
1724
|
residents (or about to become nonresidents) of the United States |
|
1725
|
or Canada shall be the same in amount as provided for residents, |
|
1726
|
except that dependents in any foreign country shall be limited |
|
1727
|
to surviving spouse and child or children, or if there be no |
|
1728
|
surviving spouse or child or children, to surviving father or |
|
1729
|
mother whom the employee has supported, either wholly or in |
|
1730
|
part, for the period of 1 year prior to the date of the injury, |
|
1731
|
and except that the judge of compensation claims may, at the |
|
1732
|
option of the judge of compensation claims, or upon the |
|
1733
|
application of the insurance carrier, commute all future |
|
1734
|
installments of compensation to be paid to such aliens by paying |
|
1735
|
or causing to be paid to them one-half of the commuted amount of |
|
1736
|
such future installments of compensation as determined by the |
|
1737
|
judge of compensation claims, and provided further that |
|
1738
|
compensation to dependents referred to in this subsection shall |
|
1739
|
in no case exceed $100,000$50,000. |
|
1740
|
Section 18. Subsection (9) is added to section 440.192, |
|
1741
|
Florida Statutes, to read: |
|
1742
|
440.192 Procedure for resolving benefit disputes.-- |
|
1743
|
(9) A petition for benefits must contain claims for all |
|
1744
|
benefits that are ripe, due, and owing on the date the petition |
|
1745
|
is filed.
|
|
1746
|
Section 19. Section 440.25, Florida Statutes, is amended |
|
1747
|
to read: |
|
1748
|
440.25 Procedures for mediation and hearings.-- |
|
1749
|
(1) Within 15090days after a petition for benefits is |
|
1750
|
filed under s. 440.192, a mediation conference concerning such |
|
1751
|
petition shall be held. Within 40 days after such petition is |
|
1752
|
filed,The judge of compensation claims shall notify the |
|
1753
|
interested parties by order that a mediation conference |
|
1754
|
concerning such petition will be held unless the parties have |
|
1755
|
notified the Office of the Judges of Compensation Claims that a |
|
1756
|
mediation has been held. Such order shallmust give the date on |
|
1757
|
by which a mandatory statethe mediation conference shallmust |
|
1758
|
be held. Such orderandmay be served personally upon the |
|
1759
|
interested parties or may be sent to the interested parties by |
|
1760
|
mail. The mediator may excuse the appearance of a represented |
|
1761
|
party and the representative for the employer and carrier, and |
|
1762
|
may permit the appearance of a party and the representative for |
|
1763
|
the employer and carrier by telephone or, if agreed to by the |
|
1764
|
parties, other electronic means, upon written request and at the |
|
1765
|
mediator’s discretion. It is the duty of the party requesting |
|
1766
|
appearance by telephone or other electronic means to ensure that |
|
1767
|
facilities and all necessary electronic equipment are arranged |
|
1768
|
at its expense and that the means are readily available to |
|
1769
|
prepare, execute, and exchange documents, stipulations, |
|
1770
|
agreements, and other pleadings without unreasonable delay. If a |
|
1771
|
party or its counsel has a conflict with the date on which the |
|
1772
|
mandatory state mediation is scheduled by order of the judge of |
|
1773
|
compensation claims, counsel or the party alleging the conflict, |
|
1774
|
if unrepresented, shall, within 21 days after the date of the |
|
1775
|
initial notice, advise the state mediator’s office in writing of |
|
1776
|
the conflict and contact the state mediator’s office by |
|
1777
|
telephone to reschedule the mediation to a date within the |
|
1778
|
timeframe set forth in this subsection. |
|
1779
|
(2)(a) The parties, upon request, shall exchange the |
|
1780
|
following documents within their actual or constructive control |
|
1781
|
within 30 days before the date of any mediation unless |
|
1782
|
previously produced:
|
|
1783
|
1. The employee’s 13-week wage statement together with |
|
1784
|
information regarding the receipt and value of fringe benefits |
|
1785
|
and the date of any suspension of same.
|
|
1786
|
2. Payroll records since the date of the accident.
|
|
1787
|
3. All medical records and reports related to the work |
|
1788
|
injury or disability claimed which relate to the claim or |
|
1789
|
defenses.
|
|
1790
|
4. A payout sheet, excluding work product, investigative |
|
1791
|
information, and payment for attorney’s fees.
|
|
1792
|
5. Statements, written or otherwise recorded, and not |
|
1793
|
privileged.
|
|
1794
|
6. All offers of employment and corresponding job |
|
1795
|
descriptions.
|
|
1796
|
7. Any and all documentation concerning the employer’s |
|
1797
|
communication with the employee about returning to work.
|
|
1798
|
8. Any and all documents relating to recommended future |
|
1799
|
medical treatment based on medical opinions pursuant to s. |
|
1800
|
440.13(9)(b).
|
|
1801
|
(b) Failure to comply with the requirements of paragraph |
|
1802
|
(a) shall result in the exclusion at any future final hearing on |
|
1803
|
the issues contained in the petitions for benefits filed prior |
|
1804
|
to the date of the mediation of the documents not timely |
|
1805
|
provided and other sanctions deemed appropriate by the judge. |
|
1806
|
Mandatory exchange of documents is required unless a stipulation |
|
1807
|
is entered into that such documents are immaterial to the |
|
1808
|
disputed issue.
|
|
1809
|
(c) No less than 30 days prior to any mediation, the |
|
1810
|
employee shall make a specific written demand for settlement of |
|
1811
|
the issues which remain outstanding, and may make a written |
|
1812
|
demand for settlement of the case, which contains sufficient |
|
1813
|
explanation and supporting documentation to enable the employer |
|
1814
|
and carrier and its counsel, if any, to evaluate the demand for |
|
1815
|
settlement.
|
|
1816
|
(d) The employer and carrier and its counsel, if any, |
|
1817
|
receiving the demand shall respond in writing within 15 working |
|
1818
|
days to the specific written demand for settlement of the |
|
1819
|
issues.
|
|
1820
|
(3) Mediations, including those that have previously been |
|
1821
|
rescheduled due to conflict pursuant to subsection (1), may be |
|
1822
|
rescheduled one additional time to a date within the timeframe |
|
1823
|
set forth in subsection (1) or for no more than an additional 30 |
|
1824
|
days beyond the timeframe set forth in subsection (1) by written |
|
1825
|
stipulation of the parties. Otherwise, all mediations may be |
|
1826
|
continued by order of the judge of compensation claims at his or |
|
1827
|
her discretion. To obtain such an order, a motion for |
|
1828
|
continuance must be filed stating the reason for the requested |
|
1829
|
continuance, the date that the order originally scheduling the |
|
1830
|
state mediation was mailed, and whether mediation had been |
|
1831
|
continued previously and, if so, the number of times. The |
|
1832
|
proposed order on the motion must contain a blank space so that |
|
1833
|
a new mediation conference date may be assigned.The claimant or |
|
1834
|
the adjuster of the employer or carrier may, at the mediator's |
|
1835
|
discretion, attend the mediation conference by telephone or, if |
|
1836
|
agreed to by the parties, other electronic means. A continuance |
|
1837
|
may be granted if the requesting party demonstrates to the judge |
|
1838
|
of compensation claims that the reason for requesting the |
|
1839
|
continuance arises from circumstances beyond the party's |
|
1840
|
control. Any order granting a continuance must set forth the |
|
1841
|
date of the rescheduled mediation conference.A mediation |
|
1842
|
conference may not be used solely for the purpose of mediating |
|
1843
|
attorney's fees. |
|
1844
|
(4) State and private mediations may be canceled if all |
|
1845
|
issues other than attorney’s fees have been settled or resolved, |
|
1846
|
the petitions for benefits have been dismissed or withdrawn, or |
|
1847
|
the state mediation conference has been waived by order of the |
|
1848
|
chief judge. State mediations may also be canceled if the |
|
1849
|
parties have filed a notice with the judge of compensation |
|
1850
|
claims at least 15 days prior to the state mediation |
|
1851
|
substituting private mediation for the mandatory state |
|
1852
|
mediation. The notice shall include the name of the private |
|
1853
|
mediator and the date and time of the private mediation.
|
|
1854
|
(5)(a) The notice substituting private mediation for state |
|
1855
|
mediation shall include language stipulating that the parties |
|
1856
|
agree to be bound by the applicable rules and statutes |
|
1857
|
pertaining to state mediations, including the filing by the |
|
1858
|
private mediator of a mediator’s report pursuant to rule |
|
1859
|
4.310(e), Florida Rules of Workers' Compensation Procedure. The |
|
1860
|
notice shall state that the private mediation may only be |
|
1861
|
continued or rescheduled pursuant to subsection (3) and that |
|
1862
|
claimant's counsel is responsible for ensuring that a mediator’s |
|
1863
|
report is filed within 10 days after the conclusion of the |
|
1864
|
private mediation conference.
