Florida Senate - 2013 SB 860
By Senator Galvano
26-00623-13 2013860__
1 A bill to be entitled
2 An act relating to workers’ compensation system
3 administration; amending s. 284.44, F.S.; revising
4 duties of state agencies covered by the state risk
5 management program with respect to funding costs for
6 employees entitled to workers’ compensation benefits;
7 revising a definition; revising terminology; amending
8 s. 440.02, F.S.; revising a definition; amending s.
9 440.05, F.S.; revising requirements relating to
10 submitting notice of election of exemption; amending
11 s. 440.102, F.S.; conforming a cross-reference;
12 amending s. 440.107, F.S.; revising effectiveness of
13 stop-work orders and penalty assessment orders;
14 amending s. 440.11, F.S.; revising immunity from
15 liability standards for employers and employees using
16 a help supply services company; amending s. 440.13,
17 F.S.; deleting and revising definitions; revising
18 health care provider requirements and
19 responsibilities; deleting rulemaking authority and
20 responsibilities of the Department of Financial
21 Services; revising provider reimbursement dispute
22 procedures; revising penalties for certain violations
23 or overutilization of treatment; deleting certain
24 Office of Insurance Regulation audit requirements;
25 deleting provisions providing for removal of
26 physicians from lists of those authorized to render
27 medical care under certain conditions; amending s.
28 440.15, F.S.; revising limitations on compensation for
29 temporary total disability; amending s. 440.185, F.S.;
30 revising and deleting penalties for noncompliance
31 relating to duty of employer upon receipt of notice of
32 injury or death; amending s. 440.20, F.S.;
33 transferring certain responsibilities of the office to
34 the department; deleting certain responsibilities of
35 the department; amending s. 440.211, F.S.; deleting a
36 requirement that a provision that is mutually agreed
37 upon in any collective bargaining agreement be filed
38 with the department; amending s. 440.385, F.S.;
39 conforming cross-references; amending s. 440.491,
40 F.S.; revising certain carrier reporting requirements;
41 revising duties of the department upon referral of an
42 injured employee; providing effective dates.
43
44 Be It Enacted by the Legislature of the State of Florida:
45
46 Section 1. Effective October 1, 2013, section 284.44,
47 Florida Statutes, is amended to read:
48 284.44 Medical care and salary indemnification costs of
49 state agencies.—
50 (1) It is the intent of the Legislature, through the
51 implementation of this section, to provide state agencies with
52 an increased incentive to become actively involved in the
53 prevention and management of workers’ compensation claims
54 involving state employees.
55 (2) State agencies covered by the state risk management
56 program established under this part shall be responsible for
57 funding an amount equal to 1.5 percent of all medical care and
58 initial salary indemnification costs, for employees who are
59 entitled to workers’ compensation benefits pursuant to chapter
60 440, from funds appropriated to pay salaries and benefits.
61 (3) For the purposes of this section, “medical care and
62 salary indemnification costs” means the payments made to
63 employees for their medical care for work-related injuries or as
64 indemnification for costs resulting from work-related injuries
65 temporary total disability benefits. After an employee has been
66 eligible for disability benefits for 10 weeks, salary
67 indemnification costs shall be funded from the State Risk
68 Management Trust Fund in accordance with the provisions of this
69 part for those agencies insured by the fund.
70 (4) For the purpose of administering this section, the
71 Division of Risk Management of the Department of Financial
72 Services shall continue to pay all claims, but shall be
73 periodically reimbursed from funds of state agencies for medical
74 care and initial salary indemnification costs for which they are
75 responsible. The amount of reimbursement due from each agency
76 shall be calculated quarterly and billed to the agency. The
77 amount due shall be 1.5 percent of all medical care and
78 indemnification costs paid for agency workers’ compensation
79 claims during the quarterly billing period.
80 (5) If a state agency demonstrates to the Executive Office
81 of the Governor and the chairs of the legislative appropriations
82 committees that no funds are available to pay medical care and
83 initial salary indemnification costs for a specific quarterly
84 billing period claim pursuant to this section without adversely
85 impacting its ability to perform statutory responsibilities, the
86 Executive Office of the Governor may direct the Division of Risk
87 Management to fund all medical care and salary indemnification
88 costs for that specific quarterly billing period claim from the
89 State Risk Management Trust Fund and waive the state agency
90 reimbursement requirement.
91 (6) The Division of Risk Management shall prepare quarterly
92 reports to the Executive Office of the Governor and the chairs
93 of the legislative appropriations committees indicating for each
94 state agency the total amount of medical care and salary
95 indemnification benefits paid to claimants and the total amount
96 of reimbursements from state agencies to the State Risk
97 Management Trust Fund for initial costs for the previous
98 quarter. These reports shall also include information for each
99 state agency indicating the number of cases and amounts of
100 initial salary indemnification costs for which reimbursement
101 requirements were waived by the Executive Office of the Governor
102 pursuant to this section.
