(1) All parties agreeing to arbitration shall execute and file with the Office of the Clerk a request for arbitration substantially in the following form:
“”We hereby agree to submit to arbitration under Sections 766.201-.212, Florida Statutes, and Chapter 60Q-3, Florida Administrative Code, the determination of the amount of damages arising from the following medical incident: (Describe the medical incident briefly, specifying dates and the categories of damages sought).
We further agree that the determination of the amount of damages be submitted to a three-member panel constituted or reconstituted in accordance with Sections 766.201-.212, Florida Statutes, and Chapter 60Q-3, Florida Administrative Code.
We further agree that we will faithfully observe this agreement, that we will abide by and fulfill any award rendered by an arbitration panel, and that a judgment of a court having jurisdiction may be entered on the award, provided only that the liability of any insurer shall be subject to applicable insurance policy limits.””

Terms Used In Florida Regulations 60Q-3.005

  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
    (2) The request for arbitration shall contain the name and address of each party joining in the request and shall also state the name and address of each party who, although not joining in the request, was named in a notice of intent to initiate litigation served in connection with the controversy.
    (3) No filing fee is required in order to initiate arbitration.
Specific Authority 766.207(9), (10) FS. Law Implemented 766.201-.212 FS. History-New 9-6-88, Formerly 22I-7.005, Amended 6-27-00.