|
|
1865
|
(b) If a notice is filed substituting private mediation for |
|
1866
|
mandatory state mediation or the parties agree to hold a private |
|
1867
|
mediation conference, such private mediation conference shall be |
|
1868
|
at the carrier's expense. The mediation conference shall be |
|
1869
|
conducted by a mediator certified under s. 44.106. If the |
|
1870
|
parties do not agree upon a rescheduled mediation date pursuant |
|
1871
|
to the timeframe requirements set forth in subsections (1) and |
|
1872
|
(3) or the parties to not agree to a private mediator within 20 |
|
1873
|
days after the date of a notice substituting private mediation |
|
1874
|
for mandatory state mediation, the employee or his or her |
|
1875
|
counsel shall notify the judge of compensation claims in writing |
|
1876
|
and the judge shall appoint a private mediator within 7 days |
|
1877
|
after the judge is notified. The terms and requirements for |
|
1878
|
state and private mediation, including the timeframe |
|
1879
|
requirements set forth in subsections (1) and (3), shall remain |
|
1880
|
in full force and effect and the parties shall comply with the |
|
1881
|
terms thereof.
|
|
1882
|
(2) Any party who participates in a mediation conference |
|
1883
|
shall not be precluded from requesting a hearing following the |
|
1884
|
mediation conference should both parties not agree to be bound |
|
1885
|
by the results of the mediation conference. A mediation |
|
1886
|
conference is required to be held unless this requirement is |
|
1887
|
waived by the Deputy Chief Judge. No later than 3 days prior to |
|
1888
|
the mediation conference, all parties must submit any applicable |
|
1889
|
motions, including, but not limited to, a motion to waive the |
|
1890
|
mediation conference, to the judge of compensation claims.
|
|
1891
|
(6)(3)(a)Such mediation conference shall be conducted |
|
1892
|
informally and does not require the use of formal rules of |
|
1893
|
evidence or procedure. Any information from the files, reports, |
|
1894
|
case summaries, mediator's notes, or other communications or |
|
1895
|
materials, oral or written, relating to a mediation conference |
|
1896
|
under this section obtained by any person performing mediation |
|
1897
|
duties is privileged and confidential and may not be disclosed |
|
1898
|
without the written consent of all parties to the conference. |
|
1899
|
Any research or evaluation effort directed at assessing the |
|
1900
|
mediation program activities or performance must protect the |
|
1901
|
confidentiality of such information. Each party to a mediation |
|
1902
|
conference has a privilege during and after the conference to |
|
1903
|
refuse to disclose and to prevent another from disclosing |
|
1904
|
communications made during the conference whether or not the |
|
1905
|
contested issues are successfully resolved. This subsection and |
|
1906
|
paragraphs (9)(4)(a) and (b) shall not be construed to prevent |
|
1907
|
or inhibit the discovery or admissibility of any information |
|
1908
|
that is otherwise subject to discovery or that is admissible |
|
1909
|
under applicable law or rule of procedure, except that any |
|
1910
|
conduct or statements made during a mediation conference or in |
|
1911
|
negotiations concerning the conference are inadmissible in any |
|
1912
|
proceeding under this chapter. |
|
1913
|
(a)1. Unless the parties conduct a private mediation under |
|
1914
|
subparagraph 2., mediation shall be conducted by a mediator |
|
1915
|
selected by the Chief Judge of Compensation ClaimsDirector of |
|
1916
|
the Division of Administrative Hearingsfrom among mediators |
|
1917
|
employed on a full-time basis by the Office of the Judges of |
|
1918
|
Compensation Claims. A mediator must be a member of The Florida |
|
1919
|
Bar for at least 5 years,andmust complete a mediation training |
|
1920
|
program approved by the Chief Judge of Compensation Claims, and |
|
1921
|
must possess a minimum of 5 years' experience in the full-time |
|
1922
|
practice of workers' compensation lawDirector of the Division |
|
1923
|
of Administrative Hearings. Adjunct mediators may be employed by |
|
1924
|
the Office of the Judges of Compensation Claims on an as-needed |
|
1925
|
basis and shall be selected from a list prepared by the Chief |
|
1926
|
Judge of Compensation ClaimsDirector of the Division of |
|
1927
|
Administrative Hearings. An adjunct mediator must be independent |
|
1928
|
of all parties participating in the mediation conference. An |
|
1929
|
adjunct mediator must be a member of The Florida Bar for at |
|
1930
|
least 5 years, must possess a minimum of 5 years' experience in |
|
1931
|
the full-time practice of Florida workers' compensation law, and |
|
1932
|
must complete a mediation training program approved by the Chief |
|
1933
|
Judge of Compensation ClaimsDirector of the Division of |
|
1934
|
Administrative Hearings. An adjunct mediator shall have access |
|
1935
|
to the office, equipment, and supplies of the judge of |
|
1936
|
compensation claims in each district. |
|
1937
|
(b)2. With respect to any mediation occurring on or after |
|
1938
|
January 1, 2003, if the parties agree or if mediators are not |
|
1939
|
available under subparagraph 1. to conduct the required |
|
1940
|
mediation within the period specified in this section, the |
|
1941
|
parties shall hold a mediation conference at the carrier's |
|
1942
|
expense within the 90-day period set for mediation. The |
|
1943
|
mediation conference shall be conducted by a mediator certified |
|
1944
|
under s. 44.106. If the parties do not agree upon a mediator |
|
1945
|
within 10 days after the date of the order, the claimant shall |
|
1946
|
notify the judge in writing and the judge shall appoint a |
|
1947
|
mediator under this subparagraph within 7 days.In the event |
|
1948
|
both parties agree, the results of the mediation conference |
|
1949
|
shall be binding and neither party shall have a right to appeal |
|
1950
|
the results. In the event either party refuses to agree to the |
|
1951
|
results of the mediation conference, the results of the |
|
1952
|
mediation conference as well as the testimony, witnesses, and |
|
1953
|
evidence presented at the conference shall not be admissible at |
|
1954
|
any subsequent proceeding on the claim. The mediator shall not |
|
1955
|
be called in to testify or give deposition to resolve any claim |
|
1956
|
for any hearing before the judge of compensation claims. The |
|
1957
|
employer may be represented by an attorney at the mediation |
|
1958
|
conference if the employee is also represented by an attorney at |
|
1959
|
the mediation conference. |
|
1960
|
(7)(a) After receiving notice of impasse from the mediator, the |
|
1961
|
judge of compensation claims shall hold a live pretrial hearing. |
|
1962
|
The judge of compensation claims shall give the parties at least |
|
1963
|
7 days' notice of the pretrial hearing and, unless the judge of |
|
1964
|
compensation claims indicates otherwise, the pretrial hearing |
|
1965
|
shall be held in the county where the office of the judge of |
|
1966
|
compensation claims is located. A pretrial hearing may be |
|
1967
|
continued with prior approval of the judge of compensation |
|
1968
|
claims.
|
|
1969
|
(b) The parties may submit their pretrial stipulations by mail |
|
1970
|
when represented by counsel and with leave of the judge of |
|
1971
|
compensation claims; however, the parties or their legal counsel |
|
1972
|
shall appear at any live pretrial hearing.
|
|
1973
|
(c) If a party or a party’s attorney fails to attend the |
|
1974
|
pretrial hearing without good cause, the judge may dismiss the |
|
1975
|
petition or claim, strike defenses, or take such other action as |
|
1976
|
may be authorized by law or rule 4.150, Florida Rules of |
|
1977
|
Workers' Compensation Procedure.
|
|
1978
|
(d) At the pretrial hearing, the parties shall:
|
|
1979
|
1. State and simplify the claims, defense, and issues.
|
|
1980
|
2. Stipulate and admit to such facts and documents as will |
|
1981
|
avoid unnecessary proof.
|
|
1982
|
3. Present, examine, and mark all exhibits for identification, |
|
1983
|
including all impeachment and rebuttal exhibits.
|
|
1984
|
4. Furnish the opposing party with the names and addresses of |
|
1985
|
all witnesses, including impeachment and rebuttal witnesses. A |
|
1986
|
party may be required by the judge of compensation claims to |
|
1987
|
provide a statement of subject matter of the expected testimony |
|
1988
|
of one or more witnesses.