103 (7) If a state agency fails to pay casualty increase
104 premiums or medical care and salary indemnification
105 reimbursements within 30 days after being billed, the Division
106 of Risk Management shall advise the Chief Financial Officer.
107 After verifying the accuracy of the billing, the Chief Financial
108 Officer shall transfer the appropriate amount from any available
109 funds of the delinquent state agency to the State Risk
110 Management Trust Fund.
111 Section 2. Subsection (8) of section 440.02, Florida
112 Statutes, is amended to read:
113 440.02 Definitions.—When used in this chapter, unless the
114 context clearly requires otherwise, the following terms shall
115 have the following meanings:
116 (8) “Construction industry” means for-profit activities
117 involving any building, clearing, filling, excavation, or
118 substantial improvement in the size or use of any structure or
119 the appearance of any land. However, “construction” does not
120 mean a homeowner’s act of construction or the result of a
121 construction upon his or her own premises, provided such
122 premises are not intended to be sold, resold, or leased by the
123 owner within 1 year after the commencement of construction. The
124 division may, by rule, establish standard industrial
125 classification codes and definitions thereof that which meet the
126 criteria of the term “construction industry” as set forth in
127 this section.
128 Section 3. Subsection (3) of section 440.05, Florida
129 Statutes, is amended to read:
130 440.05 Election of exemption; revocation of election;
131 notice; certification.—
132 (3) Each officer of a corporation who is engaged in the
133 construction industry and who elects an exemption from this
134 chapter or who, after electing such exemption, revokes that
135 exemption, must submit a notice to such effect to the department
136 on a form prescribed by the department. The notice of election
137 to be exempt must be which is electronically submitted to the
138 department by the officer of a corporation who is allowed to
139 claim an exemption as provided by this chapter and must list the
140 name, federal tax identification number, date of birth, Florida
141 driver license number or Florida identification card number, and
142 all certified or registered licenses issued pursuant to chapter
143 489 held by the person seeking the exemption, the registration
144 number of the corporation filed with the Division of
145 Corporations of the Department of State, and the percentage of
146 ownership evidencing the required ownership under this chapter.
147 The notice of election to be exempt must identify each
148 corporation that employs the person electing the exemption and
149 must list the social security number or federal tax
150 identification number of each such employer and the additional
151 documentation required by this section. In addition, the notice
152 of election to be exempt must provide that the officer electing
153 an exemption is not entitled to benefits under this chapter,
154 must provide that the election does not exceed exemption limits
155 for officers provided in s. 440.02, and must certify that any
156 employees of the corporation whose officer elects an exemption
157 are covered by workers’ compensation insurance. Upon receipt of
158 the notice of the election to be exempt, receipt of all
159 application fees, and a determination by the department that the
160 notice meets the requirements of this subsection, the department
161 shall issue a certification of the election to the officer,
162 unless the department determines that the information contained
163 in the notice is invalid. The department shall revoke a
164 certificate of election to be exempt from coverage upon a
165 determination by the department that the person does not meet
166 the requirements for exemption or that the information contained
167 in the notice of election to be exempt is invalid. The
168 certificate of election must list the name of the corporation
169 listed in the request for exemption. A new certificate of
170 election must be obtained each time the person is employed by a
171 new or different corporation that is not listed on the
172 certificate of election. A copy of the certificate of election
173 must be sent to each workers’ compensation carrier identified in
174 the request for exemption. Upon filing a notice of revocation of
175 election, an officer who is a subcontractor or an officer of a
176 corporate subcontractor must notify her or his contractor. Upon
177 revocation of a certificate of election of exemption by the
178 department, the department shall notify the workers’
179 compensation carriers identified in the request for exemption.
180 Section 4. Paragraph (p) of subsection (5) of section
181 440.102, Florida Statutes, is amended to read:
182 440.102 Drug-free workplace program requirements.—The
183 following provisions apply to a drug-free workplace program
184 implemented pursuant to law or to rules adopted by the Agency
185 for Health Care Administration:
186 (5) PROCEDURES AND EMPLOYEE PROTECTION.—All specimen
187 collection and testing for drugs under this section shall be
188 performed in accordance with the following procedures:
189 (p) All authorized remedial treatment, care, and attendance
190 provided by a health care provider to an injured employee before
191 medical and indemnity benefits are denied under this section
192 must be paid for by the carrier or self-insurer. However, the
193 carrier or self-insurer must have given reasonable notice to all
194 affected health care providers that payment for treatment, care,
195 and attendance provided to the employee after a future date
196 certain will be denied. A health care provider, as defined in s.