|
|
1989
|
5. Exchange all available written reports of experts when |
|
1990
|
expert opinion is offered at trial. The reports shall clearly |
|
1991
|
disclose the expert opinion and its basis on all subjects on |
|
1992
|
which the expert will testify. If stipulated into evidence, the |
|
1993
|
reports shall be presented to the judge of compensation claims |
|
1994
|
to be so marked. The parties shall consider and determine a |
|
1995
|
limitation of the number of expert witnesses.
|
|
1996
|
6. Estimate time of trial and schedule the final hearing.
|
|
1997
|
7. Consider and determine, as appropriate, such other matters |
|
1998
|
as may aid in the disposition of the case, including, but not |
|
1999
|
limited to, referral to additional mediation or appointment of |
|
2000
|
an expert medical advisor pursuant to s. 440.13(9)(c).
|
|
2001
|
(e) Final witness lists, final exhibit lists, supplements, and |
|
2002
|
amendments to the pretrial stipulation shall be served no later |
|
2003
|
than 30 days before the final hearing. Witness lists, exhibit |
|
2004
|
lists, supplements, and amendments to be filed less than 30 days |
|
2005
|
before the final hearing must be approved by the judge or |
|
2006
|
stipulated to by the parties. A motion seeking such approval is |
|
2007
|
a procedural motion.
|
|
2008
|
(f) At the discretion of the judge and on filing and service of |
|
2009
|
motion and notice of hearing not less than 5 days before the |
|
2010
|
date of the pretrial hearing, procedural motions may also be |
|
2011
|
heard at the pretrial hearing.
|
|
2012
|
(g) The judge shall record the pretrial hearing by stenographer |
|
2013
|
or electronic means at the request of any party or by a written |
|
2014
|
stipulation signed by the parties.
|
|
2015
|
(h)1. At the request of any party, or by his or her own motion, |
|
2016
|
the judge promptly shall enter an order reciting the actions |
|
2017
|
taken at the pretrial hearing and the agreements made by the |
|
2018
|
parties about any of the matters considered and limiting the |
|
2019
|
issues for trial to those not disposed of by admissions or |
|
2020
|
stipulations of the parties.
|
|
2021
|
2. The order may control the subsequent course of action, in |
|
2022
|
the discretion of the judge, unless the judge modifies it to |
|
2023
|
prevent injustice.
|
|
2024
|
3. The judge shall serve the order on the attorneys for the |
|
2025
|
parties and on any party not represented by counsel.
|
|
2026
|
4. Unless otherwise specified in the notice of hearing, the |
|
2027
|
judge may consider and determine all issues pending as of the |
|
2028
|
date of the pretrial hearing.
|
|
2029
|
(8) Upon the motion of the judge of compensation claims or on |
|
2030
|
the motion of any party, the judge of compensation claims may |
|
2031
|
consolidate any petitions for benefits filed 30 days before the |
|
2032
|
scheduled mediation with any pending petitions for benefits for |
|
2033
|
purposes of a hearing or for any other purpose. Any hearing on a |
|
2034
|
consolidation must be held no later than 10 days before the |
|
2035
|
mediation. Only petitions for benefits filed 30 days before the |
|
2036
|
mediation date are ripe, due, and owing for the final hearing.
|
|
2037
|
(b) The parties shall complete the pretrial stipulations |
|
2038
|
before the conclusion of the mediation conference if the claims, |
|
2039
|
except for attorney's fees and costs, have not been settled and |
|
2040
|
if any claims in any filed petition remain unresolved. The judge |
|
2041
|
of compensation claims may impose sanctions against a party or |
|
2042
|
both parties for failing to complete the pretrial stipulations |
|
2043
|
before the conclusion of the mediation conference.
|
|
2044
|
(9)(4)(a) If the parties fail to agree upon written |
|
2045
|
submission of pretrial stipulations at the mediation conference, |
|
2046
|
the judge of compensation claims shall order a pretrial hearing |
|
2047
|
to occur within 14 days after the date of mediation ordered by |
|
2048
|
the judge of compensation claims. The judge of compensation |
|
2049
|
claims shall give the interested parties at least 7 days' |
|
2050
|
advance notice of the pretrial hearing by mail.At the pretrial |
|
2051
|
hearing, the judge of compensation claims shall, subject to |
|
2052
|
paragraph (b), set a date for the final hearing that allows the |
|
2053
|
parties at least 60 days to conduct discovery unless the parties |
|
2054
|
consent to an earlier hearing date. |
|
2055
|
(b) A continuance of the final hearing must be held and |
|
2056
|
concluded within 90 days after the mediation conference is held. |
|
2057
|
Continuances may be granted when the reason for requesting the |
|
2058
|
continuance arises from circumstances beyond the party's |
|
2059
|
control, when appropriate in the discretion ofonly if the |
|
2060
|
requesting party demonstrates tothe judge of compensation |
|
2061
|
claims, or by agreement of the parties; however, any continuance |
|
2062
|
to a date greater than 150 days after the date of initial |
|
2063
|
mediation shall require the written consent of the claimantthat |
|
2064
|
the reason for requesting the continuance arises from |
|
2065
|
circumstances beyond the party's control. The written consent of |
|
2066
|
the claimant must be obtained before any request from a |
|
2067
|
claimant's attorney is granted for an additional continuance |
|
2068
|
after the initial continuance has been granted. Any order |
|
2069
|
granting a continuance must set forth the date and time of the |
|
2070
|
rescheduled hearing. A continuance may be granted only if the |
|
2071
|
requesting party demonstrates to the judge of compensation |
|
2072
|
claims that the reason for requesting the continuance arises |
|
2073
|
from circumstances beyond the control of the parties. The judge |
|
2074
|
of compensation claims shall report any grant of two or more |
|
2075
|
continuances to the Deputy Chief Judge. |
|
2076
|
(c) The judge of compensation claims shall give the |
|
2077
|
interested parties at least 7 days' advance notice of the final |
|
2078
|
hearing, served upon the interested parties by mail. |
|
2079
|
(d) The final hearing shall be held within 210 days after |
|
2080
|
receipt of the petition for benefitsin the county where the |
|
2081
|
injury occurred, if the injury occurred in this state, unless |
|
2082
|
otherwise agreed to between the parties and authorized by the |
|
2083
|
judge of compensation claims in the county where the injury |
|
2084
|
occurred. If the injury occurred outside the state and is one |
|
2085
|
for which compensation is payable under this chapter, then the |
|
2086
|
final hearing may be held in the county of the employer's |
|
2087
|
residence or place of business, or in any other county of the |
|
2088
|
state that will, in the discretion of the DeputyChief Judge, be |
|
2089
|
the most convenient for a hearing. If the employee has been |
|
2090
|
involved in one or more claimed injuries in different venues |
|
2091
|
that have been the subject of a motion to consolidate, the |
|
2092
|
hearing shall be held in the county in which the employer of the |
|
2093
|
first injury in time resides, in any other county of the state |
|
2094
|
that will, in the discretion of the Chief Judge, be the most |
|
2095
|
convenient for a hearing, or in the county agreed upon by the |
|
2096
|
parties.The final hearing shall be conducted by a judge of |
|
2097
|
compensation claims, who shall, within 30 days after final |
|
2098
|
hearing or closure of the hearing record, unless otherwise |
|
2099
|
agreed by the parties, enter a final order on the merits of the |
|
2100
|
disputed issues. The judge of compensation claims may enter an |
|
2101
|
abbreviated final order in cases in which compensability is not |
|
2102
|
disputed. Either party may request separate findings of fact and |
|
2103
|
conclusions of law. At the final hearing, the claimant and |
|
2104
|
employer may each present evidence with respect to the claims |
|
2105
|
presented by the petition for benefits and may be represented by |
|
2106
|
any attorney authorized in writing for such purpose. When there |
|
2107
|
is a conflict in the medical evidence submitted at the hearing, |
|
2108
|
the provisions of s. 440.13 shall apply. The report or testimony |
|
2109
|
of the expert medical advisor shall be made a part of the record |
|
2110
|
of the proceeding and shall be given the same consideration by |
|
2111
|
the judge of compensation claims as is accorded other medical |
|
2112
|
evidence submitted in the proceeding; and all costs incurred in |
|
2113
|
connection with such examination and testimony may be assessed |
|
2114
|
as costs in the proceeding, subject to the provisions of s. |
|
2115
|
440.13. No judge of compensation claims may make a finding of a |
|
2116
|
degree of permanent impairment that is greater than the greatest |
|
2117
|
permanent impairment rating given the claimant by any examining |
|
2118
|
or treating physician, except upon stipulation of the parties. |
|
2119
|
Any benefit due but not raised at the final hearing which was |
|
2120
|
ripe, due, or owing at the time of the final hearing is waived. |
|
2121
|
(e) Co-counsel or any successor attorney shall file a |
|
2122
|
notice of appearance in accordance with the Florida Rules of |
|
2123
|
Workers' Compensation Procedure. Substitution of counsel may be |
|
2124
|
made:
|
|
2125
|
1. By the filing and service of a stipulation, which does |
|
2126
|
not require the approval of the judge; or
|
|
2127
|
2. By motion, which requires approval of the judge.
|
|
2128
|
(f) An attorney of record shall remain the attorney of |
|
2129
|
record and not be permitted to withdraw unless:
|
|
2130
|
1. The attorney files a written motion for withdrawal |
|
2131
|
setting forth the reasons for the motion.