197 440.13(1)(g) 440.13(1)(h), that refuses, without good cause, to
198 continue treatment, care, and attendance before the provider
199 receives notice of benefit denial commits a misdemeanor of the
200 second degree, punishable as provided in s. 775.082 or s.
201 775.083.
202 Section 5. Paragraph (b) of subsection (7) of section
203 440.107, Florida Statutes, is amended to read:
204 440.107 Department powers to enforce employer compliance
205 with coverage requirements.—
206 (7)
207 (b) Stop-work orders and penalty assessment orders issued
208 under this section against a corporation, limited liability
209 company, partnership, or sole proprietorship shall be in effect
210 against any successor corporation or business entity that has
211 one or more of the same principals or officers as the
212 corporation, limited liability company, or partnership against
213 which the stop-work order was issued and are engaged in the same
214 or equivalent trade or activity.
215 Section 6. Subsection (2) of section 440.11, Florida
216 Statutes, is amended to read:
217 440.11 Exclusiveness of liability.—
218 (2) The immunity from liability described in subsection (1)
219 shall extend to an employer and to each employee of the employer
220 which uses utilizes the services of the employees of a help
221 supply services company, as set forth in North American
222 Industrial Classification System Codes 561320 and 561330
223 Standard Industry Code Industry Number 7363, when such
224 employees, whether management or staff, are acting in
225 furtherance of the employer’s business. An employee so engaged
226 by the employer shall be considered a borrowed employee of the
227 employer, and, for the purposes of this section, shall be
228 treated as any other employee of the employer. The employer
229 shall be liable for and shall secure the payment of compensation
230 to all such borrowed employees as required in s. 440.10, except
231 when such payment has been secured by the help supply services
232 company.
233 Section 7. Paragraphs (e) through (t) of subsection (1) of
234 section 440.13, Florida Statutes, are redesignated as paragraphs
235 (d) through (s), respectively, subsections (14) through (17) are
236 renumbered as subsections (13) through (16), respectively, and
237 present paragraphs (h) and (q) of subsection (1), paragraphs
238 (a), (c), (e), and (i) of subsection (3), subsection (7),
239 paragraph (b) of subsection (8), paragraph (b) of subsection
240 (11), paragraph (e) of subsection (12), and present subsections
241 (13) and (14) of that section are amended to read:
242 440.13 Medical services and supplies; penalty for
243 violations; limitations.—
244 (1) DEFINITIONS.—As used in this section, the term:
245 (d) “Certified health care provider” means a health care
246 provider who has been certified by the department or who has
247 entered an agreement with a licensed managed care organization
248 to provide treatment to injured workers under this section.
249 Certification of such health care provider must include
250 documentation that the health care provider has read and is
251 familiar with the portions of the statute, impairment guides,
252 practice parameters, protocols of treatment, and rules which
253 govern the provision of remedial treatment, care, and
254 attendance.
255 (g)(h) “Health care provider” means a physician or any
256 recognized practitioner licensed to provide who provides skilled
257 services pursuant to a prescription or under the supervision or
258 direction of a physician and who has been certified by the
259 department as a health care provider. The term “health care
260 provider” includes a health care facility.
261 (p)(q) “Physician” or “doctor” means a physician licensed
262 under chapter 458, an osteopathic physician licensed under
263 chapter 459, a chiropractic physician licensed under chapter
264 460, a podiatric physician licensed under chapter 461, an
265 optometrist licensed under chapter 463, or a dentist licensed
266 under chapter 466, each of whom must be certified by the
267 department as a health care provider.
268 (3) PROVIDER ELIGIBILITY; AUTHORIZATION.—
269 (a) As a condition to eligibility for payment under this
270 chapter, a health care provider who renders services must be a
271 certified health care provider and must receive authorization
272 from the carrier before providing treatment. This paragraph does
273 not apply to emergency care. The department shall adopt rules to
274 implement the certification of health care providers.
275 (c) A health care provider may not refer the employee to
276 another health care provider, diagnostic facility, therapy
277 center, or other facility without prior authorization from the
278 carrier, except when emergency care is rendered. Any referral
279 must be to a health care provider that has been certified by the
280 department, unless the referral is for emergency treatment, and
281 the referral must be made in accordance with practice parameters
282 and protocols of treatment as provided for in this chapter.
283 (e) Carriers shall adopt procedures for receiving,
284 reviewing, documenting, and responding to requests for
285 authorization. Such procedures shall be for a health care
286 provider certified under this section.