|
|
2132
|
2. The motion is served on the client and counsel for all |
|
2133
|
parties. |
|
2134
|
3. An order is entered granting the motion of withdrawal.
|
|
2135
|
(g)(e)The order making an award or rejecting the claim, |
|
2136
|
referred to in this chapter as a "compensation order," shall set |
|
2137
|
forth the findings of ultimate facts and the mandate; and the |
|
2138
|
order need not include any other reason or justification for |
|
2139
|
such mandate. The compensation order shall be filed in the |
|
2140
|
Office of the Judges of Compensation Claims at Tallahassee. A |
|
2141
|
copy of such compensation order shall be sent by mail to the |
|
2142
|
parties and attorneys of record at the last known address of |
|
2143
|
each, with the date of mailing noted thereon. |
|
2144
|
(h)(f)Each judge of compensation claims is required to |
|
2145
|
submit a special report to the DeputyChief Judge in each |
|
2146
|
contested workers' compensation case in which the case is not |
|
2147
|
determined within 30 days of final hearing or closure of the |
|
2148
|
hearing record. Said form shall be provided by the Secretary |
|
2149
|
director of Management Servicesthe Division of Administrative |
|
2150
|
Hearingsand shall contain the names of the judge of |
|
2151
|
compensation claims and of the attorneys involved and a brief |
|
2152
|
explanation by the judge of compensation claims as to the reason |
|
2153
|
for such a delay in issuing a final order. |
|
2154
|
(g) Notwithstanding any other provision of this section, |
|
2155
|
the judge of compensation claims may require the appearance of |
|
2156
|
the parties and counsel before her or him without written notice |
|
2157
|
for an emergency conference where there is a bona fide emergency |
|
2158
|
involving the health, safety, or welfare of an employee. An |
|
2159
|
emergency conference under this section may result in the entry |
|
2160
|
of an order or the rendering of an adjudication by the judge of |
|
2161
|
compensation claims.
|
|
2162
|
(h) To expedite dispute resolution and to enhance the |
|
2163
|
self-executing features of the Workers' Compensation Law, the |
|
2164
|
Deputy Chief Judge shall make provision by rule or order for the |
|
2165
|
resolution of appropriate motions by judges of compensation |
|
2166
|
claims without oral hearing upon submission of brief written |
|
2167
|
statements in support and opposition, and for expedited |
|
2168
|
discovery and docketing. Unless the judge of compensation |
|
2169
|
claims, for good cause, orders a hearing under paragraph (i), |
|
2170
|
each claim in a petition relating to the determination of pay |
|
2171
|
under s. 440.14 shall be resolved under this paragraph without |
|
2172
|
oral hearing.
|
|
2173
|
(i) To further expedite dispute resolution and to enhance |
|
2174
|
the self-executing features of the system, those petitions filed |
|
2175
|
in accordance with s. 440.192 that involve a claim for benefits |
|
2176
|
of $5,000 or less shall, in the absence of compelling evidence |
|
2177
|
to the contrary, be presumed to be appropriate for expedited |
|
2178
|
resolution under this paragraph; and any other claim filed in |
|
2179
|
accordance with s. 440.192, upon the written agreement of both |
|
2180
|
parties and application by either party, may similarly be |
|
2181
|
resolved under this paragraph. A claim in a petition or $5,000 |
|
2182
|
or less for medical benefits only or a petition for |
|
2183
|
reimbursement for mileage for medical purposes shall, in the |
|
2184
|
absence of compelling evidence to the contrary, be resolved |
|
2185
|
through the expedited dispute resolution process provided in |
|
2186
|
this paragraph. For purposes of expedited resolution pursuant to |
|
2187
|
this paragraph, the Deputy Chief Judge shall make provision by |
|
2188
|
rule or order for expedited and limited discovery and expedited |
|
2189
|
docketing in such cases. At least 15 days prior to hearing, the |
|
2190
|
parties shall exchange and file with the judge of compensation |
|
2191
|
claims a pretrial outline of all issues, defenses, and witnesses |
|
2192
|
on a form adopted by the Deputy Chief Judge; provided, in no |
|
2193
|
event shall such hearing be held without 15 days' written notice |
|
2194
|
to all parties. No pretrial hearing shall be held. The judge of |
|
2195
|
compensation claims shall limit all argument and presentation of |
|
2196
|
evidence at the hearing to a maximum of 30 minutes, and such |
|
2197
|
hearings shall not exceed 30 minutes in length. Neither party |
|
2198
|
shall be required to be represented by counsel. The employer or |
|
2199
|
carrier may be represented by an adjuster or other qualified |
|
2200
|
representative. The employer or carrier and any witness may |
|
2201
|
appear at such hearing by telephone. The rules of evidence shall |
|
2202
|
be liberally construed in favor of allowing introduction of |
|
2203
|
evidence.
|
|
2204
|
(i)(j)A judge of compensation claims may, upon the motion |
|
2205
|
of a party or the judge's own motion, dismiss a petition for |
|
2206
|
lack of prosecution if a petition, response, motion, order, |
|
2207
|
request for hearing, or notice of deposition has not been filed |
|
2208
|
during the previous 12 months unless good cause is shown. A |
|
2209
|
dismissal for lack of prosecution is without prejudice and does |
|
2210
|
not require a hearing. |
|
2211
|
(j)(k)A judge of compensation claims may not award |
|
2212
|
interest on unpaid medical bills and the amount of such bills |
|
2213
|
may not be used to calculate the amount of interest awarded. |
|
2214
|
Regardless of the date benefits were initially requested, |
|
2215
|
attorney's fees do not attach under this subsection until 30 |
|
2216
|
days after the date the carrier or self-insured employer |
|
2217
|
receives the petition. |
|
2218
|
(10)(5)(a) Procedures with respect to appeals from orders |
|
2219
|
of judges of compensation claims shall be governed by rules |
|
2220
|
adopted by the Supreme Court. Such an order shall become final |
|
2221
|
30 days after mailing of copies of such order to the parties, |
|
2222
|
unless appealed pursuant to such rules. |
|
2223
|
(b) An appellant may be relieved of any necessary filing |
|
2224
|
fee by filing a verified petition of indigency for approval as |
|
2225
|
provided in s. 57.081(1) and may be relieved in whole or in part |
|
2226
|
from the costs for preparation of the record on appeal if, |
|
2227
|
within 15 days after the date notice of the estimated costs for |
|
2228
|
the preparation is served, the appellant files with the judge of |
|
2229
|
compensation claims a copy of the designation of the record on |
|
2230
|
appeal, and a verified petition to be relieved of costs. A |
|
2231
|
verified petition filed prior to the date of service of the |
|
2232
|
notice of the estimated costs shall be deemed not timely filed. |
|
2233
|
The verified petition relating to record costs shall contain a |
|
2234
|
sworn statement that the appellant is insolvent and a complete, |
|
2235
|
detailed, and sworn financial affidavit showing all the |
|
2236
|
appellant's assets, liabilities, and income. Failure to state in |
|
2237
|
the affidavit all assets and income, including marital assets |
|
2238
|
and income, shall be grounds for denying the petition with |
|
2239
|
prejudice. The Office of the Judges of Compensation Claims shall |
|
2240
|
adopt rules as may be required pursuant to this subsection, |
|
2241
|
including forms for use in all petitions brought under this |
|
2242
|
subsection. The appellant's attorney, or the appellant if she or |
|
2243
|
he is not represented by an attorney, shall include as a part of |
|
2244
|
the verified petition relating to record costs an affidavit or |
|
2245
|
affirmation that, in her or his opinion, the notice of appeal |
|
2246
|
was filed in good faith and that there is a probable basis for |
|
2247
|
the District Court of Appeal, First District, to find reversible |
|
2248
|
error, and shall state with particularity the specific legal and |
|
2249
|
factual grounds for the opinion. Failure to so affirm shall be |
|
2250
|
grounds for denying the petition. A copy of the verified |
|
2251
|
petition relating to record costs shall be served upon all |
|
2252
|
interested parties. The judge of compensation claims shall |
|
2253
|
promptly conduct a hearing on the verified petition relating to |
|
2254
|
record costs, giving at least 15 days' notice to the appellant, |
|
2255
|
the department, and all other interested parties, all of whom |
|
2256
|
shall be parties to the proceedings. The judge of compensation |
|
2257
|
claims may enter an order without such hearing if no objection |
|
2258
|
is filed by an interested party within 20 days from the service |
|
2259
|
date of the verified petition relating to record costs. Such |
|
2260
|
proceedings shall be conducted in accordance with the provisions |
|
2261
|
of this section and with the workers' compensation rules of |
|
2262
|
procedure, to the extent applicable. In the event an insolvency |
|
2263
|
petition is granted, the judge of compensation claims shall |
|
2264
|
direct the department to pay record costs and filing fees from |
|
2265
|
the Workers' Compensation Administration Trust Fund pending |
|
2266
|
final disposition of the costs of appeal. The department may |
|
2267
|
transcribe or arrange for the transcription of the record in any |
|
2268
|
proceeding for which it is ordered to pay the cost of the |
|
2269
|
record. |
|
2270
|
(c) As a condition of filing a notice of appeal to the |
|
2271
|
District Court of Appeal, First District, an employer who has |
|
2272
|
not secured the payment of compensation under this chapter in |
|
2273
|
compliance with s. 440.38 shall file with the notice of appeal a |
|
2274
|
good and sufficient bond, as provided in s. 59.13, conditioned |
|
2275
|
to pay the amount of the demand and any interest and costs |
|
2276
|
payable under the terms of the order if the appeal is dismissed, |
|
2277
|
or if the District Court of Appeal, First District, affirms the |
|
2278
|
award in any amount. Upon the failure of such employer to file |
|
2279
|
such bond with the judge of compensation claims or the District |
|
2280
|
Court of Appeal, First District, along with the notice of |
|
2281
|
appeal, the District Court of Appeal, First District, shall |
|
2282
|
dismiss the notice of appeal. |
|
2283
|
(11)(6)An award of compensation for disability may be |
|
2284
|
made after the death of an injured employee. |
|
2285
|
(12)(7)An injured employee claiming or entitled to |
|
2286
|
compensation shall submit to such physical examination by a |
|
2287
|
certified expert medical advisor approved by the agency or the |
|
2288
|
judge of compensation claims as the agency or the judge of |
|
2289
|
compensation claims may require. The place or places shall be |
|
2290
|
reasonably convenient for the employee. Such physician or |
|
2291
|
physicians as the employee, employer, or carrier may select and |
|
2292
|
pay for may participate in an examination if the employee, |
|
2293
|
employer, or carrier so requests. Proceedings shall be suspended |
|
2294
|
and no compensation shall be payable for any period during which |
|
2295
|
the employee may refuse to submit to examination. Any interested |
|
2296
|
party shall have the right in any case of death to require an |
|
2297
|
autopsy, the cost thereof to be borne by the party requesting |
|
2298
|
it; and the judge of compensation claims shall have authority to |
|
2299
|
order and require an autopsy and may, in her or his discretion, |
|
2300
|
withhold her or his findings and award until an autopsy is held. |
|
2301
|
Section 20. Subsections (1), (2), and (3) of section |
|
2302
|
440.34, Florida Statutes, are amended to read: |
|
2303
|
440.34 Attorney's fees; costs.-- |
|
2304
|
(1) A fee, gratuity, or other consideration may not be |
|
2305
|
paid for services rendered for a claimant in connection with any |
|
2306
|
proceedings arising under this chapter, unless approved as |
|
2307
|
reasonable by the judge of compensation claims or court having |
|
2308
|
jurisdiction over such proceedings. Except as provided by this |
|
2309
|
sectionsubsection, any attorney's fee approved by a judge of |
|
2310
|
compensation claims for services rendered to a claimant must be |
|
2311
|
equal to 20 percent of the first $5,000 of the amountof the |
|
2312
|
benefits secured, 15 percent of the next $5,000 of the amount of |
|
2313
|
the benefits secured, 10 percent of the remaining amount of the |
|
2314
|
benefits secured to be provided during the first 10 yearsafter |
|
2315
|
the date the petition for benefitsclaim is filed, and 5 percent |
|
2316
|
of the benefits secured after 10 years. However,The judge of |
|
2317
|
compensation claims shall consider the following factors in each |
|
2318
|
case in which an hourly fee may be awarded as set forth in |
|
2319
|
subsection (3),and may increase or decrease the attorney's fee |
|
2320
|
if, in her or his judgment, the circumstances of the particular |
|
2321
|
case warrant such action: |
|
2322
|
(a) The time and labor required, the novelty and |
|
2323
|
difficulty of the questions involved, and the skill requisite to |
|
2324
|
perform the legal service properly. |
|
2325
|
(b) The fee customarily charged in the locality for |
|
2326
|
similar legal services. |
|
2327
|
(c) The amount involved in the controversy and the |
|
2328
|
benefits resulting to the claimant. |
|
2329
|
(d) The time limitation imposed by the claimant or the |
|
2330
|
circumstances. |
|
2331
|
(e) The experience, reputation, and ability of the lawyer |
|
2332
|
or lawyers performing services. |
|
2333
|
(f) The contingency or certainty of a fee. |
|
2334
|
(2) In awarding a reasonable claimant's attorney's fee, |
|
2335
|
the judge of compensation claims shall consider only those |
|
2336
|
benefits to the claimant that the attorney is responsible for |
|
2337
|
securing. The amount, statutory basis, and type of benefits |
|
2338
|
obtained through legal representation shall be listed on all |
|
2339
|
attorney's fees awarded by the judge of compensation claims. For |
|
2340
|
purposes of this section, the term "benefits secured" means |
|
2341
|
benefits obtained as a result of the claimant's attorney's legal |
|
2342
|
services rendered in connection with the claim for benefits. |
|
2343
|
However, such term does not include future medical benefits to |
|
2344
|
be provided on any date more than 5 years after the date the |
|
2345
|
claim is filed. |
|
2346
|
(3) If the claimant should prevail in any proceedings |
|
2347
|
before a judge of compensation claims or court, there shall be |
|
2348
|
taxed against the employer the reasonable costs of such |
|
2349
|
proceedings, not to include the attorney's fees of the claimant. |
|
2350
|
A claimant shall be responsible for the payment of her or his |
|
2351
|
own attorney's fees, except that a claimant shall be entitled to |
|
2352
|
recover a reasonable attorney's fee from a carrier or employer: |
|
2353
|
(a) Against whom she or he successfully asserts a petition |
|
2354
|
for medical benefits only, which may be enhanced by an |
|
2355
|
additional hourly fee not to exceed $5,000if the claimant has |
|
2356
|
not filed or is not entitled to file at such time a claim for |
|
2357
|
disability, permanent impairment, wage-loss, or death benefits, |
|
2358
|
arising out of the same accident; |
|
2359
|
(b) In any case in which the employer or carrier files a |
|
2360
|
response to petition denying benefits with the Office of the |
|
2361
|
Judges of Compensation Claims and the injured person has |
|
2362
|
employed an attorney in the successful prosecution of the |
|
2363
|
petition; |
|
2364
|
(c) In a proceeding in which a carrier or employer denies |
|
2365
|
that an accident occurred for which compensation benefits are |
|
2366
|
payable, and the claimant prevails on the issue of |
|
2367
|
compensability, either the amount set forth in subsection (1) |
|
2368
|
or, upon showing to the judge of compensation claims, an hourly |
|
2369
|
fee not to exceed $20,000, whichever is greater; or |
|
2370
|
(d) In cases where the claimant successfully prevails in |
|
2371
|
proceedings filed under s. 440.24 or s. 440.28. |
|
2372
|
|
|
2373
|
Regardless of the date benefits were initially requested, |
|
2374
|
attorney's fees shall not attach under this subsection until 30 |
|
2375
|
days after the date the carrier or employer, if self-insured, |
|
2376
|
receives the petition. In applying the factors set forth in |
|
2377
|
subsection (1) to cases arising under paragraphs (a), (b), (c), |
|
2378
|
and (d), the judge of compensation claims must only consider |
|
2379
|
only such benefits and the time reasonably spent in obtaining |
|
2380
|
them as were secured for the claimant within the scope of |
|
2381
|
paragraphs (a), (b), (c), and (d). |
|
2382
|
Section 21. Subsection (7) is added to section 440.38, |
|
2383
|
Florida Statutes, to read: |
|
2384
|
440.38 Security for compensation; insurance carriers and |
|
2385
|
self-insurers.— |
|
2386
|
(7) Any employer who meets the requirements of subsection |
|
2387
|
(1) through a policy of insurance issued outside of this state |
|
2388
|
must at all times, with respect to all employees working in this |
|
2389
|
state, maintain the required coverage under a Florida |
|
2390
|
endorsement using Florida rates and rules pursuant to payroll |
|
2391
|
reporting that accurately reflects the work performed in this |
|
2392
|
state by such employees.