287 (i) Notwithstanding paragraph (d), a claim for specialist
288 consultations, surgical operations, physiotherapeutic or
289 occupational therapy procedures, X-ray examinations, or special
290 diagnostic laboratory tests that cost more than $1,000 and other
291 specialty services that the department identifies by rule is not
292 valid and reimbursable unless the services have been expressly
293 authorized by the carrier, or unless the carrier has failed to
294 respond within 10 days to a written request for authorization,
295 or unless emergency care is required. The insurer shall
296 authorize such consultation or procedure unless the health care
297 provider or facility is not authorized or certified, unless such
298 treatment is not in accordance with practice parameters and
299 protocols of treatment established in this chapter, or unless a
300 judge of compensation claims has determined that the
301 consultation or procedure is not medically necessary, not in
302 accordance with the practice parameters and protocols of
303 treatment established in this chapter, or otherwise not
304 compensable under this chapter. Authorization of a treatment
305 plan does not constitute express authorization for purposes of
306 this section, except to the extent the carrier provides
307 otherwise in its authorization procedures. This paragraph does
308 not limit the carrier’s obligation to identify and disallow
309 overutilization or billing errors.
310 (7) UTILIZATION AND REIMBURSEMENT DISPUTES.—
311 (a) Any health care provider, carrier, or employer who
312 elects to contest the disallowance or adjustment of payment by a
313 carrier under subsection (6) must, within 45 30 days after
314 receipt of notice of disallowance or adjustment of payment,
315 petition the department to resolve the dispute. The health care
316 provider petitioner must serve a copy of the petition on the
317 carrier and on all affected parties by certified mail. The
318 petition must be accompanied by all documents and records that
319 support the allegations contained in the petition. Failure of a
320 health care provider petitioner to submit such documentation to
321 the department results in dismissal of the petition.
322 (b) The carrier must submit to the department within 30 10
323 days after receipt of the petition all documentation
324 substantiating the carrier’s disallowance or adjustment. Failure
325 of the carrier to timely submit such the requested documentation
326 to the department within 30 10 days constitutes a waiver of all
327 objections to the petition.
328 (c) Within 120 60 days after receipt of all documentation,
329 the department must provide to the health care provider
330 petitioner, the carrier, and the affected parties a written
331 determination of whether the carrier properly adjusted or
332 disallowed payment. The department must be guided by standards
333 and policies set forth in this chapter, including all applicable
334 reimbursement schedules, practice parameters, and protocols of
335 treatment, in rendering its determination.
336 (d) If the department finds an improper disallowance or
337 improper adjustment of payment by an insurer, the insurer shall
338 reimburse the health care provider, facility, insurer, or
339 employer within 30 days, subject to the penalties provided in
340 this subsection.
341 (e) The department shall adopt rules to carry out this
342 subsection. The rules may include provisions for consolidating
343 petitions filed by a health care provider petitioner and
344 expanding the timetable for rendering a determination upon a
345 consolidated petition.
346 (f) Any carrier that engages in a pattern or practice of
347 arbitrarily or unreasonably disallowing or reducing payments to
348 health care providers may be subject to one or more of the
349 following penalties imposed by the department:
350 1. Repayment of the appropriate amount to the health care
351 provider.
352 2. An administrative fine assessed by the department in an
353 amount not to exceed $5,000 per instance of improperly
354 disallowing or reducing payments.
355 3. Award of the health care provider’s costs, including a
356 reasonable attorney attorney’s fee, for prosecuting the
357 petition.
358 (8) PATTERN OR PRACTICE OF OVERUTILIZATION.—
359 (b) If the department determines that a health care
360 provider has engaged in a pattern or practice of overutilization
361 or a violation of this chapter or rules adopted by the
362 department, including a pattern or practice of providing
363 treatment in excess of the practice parameters or protocols of
364 treatment, it may impose one or more of the following penalties:
365 1. An order of the department barring the provider from
366 payment under this chapter;
367 2. Deauthorization of care under review;
368 3. Denial of payment for care rendered in the future;
369 4. Decertification of a health care provider certified as
370 an expert medical advisor under subsection (9) or of a
371 rehabilitation provider certified under s. 440.49;
372 4.5. An administrative fine of assessed by the department
373 in an amount not to exceed $5,000 per instance of
374 overutilization or violation; and
375 5.6. Notification of and review by the appropriate
376 licensing authority pursuant to s. 440.106(3).
377 (11) AUDITS.—
378 (b) The department shall monitor carriers as provided in
379 this chapter and the Office of Insurance Regulation shall audit
380 insurers and group self-insurance funds as provided in s.