|
|
2393
|
Section 22. Subsection (2) of section 440.381, Florida |
|
2394
|
Statutes, is amended to read: |
|
2395
|
440.381 Application for coverage; reporting payroll; |
|
2396
|
payroll audit procedures; penalties.-- |
|
2397
|
(2) Submission of an application that contains false, |
|
2398
|
misleading, or incomplete information provided with the purpose |
|
2399
|
of avoiding or reducing the amount of premiums for workers’ |
|
2400
|
compensation coverage is a felony of the second degree, |
|
2401
|
punishable as provided in s. 775.082, s. 775.083, or s. 775.084. |
|
2402
|
The application must contain a statement that the filing of an |
|
2403
|
application containing false, misleading, or incomplete |
|
2404
|
information providedwith the purpose of avoiding or reducing |
|
2405
|
the amount of premiums for workers' compensation coverage is a |
|
2406
|
felony of the third degree, punishable as provided in s. |
|
2407
|
775.082, s. 775.083, or s. 775.084. The application must contain |
|
2408
|
a sworn statement by the employer attesting to the accuracy of |
|
2409
|
the information submitted and acknowledging the provisions of |
|
2410
|
former s. 440.37(4). The application must contain a sworn |
|
2411
|
statement by the agent attesting that the agent explained to the |
|
2412
|
employer or officer the classification codes that are used for |
|
2413
|
premium calculations. |
|
2414
|
Section 23. Paragraphs (c) and (d) of subsection (4) of |
|
2415
|
section 627.311, Florida Statutes, are amended to read |
|
2416
|
627.311 Joint underwriters and joint reinsurers.-- |
|
2417
|
(4) |
|
2418
|
(c) The operation of the plan shall be governed by a plan |
|
2419
|
of operation that is prepared at the direction of the board of |
|
2420
|
governors. The plan of operation may be changed at any time by |
|
2421
|
the board of governors or upon request of the department. The |
|
2422
|
plan of operation and all changes thereto are subject to the |
|
2423
|
approval of the department. The plan of operation shall: |
|
2424
|
1. Authorize the board to engage in the activities |
|
2425
|
necessary to implement this subsection, including, but not |
|
2426
|
limited to, borrowing money. |
|
2427
|
2. Develop criteria for eligibility for coverage by the |
|
2428
|
plan, including, but not limited to, documented rejection by at |
|
2429
|
least two insurers which reasonably assures that insureds |
|
2430
|
covered under the plan are unable to acquire coverage in the |
|
2431
|
voluntary market. Any insured may voluntarily elect to accept |
|
2432
|
coverage from an insurer for a premium equal to or greater than |
|
2433
|
the plan premium if the insurer writing the coverage adheres to |
|
2434
|
the provisions of s. 627.171. |
|
2435
|
3. Require notice from the agent to the insured at the |
|
2436
|
time of the application for coverage that the application is for |
|
2437
|
coverage with the plan and that coverage may be available |
|
2438
|
through an insurer, group self-insurers' fund, commercial self- |
|
2439
|
insurance fund, or assessable mutual insurer through another |
|
2440
|
agent at a lower cost. |
|
2441
|
4. Establish programs to encourage insurers to provide |
|
2442
|
coverage to applicants of the plan in the voluntary market and |
|
2443
|
to insureds of the plan, including, but not limited to: |
|
2444
|
a. Establishing procedures for an insurer to use in |
|
2445
|
notifying the plan of the insurer's desire to provide coverage |
|
2446
|
to applicants to the plan or existing insureds of the plan and |
|
2447
|
in describing the types of risks in which the insurer is |
|
2448
|
interested. The description of the desired risks must be on a |
|
2449
|
form developed by the plan. |
|
2450
|
b. Developing forms and procedures that provide an insurer |
|
2451
|
with the information necessary to determine whether the insurer |
|
2452
|
wants to write particular applicants to the plan or insureds of |
|
2453
|
the plan. |
|
2454
|
c. Developing procedures for notice to the plan and the |
|
2455
|
applicant to the plan or insured of the plan that an insurer |
|
2456
|
will insure the applicant or the insured of the plan, and notice |
|
2457
|
of the cost of the coverage offered; and developing procedures |
|
2458
|
for the selection of an insuring entity by the applicant or |
|
2459
|
insured of the plan. |
|
2460
|
d. Provide for a market-assistance plan to assist in the |
|
2461
|
placement of employers. All applications for coverage in the |
|
2462
|
plan received 45 days before the effective date for coverage |
|
2463
|
shall be processed through the market-assistance plan. A market- |
|
2464
|
assistance plan specifically designed to serve the needs of |
|
2465
|
small good policyholders as defined by the board must be |
|
2466
|
finalized by January 1, 1994. |
|
2467
|
5. Provide for policy and claims services to the insureds |
|
2468
|
of the plan of the nature and quality provided for insureds in |
|
2469
|
the voluntary market. |
|
2470
|
6. Provide for the review of applications for coverage |
|
2471
|
with the plan for reasonableness and accuracy, using any |
|
2472
|
available historic information regarding the insured. |
|
2473
|
7. Provide for procedures for auditing insureds of the |
|
2474
|
plan which are based on reasonable business judgment and are |
|
2475
|
designed to maximize the likelihood that the plan will collect |
|
2476
|
the appropriate premiums. |
|
2477
|
8. Authorize the plan to terminate the coverage of and |
|
2478
|
refuse future coverage for any insured that submits a fraudulent |
|
2479
|
application to the plan or provides fraudulent or grossly |
|
2480
|
erroneous records to the plan or to any service provider of the |
|
2481
|
plan in conjunction with the activities of the plan. |
|
2482
|
9. Establish service standards for agents who submit |
|
2483
|
business to the plan. |
|
2484
|
10. Establish criteria and procedures to prohibit any |
|
2485
|
agent who does not adhere to the established service standards |
|
2486
|
from placing business with the plan or receiving, directly or |
|
2487
|
indirectly, any commissions for business placed with the plan. |
|
2488
|
11. Provide for the establishment of reasonable safety |
|
2489
|
programs for all insureds in the plan. All insureds of the plan |
|
2490
|
must participate in the safety program.