381 624.3161, to determine if medical bills are paid in accordance
382 with this section and rules of the department and Financial
383 Services Commission, respectively. Any employer, if self
384 insured, or carrier found by the department or Office of
385 Insurance Regulation not to be within 90 percent compliance as
386 to the payment of medical bills after July 1, 1994, must be
387 assessed a fine not to exceed 1 percent of the prior year’s
388 assessment levied against such entity under s. 440.51 for every
389 quarter in which the entity fails to attain 90-percent
390 compliance. The department shall fine or otherwise discipline an
391 employer or carrier, pursuant to this chapter or rules adopted
392 by the department, and the Office of Insurance Regulation shall
393 fine or otherwise discipline an insurer or group self-insurance
394 fund pursuant to the insurance code or rules adopted by the
395 Financial Services Commission, for each late payment of
396 compensation that is below the minimum 95-percent performance
397 standard. Any carrier that is found to be not in compliance in
398 subsequent consecutive quarters must implement a medical-bill
399 review program approved by the department or office, and an
400 insurer or group self-insurance fund is subject to disciplinary
401 action by the Office of Insurance Regulation.
402 (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
403 REIMBURSEMENT ALLOWANCES.—
404 (e) In addition to establishing the uniform schedule of
405 maximum reimbursement allowances, the panel shall:
406 1. Take testimony, receive records, and collect data to
407 evaluate the adequacy of the workers’ compensation fee schedule,
408 nationally recognized fee schedules and alternative methods of
409 reimbursement to certified health care providers and health care
410 facilities for inpatient and outpatient treatment and care.
411 2. Survey certified health care providers and health care
412 facilities to determine the availability and accessibility of
413 workers’ compensation health care delivery systems for injured
414 workers.
415 3. Survey carriers to determine the estimated impact on
416 carrier costs and workers’ compensation premium rates by
417 implementing changes to the carrier reimbursement schedule or
418 implementing alternative reimbursement methods.
419 4. Submit recommendations on or before January 1, 2003, and
420 biennially thereafter, to the President of the Senate and the
421 Speaker of the House of Representatives on methods to improve
422 the workers’ compensation health care delivery system.
423
424 The department, as requested, shall provide data to the panel,
425 including, but not limited to, utilization trends in the
426 workers’ compensation health care delivery system. The
427 department shall provide the panel with an annual report
428 regarding the resolution of medical reimbursement disputes and
429 any actions pursuant to subsection (8). The department shall
430 provide administrative support and service to the panel to the
431 extent requested by the panel.
432 (13) REMOVAL OF PHYSICIANS FROM LISTS OF THOSE AUTHORIZED
433 TO RENDER MEDICAL CARE.—The department shall remove from the
434 list of physicians or facilities authorized to provide remedial
435 treatment, care, and attendance under this chapter the name of
436 any physician or facility found after reasonable investigation
437 to have:
438 (a) Engaged in professional or other misconduct or
439 incompetency in connection with medical services rendered under
440 this chapter;
441 (b) Exceeded the limits of his or her or its professional
442 competence in rendering medical care under this chapter, or to
443 have made materially false statements regarding his or her or
444 its qualifications in his or her application;
445 (c) Failed to transmit copies of medical reports to the
446 employer or carrier, or failed to submit full and truthful
447 medical reports of all his or her or its findings to the
448 employer or carrier as required under this chapter;
449 (d) Solicited, or employed another to solicit for himself
450 or herself or itself or for another, professional treatment,
451 examination, or care of an injured employee in connection with
452 any claim under this chapter;
453 (e) Refused to appear before, or to answer upon request of,
454 the department or any duly authorized officer of the state, any
455 legal question, or to produce any relevant book or paper
456 concerning his or her conduct under any authorization granted to
457 him or her under this chapter;
458 (f) Self-referred in violation of this chapter or other
459 laws of this state; or
460 (g) Engaged in a pattern of practice of overutilization or
461 a violation of this chapter or rules adopted by the department,
462 including failure to adhere to practice parameters and protocols
463 established in accordance with this chapter.
464 (13)(14) PAYMENT OF MEDICAL FEES.—
465 (a) Except for emergency care treatment, fees for medical
466 services are payable only to a health care provider certified
467 and authorized to render remedial treatment, care, or attendance
468 under this chapter. Carriers shall pay, disallow, or deny
469 payment to health care providers in the manner and at times set
470 forth in this chapter. A health care provider may not collect or
471 receive a fee from an injured employee within this state, except
472 as otherwise provided by this chapter. Such providers have
473 recourse against the employer or carrier for payment for
474 services rendered in accordance with this chapter. Payment to
475 health care providers or physicians shall be subject to the
476 medical fee schedule and applicable practice parameters and
477 protocols, regardless of whether the health care provider or
478 claimant is asserting that the payment should be made.
479 (b) Fees charged for remedial treatment, care, and
480 attendance, except for independent medical examinations and
481 consensus independent medical examinations, may not exceed the
482 applicable fee schedules adopted under this chapter and
483 department rule. Notwithstanding any other provision in this
484 chapter, if a physician or health care provider specifically
485 agrees in writing to follow identified procedures aimed at
486 providing quality medical care to injured workers at reasonable
487 costs, deviations from established fee schedules shall be
488 permitted. Written agreements warranting deviations may include,
489 but are not limited to, the timely scheduling of appointments
490 for injured workers, participating in return-to-work programs
491 with injured workers’ employers, expediting the reporting of
492 treatments provided to injured workers, and agreeing to
493 continuing education, utilization review, quality assurance,
494 precertification, and case management systems that are designed
495 to provide needed treatment for injured workers.
496 (c) Notwithstanding any other provision of this chapter,
497 following overall maximum medical improvement from an injury
498 compensable under this chapter, the employee is obligated to pay
499 a copayment of $10 per visit for medical services. The copayment
500 shall not apply to emergency care provided to the employee.
501 Section 8. Paragraph (b) of subsection (2) of section
502 440.15, Florida Statutes, is amended to read:
503 440.15 Compensation for disability.—Compensation for
504 disability shall be paid to the employee, subject to the limits
505 provided in s. 440.12(2), as follows:
506 (2) TEMPORARY TOTAL DISABILITY.—
507 (b) Notwithstanding the provisions of paragraph (a), an
508 employee who has sustained the loss of an arm, leg, hand, or
509 foot, has been rendered a paraplegic, paraparetic, quadriplegic,
510 or quadriparetic, or has lost the sight of both eyes shall be
511 paid temporary total disability of 80 percent of her or his
512 average weekly wage. The increased temporary total disability
513 compensation provided for in this paragraph must not extend
514 beyond 6 months from the date of the accident; however, such
515 benefits shall not be due or payable if the employee is eligible
516 for, entitled to, or collecting permanent total disability
517 benefits. The compensation provided by this paragraph is not
518 subject to the limits provided in s. 440.12(2), but instead is
519 subject to a maximum weekly compensation rate of $700. If, at
520 the conclusion of this period of increased temporary total
521 disability compensation, the employee is still temporarily
522 totally disabled, the employee shall continue to receive
523 temporary total disability compensation as set forth in
524 paragraphs (a) and (c). The period of time the employee has
525 received this increased compensation will be counted as part of,
526 and not in addition to, the maximum periods of time for which
527 the employee is entitled to compensation under paragraph (a) but
528 not paragraph (c).
529 Section 9. Subsection (9) of section 440.185, Florida
530 Statutes, is amended to read:
531 440.185 Notice of injury or death; reports; penalties for
532 violations.—
533 (9) Any employer or carrier who fails or refuses to timely
534 send any form, report, or notice required by this section shall
535 be subject to an administrative fine by the department not to
536 exceed $500 $1,000 for each such failure or refusal. If, within
537 1 calendar year, an employer fails to timely submit to the
538 carrier more than 10 percent of its notices of injury or death,
539 the employer shall be subject to an administrative fine by the
540 department not to exceed $2,000 for each such failure or
541 refusal. However, any employer who fails to notify the carrier
542 of an the injury on the prescribed form or by letter within the
543 7 days required in subsection (2) shall be liable for the
544 administrative fine, which shall be paid by the employer and not
545 the carrier. Failure by the employer to meet its obligations
546 under subsection (2) shall not relieve the carrier from
547 liability for the administrative fine if it fails to comply with
548 subsections (4) and (5).
549 Section 10. Paragraph (b) of subsection (8) and paragraphs
550 (a), (b), and (c) of subsection (12) of section 440.20, Florida
551 Statutes, are amended to read:
552 440.20 Time for payment of compensation and medical bills;
553 penalties for late payment.—
554 (8)
555 (b) In order to ensure carrier compliance under this
556 chapter, the department office shall monitor, audit, and
557 investigate the performance of carriers. The department office
558 shall require that all compensation benefits be are timely paid
559 in accordance with this section. The department office shall
560 impose penalties for late payments of compensation that are
561 below a minimum 95-percent 95 percent timely payment performance
562 standard. The carrier shall pay to the Workers’ Compensation
563 Administration Trust Fund a penalty of:
564 1. Fifty dollars per number of installments of compensation
565 below the 95-percent 95 percent timely payment performance
566 standard and equal to or greater than a 90-percent 90 percent
567 timely payment performance standard.
568 2. One hundred dollars per number of installments of
569 compensation below a 90-percent 90 percent timely payment
570 performance standard.
571
572 This section does not affect the imposition of any penalties or
573 interest due to the claimant. If a carrier contracts with a
574 servicing agent to fulfill its administrative responsibilities
575 under this chapter, the payment practices of the servicing agent
576 are deemed the payment practices of the carrier for the purpose
577 of assessing penalties against the carrier.