|
|
2491
|
12. Authorize the plan to terminate the coverage of and |
|
2492
|
refuse future coverage to any insured who fails to pay premiums |
|
2493
|
or surcharges when due; who, at the time of application, is |
|
2494
|
delinquent in payments of workers' compensation or employer's |
|
2495
|
liability insurance premiums or surcharges owed to an insurer, |
|
2496
|
group self-insurers' fund, commercial self-insurance fund, or |
|
2497
|
assessable mutual insurer licensed to write such coverage in |
|
2498
|
this state; or who refuses to substantially comply with any |
|
2499
|
safety programs recommended by the plan. |
|
2500
|
13. Authorize the board of governors to provide the |
|
2501
|
services required by the plan through staff employed by the |
|
2502
|
plan, through reasonably compensated service providers who |
|
2503
|
contract with the plan to provide services as specified by the |
|
2504
|
board of governors, or through a combination of employees and |
|
2505
|
service providers. |
|
2506
|
14. Provide for service standards for service providers, |
|
2507
|
methods of determining adherence to those service standards, |
|
2508
|
incentives and disincentives for service, and procedures for |
|
2509
|
terminating contracts for service providers that fail to adhere |
|
2510
|
to service standards. |
|
2511
|
15. Provide procedures for selecting service providers and |
|
2512
|
standards for qualification as a service provider that |
|
2513
|
reasonably assure that any service provider selected will |
|
2514
|
continue to operate as an ongoing concern and is capable of |
|
2515
|
providing the specified services in the manner required. |
|
2516
|
16. Provide for reasonable accounting and data-reporting |
|
2517
|
practices. |
|
2518
|
17. Provide for annual review of costs associated with the |
|
2519
|
administration and servicing of the policies issued by the plan |
|
2520
|
to determine alternatives by which costs can be reduced. |
|
2521
|
18. Authorize the acquisition of such excess insurance or |
|
2522
|
reinsurance as is consistent with the purposes of the plan. |
|
2523
|
19. Provide for an annual report to the department on a |
|
2524
|
date specified by the department and containing such information |
|
2525
|
as the department reasonably requires. |
|
2526
|
20. Establish multiple rating plans for various |
|
2527
|
classifications of risk which reflect risk of loss, hazard |
|
2528
|
grade, actual losses, size of premium, and compliance with loss |
|
2529
|
control. At least one of such plans must be a preferred-rating |
|
2530
|
plan to accommodate small-premium policyholders with good |
|
2531
|
experience as defined in sub-subparagraph 22.a. |
|
2532
|
21. Establish agent commission schedules. |
|
2533
|
22. Establish fourthreesubplans as follows: |
|
2534
|
a. Subplan “A” must include those insureds whose annual |
|
2535
|
premium does not exceed $2,500 and who have neither incurred any |
|
2536
|
lost-time claims nor incurred medical-only claims exceeding 50 |
|
2537
|
percent of their premium for the immediate 2 years. |
|
2538
|
b. Subplan “B” must include insureds that are employers |
|
2539
|
identified by the board of governors as high-risk employers due |
|
2540
|
solely to the nature of the operations being performed by those |
|
2541
|
insureds and for whom no market exists in the voluntary market, |
|
2542
|
and whose experience modifications are less than 1.00. |
|
2543
|
c. Subplan “C” must include all otherinsureds within the |
|
2544
|
plan that are not eligible for subplan “A,” subplan “B,” or |
|
2545
|
subplan “D.” |
|
2546
|
d. Subplan “D” must include any employer with 50 or fewer |
|
2547
|
employees, except that an employer who is eligible for subplan |
|
2548
|
“D” and another subplan may elect the subplan in which it will |
|
2549
|
participate. The rate plan for subplan “D” shall be the same |
|
2550
|
rate plan as the plan approved under ss. 627.091-627.151, and |
|
2551
|
each participant in subplan “D” shall pay the premium determined |
|
2552
|
under such rate plan, plus a surcharge determined by the board |
|
2553
|
to be sufficient to ensure that the plan does not compete with |
|
2554
|
the voluntary market but not to exceed 25 percent.
|
|
2555
|
(d)1.The plan must be funded through actuarially sound |
|
2556
|
premiums charged to insureds of the plan. |
|
2557
|
2.The plan may issue assessable policies only to those |
|
2558
|
insureds in subplan “C.” and subplan “D.” Assessments levied |
|
2559
|
against subplan “C” participants shall cover only the excess |
|
2560
|
losses attributable to subplan “C,” and assessments levied |
|
2561
|
against subplan “D” participants shall cover only the excess |
|
2562
|
losses attributable to subplan “D.” In no event may the plan |
|
2563
|
levy assessments against any person or entity except as |
|
2564
|
authorized by this paragraph.Those assessable policies must be |
|
2565
|
clearly identified as assessable by containing, in contrasting |
|
2566
|
color and in not less than 10-point type, the following |
|
2567
|
statements: “This is an assessable policy. If the plan is unable |
|
2568
|
to pay its obligations, policyholders will be required to |
|
2569
|
contribute on a pro rata earned premium basis the money |
|
2570
|
necessary to meet any assessment levied.” |
|
2571
|
3.The plan may issue assessable policies with differing |
|
2572
|
terms and conditions to different groups within subplan “C” and |
|
2573
|
subplan “D”the planwhen a reasonable basis exists for the |
|
2574
|
differentiation. |
|
2575
|
4.The plan may offer rating, dividend plans, and other |
|
2576
|
plans to encourage loss prevention programs. |
|
2577
|
Section 24. Paragraphs (c) and (e) of Subsection (3) of |
|
2578
|
section 921.0022, Florida Statutes, are amended to read: |
|
2579
|
921.0022 Criminal Punishment Code; offense severity |
|
2580
|
ranking chart.-- |
|
2581
|
(3) OFFENSE SEVERITY RANKING CHART |
|
2582
|
| FloridaStatute | FelonyDegree | Description |
|
|
2583
|
|
|
2584
|
| 316.193(2)(b) | 3rd | Felony DUI, 3rd conviction. |
|
|
2585
|
| 316.1935(2) | 3rd | Fleeing or attempting to elude law enforcement officer in marked patrol vehicle with siren and lights activated. |
|
|
2586
|
| 319.30(4) | 3rd | Possession by junkyard of motor vehicle with identification number plate removed. |
|
|
2587
|
| 319.33(1)(a) | 3rd | Alter or forge any certificate of title to a motor vehicle or mobile home. |
|
|
2588
|
| 319.33(1)(c) | 3rd | Procure or pass title on stolen vehicle. |
|
|
2589
|
| 319.33(4) | 3rd | With intent to defraud, possess, sell, etc., a blank, forged, or unlawfully obtained title or registration. |
|
|
2590
|
| 327.35(2)(b) | 3rd | Felony BUI. |
|
|
2591
|
| 328.05(2) | 3rd | Possess, sell, or counterfeit fictitious, stolen, or fraudulent titles or bills of sale of vessels. |
|
|
2592
|
| 328.07(4) | 3rd | Manufacture, exchange, or possess vessel with counterfeit or wrong ID number. |
|
|
2593
|
| 376.302(5) | 3rd | Fraud related to reimbursement for cleanup expenses under the Inland Protection Trust Fund. |
|
|
2594
|
| 440.105(3)(a) | 3rd | Failure to update workers’ compensation insurance coverage application or to post notice of coverage. |
|
|
2595
|
| 440.105(3)(b) | 3rd | Receipt of fee or consideration without approval by judge of compensation claims. |
|
|
2596
|
| 440.1051(3) | 3rd | False report of workers’ compensation fraud or retaliation for making such a report. |
|
|
2597
|
| 697.08 | 3rd | Equity skimming. |
|
|
2598
|
| 790.15(3) | 3rd | Person directs another to discharge firearm from a vehicle. |
|
|
2599
|
| 796.05(1) | 3rd | Live on earnings of a prostitute. |
|
|
2600
|
| 806.10(1) | 3rd | Maliciously injure, destroy, or interfere with vehicles or equipment used in firefighting. |
|
|
2601
|
| 806.10(2) | 3rd | Interferes with or assaults firefighter in performance of duty. |
|
|
2602
|
| 810.09(2)(c) | 3rd | Trespass on property other than structure or conveyance armed with firearm or dangerous weapon. |
|
|
2603
|
| 812.014(2)(c)2. | 3rd | Grand theft; $5,000 or more but less than $10,000. |
|
|
2604
|
| 812.0145(2)(c) | 3rd | Theft from person 65 years of age or older; $300 or more but less than $10,000. |
|
|
2605
|
| 815.04(4)(b) | 2nd | Computer offense devised to defraud or obtain property. |
|
|
2606
|
| 817.034(4)(a)3. | 3rd | Engages in scheme to defraud (Florida Communications Fraud Act), property valued at less than $20,000. |
|
|
2607
|
| 817.233 | 3rd | Burning to defraud insurer. |
|
|
2608
|
| 817.234(8)&(9) | 3rd | Unlawful solicitation of persons involved in motor vehicle accidents. |
|
|
2609
|
| 817.234(11)(a) | 3rd | Insurance fraud; property value less than $20,000. |
|
|
2610
|
| 817.505(4) | 3rd | Patient brokering. |
|
|
2611
|