578 (12)
579 (a) Liability of an employer for future payments of
580 compensation may not be discharged by advance payment unless
581 prior approval of a judge of compensation claims or the
582 department has been obtained as hereinafter provided. The
583 approval shall not constitute an adjudication of the claimant’s
584 percentage of disability.
585 (b) When the claimant has reached maximum recovery and
586 returned to her or his former or equivalent employment with no
587 substantial reduction in wages, such approval of a reasonable
588 advance payment of a part of the compensation payable to the
589 claimant may be given informally by letter by a judge of
590 compensation claims or by the department.
591 (c) In the event the claimant has not returned to the same
592 or equivalent employment with no substantial reduction in wages
593 or has suffered a substantial loss of earning capacity or a
594 physical impairment, actual or apparent:
595 1. An advance payment of compensation not in excess of
596 $2,000 may be approved informally by letter, without hearing, by
597 any judge of compensation claims or the Chief Judge.
598 2. An advance payment of compensation not in excess of
599 $2,000 may be ordered by any judge of compensation claims after
600 giving the interested parties an opportunity for a hearing
601 thereon pursuant to not less than 10 days’ notice by mail,
602 unless such notice is waived, and after giving due consideration
603 to the interests of the person entitled thereto. When the
604 parties have stipulated to an advance payment of compensation
605 not in excess of $2,000, such advance may be approved by an
606 order of a judge of compensation claims, with or without
607 hearing, or informally by letter by any such judge of
608 compensation claims, or by the department, if such advance is
609 found to be for the best interests of the person entitled
610 thereto.
611 3. When the parties have stipulated to an advance payment
612 in excess of $2,000, subject to the approval of the department,
613 such payment may be approved by a judge of compensation claims
614 by order if the judge finds that such advance payment is for the
615 best interests of the person entitled thereto and is reasonable
616 under the circumstances of the particular case. The judge of
617 compensation claims shall make or cause to be made such
618 investigations as she or he considers necessary concerning the
619 stipulation and, in her or his discretion, may have an
620 investigation of the matter made. The stipulation and the report
621 of any investigation shall be deemed a part of the record of the
622 proceedings.
623 Section 11. Subsection (1) of section 440.211, Florida
624 Statutes, is amended to read:
625 440.211 Authorization of collective bargaining agreement.—
626 (1) Subject to the limitation stated in subsection (2), a
627 provision that is mutually agreed upon in any collective
628 bargaining agreement filed with the department between an
629 individually self-insured employer or other employer upon
630 consent of the employer’s carrier and a recognized or certified
631 exclusive bargaining representative establishing any of the
632 following shall be valid and binding:
633 (a) An alternative dispute resolution system to supplement,
634 modify, or replace the provisions of this chapter which may
635 include, but is not limited to, conciliation, mediation, and
636 arbitration. Arbitration held pursuant to this section shall be
637 binding on the parties.
638 (b) The use of an agreed-upon list of certified health care
639 providers of medical treatment which may be the exclusive source
640 of all medical treatment under this chapter.
641 (c) The use of a limited list of physicians to conduct
642 independent medical examinations which the parties may agree
643 shall be the exclusive source of independent medical examiners
644 pursuant to this chapter.
645 (d) A light-duty, modified-job, or return-to-work program.
646 (e) A vocational rehabilitation or retraining program.
647 Section 12. Paragraph (b) of subsection (1) of section
648 440.385, Florida Statutes, is amended to read:
649 440.385 Florida Self-Insurers Guaranty Association,
650 Incorporated.—
651 (1) CREATION OF ASSOCIATION.—
652 (b) A member may voluntarily withdraw from the association
653 when the member voluntarily terminates the self-insurance
654 privilege and pays all assessments due to the date of such
655 termination. However, the withdrawing member shall continue to
656 be bound by the provisions of this section relating to the
657 period of his or her membership and any claims charged pursuant
658 thereto. The withdrawing member who is a member on or after
659 January 1, 1991, shall also be required to provide to the
660 association upon withdrawal, and at 12-month intervals
661 thereafter, satisfactory proof, including, if requested by the
662 association, a report of known and potential claims certified by
663 a member of the American Academy of Actuaries, that it continues
664 to meet the standards of s. 440.38(1)(b) 440.38(1)(b)1. in
665 relation to claims incurred while the withdrawing member
666 exercised the privilege of self-insurance. Such reporting shall
667 continue until the withdrawing member demonstrates to the
668 association that there is no remaining value to claims incurred
669 while the withdrawing member was self-insured. If a withdrawing
670 member fails or refuses to timely provide an actuarial report to
671 the association, the association may obtain an order from a
672 circuit court requiring the member to produce such a report and
673 ordering any other relief that the court determines appropriate.