| 828.12(2) | 3rd | Tortures any animal with intent to inflict intense pain, serious physical injury, or death. |
|
|
2612
|
| 831.28(2)(a) | 3rd | Counterfeiting a payment instrument with intent to defraud or possessing a counterfeit payment instrument. |
|
|
2613
|
| 831.29 | 2nd | Possession of instruments for counterfeiting drivers' licenses or identification cards. |
|
|
2614
|
| 838.021(3)(b) | 3rd | Threatens unlawful harm to public servant. |
|
|
2615
|
| 843.19 | 3rd | Injure, disable, or kill police dog or horse. |
|
|
2616
|
| 870.01(2) | 3rd | Riot; inciting or encouraging. |
|
|
2617
|
| 893.13(1)(a)2. | 3rd | Sell, manufacture, or deliver cannabis (or other s. 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)5., (2)(c)6., (2)(c)7., (2)(c)8., (2)(c)9., (3), or (4) drugs). |
|
|
2618
|
| 893.13(1)(d)2. | 2nd | Sell, manufacture, or deliver s. 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)5., (2)(c)6., (2)(c)7., (2)(c)8., (2)(c)9., (3), or (4) drugs within 200 feet of university or public park. |
|
|
2619
|
| 893.13(1)(f)2. | 3rd | Sell, manufacture, or deliver s. 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)5., (2)(c)6., (2)(c)7., (2)(c)8., (2)(c)9., (3), or (4) drugs within 200 feet of public housing facility. |
|
|
2620
|
| 893.13(6)(a) | 3rd | Possession of any controlled substance other than felony possession of cannabis. |
|
|
2621
|
| 893.13(7)(a)8. | 3rd | Withhold information from practitioner regarding previous receipt of or prescription for a controlled substance. |
|
|
2622
|
| 893.13(7)(a)9. | 3rd | Obtain or attempt to obtain controlled substance by fraud, forgery, misrepresentation, etc. |
|
|
2623
|
| 893.13(7)(a)10. | 3rd | Affix false or forged label to package of controlled substance. |
|
|
2624
|
| 893.13(7)(a)11. | 3rd | Furnish false or fraudulent material information on any document or record required by chapter 893. |
|
|
2625
|
| 893.13(8)(a)1. | 3rd | Knowingly assist a patient, other person, or owner of an animal in obtaining a controlled substance through deceptive, untrue, or fraudulent representations in or related to the practitioner's practice. |
|
|
2626
|
| 893.13(8)(a)2. | 3rd | Employ a trick or scheme in the practitioner's practice to assist a patient, other person, or owner of an animal in obtaining a controlled substance. |
|
|
2627
|
| 893.13(8)(a)3. | 3rd | Knowingly write a prescription for a controlled substance for a fictitious person. |
|
|
2628
|
| 893.13(8)(a)4. | 3rd | Write a prescription for a controlled substance for a patient, other person, or an animal if the sole purpose of writing the prescription is a monetary benefit for the practitioner. |
|
|
2629
|
| 918.13(1)(a) | 3rd | Alter, destroy, or conceal investigation evidence. |
|
|
2630
|
| 944.47(1)(a)1.-2. | 3rd | Introduce contraband to correctional facility. |
|
|
2631
|
| 944.47(1)(c) | 2nd | Possess contraband while upon the grounds of a correctional institution. |
|
|
2632
|
| 985.3141 | 3rd | Escapes from a juvenile facility (secure detention or residential commitment facility). |
|
|
2633
|
|
|
2634
|
| 316.027(1)(a) | 3rd | Accidents involving personal injuries, failure to stop; leaving scene. |
|
|
2635
|
| 316.1935(4) | 2nd | Aggravated fleeing or eluding. |
|
|
2636
|
| 322.34(6) | 3rd | Careless operation of motor vehicle with suspended license, resulting in death or serious bodily injury. |
|
|
2637
|
| 327.30(5) | 3rd | Vessel accidents involving personal injury; leaving scene. |
|
|
2638
|
| 381.0041(11)(b) | 3rd | Donate blood, plasma, or organs knowing HIV positive. |
|
|
2639
|
| 440.105(5) | 2nd | Unlawful solicitation for the purpose of making workers' compensation claims. |
|
|
2640
|
| 440.381(2) | 2nd | Submission of information with the purpose of avoiding or reducing workers’ compensation premiums. |
|
|
2641
|
| 790.01(2) | 3rd | Carrying a concealed firearm. |
|
|
2642
|
| 790.162 | 2nd | Threat to throw or discharge destructive device. |
|
|
2643
|
| 790.163(1) | 2nd | False report of deadly explosive or weapon of mass destruction. |
|
|
2644
|
| 790.221(1) | 2nd | Possession of short-barreled shotgun or machine gun. |
|
|
2645
|
| 790.23 | 2nd | Felons in possession of firearms or electronic weapons or devices. |
|
|
2646
|
| 800.04(6)(c) | 3rd | Lewd or lascivious conduct; offender less than 18 years. |
|
|
2647
|
| 800.04(7)(c) | 2nd | Lewd or lascivious exhibition; offender 18 years or older. |
|
|
2648
|
| 806.111(1) | 3rd | Possess, manufacture, or dispense fire bomb with intent to damage any structure or property. |
|
|
2649
|
| 812.0145(2)(b) | 2nd | Theft from person 65 years of age or older; $10,000 or more but less than $50,000. |
|
|
2650
|
| 812.015(8) | 3rd | Retail theft; property stolen is valued at $300 or more and one or more specified acts. |
|
|
2651
|
| 812.019(1) | 2nd | Stolen property; dealing in or trafficking in. |
|
|
2652
|
| 812.131(2)(b) | 3rd | Robbery by sudden snatching. |
|
|
2653
|
| 812.16(2) | 3rd | Owning, operating, or conducting a chop shop. |
|
|
2654
|
| 817.034(4)(a)2. | 2nd | Communications fraud, value $20,000 to $50,000. |
|
|
2655
|
| 817.234(11)(b) | 2nd | Insurance fraud; property value $20,000 or more but less than $100,000. |
|
|
2656
|
| 817.568(2)(b) | 2nd | Fraudulent use of personal identification information; value of benefit, services received, payment avoided, or amount of injury or fraud, $75,000 or more. |
|
|
2657
|
| 817.625(2)(b) | 2nd | Second or subsequent fraudulent use of scanning device or reencoder. |
|
|
2658
|
| 825.1025(4) | 3rd | Lewd or lascivious exhibition in the presence of an elderly person or disabled adult. |
|
|
2659
|
| 827.071(4) | 2nd | Possess with intent to promote any photographic material, motion picture, etc., which includes sexual conduct by a child. |
|
|
2660
|
| 839.13(2)(b) | 2nd | Falsifying records of an individual in the care and custody of a state agency involving great bodily harm or death. |
|
|
2661
|
| 843.01 | 3rd | Resist officer with violence to person; resist arrest with violence. |
|
|
2662
|
| 874.05(2) | 2nd | Encouraging or recruiting another to join a criminal street gang; second or subsequent offense. |
|
|
2663
|
| 893.13(1)(a)1. | 2nd | Sell, manufacture, or deliver cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs). |
|
|
2664
|
| 893.13(1)(c)2. | 2nd | Sell, manufacture, or deliver cannabis (or other s. 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)5., (2)(c)6., (2)(c)7., (2)(c)8., (2)(c)9., (3), or (4) drugs) within 1,000 feet of a child care facility or school. |
|
|
2665
|
| 893.13(1)(d)1. | 1st | Sell, manufacture, or deliver cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs) within 200 feet of university or public park. |
|
|
2666
|
| 893.13(1)(e)2. | 2nd | Sell, manufacture, or deliver cannabis or other drug prohibited under s. 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)5., (2)(c)6., (2)(c)7., (2)(c)8., (2)(c)9., (3), or (4) within 1,000 feet of property used for religious services or a specified business site. |
|
|
2667
|
| 893.13(1)(f)1. | 1st | Sell, manufacture, or deliver cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), or (2)(a), (2)(b), or (2)(c)4. drugs) within 200 feet of public housing facility. |
|
|
2668
|
| 893.13(4)(b) | 2nd | Deliver to minor cannabis (or other s. 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)5., (2)(c)6., (2)(c)7., (2)(c)8., (2)(c)9., (3), or (4) drugs). |
|
|
2669
|
Section 25. Report to the Legislature regarding |
|
2670
|
outstanding enforcement issues.--The Department of Financial |
|
2671
|
Services shall, no later than January 1, 2004, provide a report |
|
2672
|
to the President of the Senate, the Speaker of the House of |
|
2673
|
Representatives, the minority leaders of the Senate and the |
|
2674
|
House of Representatives, and the chairs of the standing |
|
2675
|
committees of the Senate and the House of Representatives having |
|
2676
|
jurisdiction over insurance issues, containing the following |
|
2677
|
information:
|
|
2678
|
(1) Any provision of chapter 440, Florida Statutes, |
|
2679
|
relating to workers’ compensation carrier compliance and |
|
2680
|
enforcement, that the department finds it is unable to enforce. |
|
2681
|
(2) Any administrative rule relating to workers’ |
|
2682
|
compensation carrier compliance and enforcement that the |
|
2683
|
department finds it is unable to enforce.
|
|
2684
|
(3) Any other impediment to enforcement of chapter 440, |
|
2685
|
Florida Statutes, resulting from the transfer of activities from |
|
2686
|
the former Department of Labor and Employment Security to the |
|
2687
|
department or the reorganization of the former Department of |
|
2688
|
Insurance into the department.
|
|
2689
|
Section 26. Except as otherwise provided herein, this act |
|
2690
|
shall take effect upon becoming a law. |