674 The association is entitled to recover all reasonable costs and
675 attorney attorney’s fees expended in such proceedings. If during
676 this reporting period the withdrawing member fails to meet the
677 standards of s. 440.38(1)(b) 440.38(1)(b)1., the withdrawing
678 member who is a member on or after January 1, 1991, shall
679 thereupon, and at 6-month intervals thereafter, provide to the
680 association the certified opinion of an independent actuary who
681 is a member of the American Academy of Actuaries of the
682 actuarial present value of the determined and estimated future
683 compensation payments of the member for claims incurred while
684 the member was a self-insurer, using a discount rate of 4
685 percent. With each such opinion, the withdrawing member shall
686 deposit with the association security in an amount equal to the
687 value certified by the actuary and of a type that is acceptable
688 for qualifying security deposits under s. 440.38(1)(b). The
689 withdrawing member shall continue to provide such opinions and
690 to provide such security until such time as the latest opinion
691 shows no remaining value of claims. The association has a cause
692 of action against a withdrawing member, and against any
693 successor of a withdrawing member, who fails to timely provide
694 the required opinion or who fails to maintain the required
695 deposit with the association. The association shall be entitled
696 to recover a judgment in the amount of the actuarial present
697 value of the determined and estimated future compensation
698 payments of the withdrawing member for claims incurred during
699 the time that the withdrawing member exercised the privilege of
700 self-insurance, together with reasonable attorney attorney’s
701 fees. The association is also entitled to recover reasonable
702 attorney attorney’s fees in any action to compel production of
703 any actuarial report required by this section. For purposes of
704 this section, the successor of a withdrawing member means any
705 person, business entity, or group of persons or business
706 entities, which holds or acquires legal or beneficial title to
707 the majority of the assets or the majority of the shares of the
708 withdrawing member.
709 Section 13. Paragraph (a) of subsection (3) and paragraph
710 (a) of subsection (6) of section 440.491, Florida Statutes, are
711 amended to read:
712 440.491 Reemployment of injured workers; rehabilitation.—
713 (3) REEMPLOYMENT STATUS REVIEWS AND REPORTS.—
714 (a) When an employee who has suffered an injury compensable
715 under this chapter is unemployed 60 days after the date of
716 injury and is receiving benefits for temporary total disability,
717 temporary partial disability, or wage loss, and has not yet been
718 provided medical care coordination and reemployment services
719 voluntarily by the carrier, the carrier must determine whether
720 the employee is likely to return to work and must report its
721 determination to the department and the employee. The report
722 shall include the identification of both the carrier and the
723 employee, and the carrier claim number, and any case number
724 assigned by the Office of the Judges of Compensation Claims. The
725 carrier must thereafter determine the reemployment status of the
726 employee at 90-day intervals as long as the employee remains
727 unemployed, is not receiving medical care coordination or
728 reemployment services, and is receiving the benefits specified
729 in this subsection.
730 (6) TRAINING AND EDUCATION.—
731 (a) Upon referral of an injured employee by the carrier, or
732 upon the request of an injured employee, the department shall
733 conduct a training and education screening to determine whether
734 it should refer the employee for a vocational evaluation and, if
735 appropriate, approve training and education, or approve other
736 vocational services for the employee. At the time of such
737 referral, the carrier shall provide the department a copy of any
738 reemployment assessment or reemployment plan provided to the
739 carrier by a rehabilitation provider. The department may not
740 approve formal training and education programs unless it
741 determines, after consideration of the reemployment assessment,
742 that the reemployment plan is likely to result in return to
743 suitable gainful employment. The department may is authorized to
744 expend moneys from the Workers’ Compensation Administration
745 Trust Fund, established by s. 440.50, to secure appropriate
746 training and education at a Florida public college or at a
747 career center established under s. 1001.44, or to secure other
748 vocational services when necessary to satisfy the recommendation
749 of a vocational evaluator. As used in this paragraph,
750 “appropriate training and education” includes securing a general
751 education diploma (GED), if necessary. The department shall by
752 rule establish training and education standards pertaining to
753 employee eligibility, course curricula and duration, and
754 associated costs. For purposes of this subsection, training and
755 education services may be secured from additional providers if:
756 1. The injured employee currently holds an associate degree
757 and requests to earn a bachelor’s degree not offered by a
758 Florida public college located within 50 miles from his or her
759 customary residence;
760 2. The injured employee’s enrollment in an education or
761 training program in a Florida public college or career center
762 would be significantly delayed; or
763 3. The most appropriate training and education program is
764 available only through a provider other than a Florida public
765 college or career center or at a Florida public college or
766 career center located more than 50 miles from the injured
767 employee’s customary residence.
768 Section 14. Except as otherwise expressly provided in this
769 act, this act shall take effect July 1, 2013.