Florida Regulations 69L-5.229: Application Process
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(1) Application to become a Qualified Servicing Entity shall be made on Form DFS-F2-SI-22 (Qualified Servicing Entity Application), effective 08/09, incorporated by reference. Entities may apply to become a Qualified Servicing Entity in any or all of the following: claims-adjusting, loss control or safety engineering. The application shall be submitted to the Division at least ninety (90) days prior to the desired effective date. The application may be obtained at:
Department of Financial Services
Division of Workers’ Compensation
Bureau of Monitoring and Audit/Self-Insurance
1579 Summit Lake Drive
Tallahassee, FL 32317
(a) Entities that are not insurance companies licensed to write workers’ compensation insurance by the Florida Office of Insurance Regulation shall include the following in the application package:
1. A completed Form DFS-F2-SI-22 (Qualified Servicing Entity Application), effective 08/09, as incorporated by reference.
2. Proof that the management and ownership of the Qualified Servicing Entity is competent, trustworthy and possesses managerial experience that would make the proposed operation beneficial to the workers covered. In determining competency the Department shall consider the applicant’s claims-handling history. If the applicant’s history contains any of the following it shall be considered a demonstration of a lack of competency:
a. A repeated pattern or practice of questionable claims-handling techniques pursuant to Section 440.525 or 440.20, F.S.;
b. A repeated pattern or practice of unreasonably controverting claims;
c. A repeated pattern or practice of failing to pay compensation orders as required by statute; or
d. A repeated pattern or practice of arbitrarily or unreasonably disallowing or reducing payments to healthcare providers pursuant to Section 440.13(7)(f), F.S.
(b) A completed Form DFS-F2-SI-27 (Biographical Statement and Affidavit), effective 08/09, as incorporated by reference, for each owner and member of management, along with a brief resume. Copies of this form are available at the Division of Workers’ Compensation, Bureau of Monitoring and Audit, Self-Insurance Section, 1579 Summit Lake Drive, Tallahassee, FL 32317.
(c) Independent background investigation reports on the owners and management performed by a company approved by the National Association of Insurance Commissioners (NAIC).
(d) Proof that the applicant has a sufficient number of workers’ compensation claims adjusters licensed by the State of Florida and loss control and safety engineering personnel employed on a full-time basis to meet the needs of all self-insurers with which it intends to contract. The following information shall be submitted for each employee:
1. A copy of their Florida Adjusters License, for the adjusters.
2. A copy of a current resume for loss control and safety engineering personnel.
(e) Proof of a physical location within the State of Florida separate from the client’s location. If the Qualified Servicing Entity is a subsidiary of the self-insurer that it services, then the physical location may be the same as that of the self-insurer.
(f) Proof that they have within the State of Florida, an insurance professional qualified in the field of workers’ compensation and authorized to act in all matters concerning the company’s claims-handling;
(g) A statement signed by an officer of the company that the Qualified Servicing Entity utilizes only authorized rehabilitation services pursuant to Florida Statutes § 440.491(7);
(h) Two (2) letters of recommendation from prior or current customers;
(i) A statement detailing the record handling and maintenance practices; and,
(j) A copy of the standards and procedures used to develop safety programs for their clients if applicable.
(2) Entities that are insurance companies licensed to write workers’ compensation insurance by the Florida Office of Insurance Regulation shall include the following in the application package:
(a) A completed Form DFS-F2-SI-22 (Qualified Servicing Entity Application), effective 08/09; and,
(b) Proof of their certificate of authority.
(3) The entity submitting an application must have no outstanding penalties or fines owed.
(4) The entity submitting an application must be approved by the Department before engaging in business in Florida as a Qualified Servicing Entity.
Rulemaking Authority 440.38(1), (2), (3), 440.385(6), 440.591 FS. Law Implemented 440.38(1), (2), (3), 440.385(1), (3), (6) FS. History-New 3-9-10.
Department of Financial Services
Division of Workers’ Compensation
Bureau of Monitoring and Audit/Self-Insurance
1579 Summit Lake Drive
Tallahassee, FL 32317
Terms Used In Florida Regulations 69L-5.229
- Contract: A legal written agreement that becomes binding when signed.
- Statute: A law passed by a legislature.
1. A completed Form DFS-F2-SI-22 (Qualified Servicing Entity Application), effective 08/09, as incorporated by reference.
2. Proof that the management and ownership of the Qualified Servicing Entity is competent, trustworthy and possesses managerial experience that would make the proposed operation beneficial to the workers covered. In determining competency the Department shall consider the applicant’s claims-handling history. If the applicant’s history contains any of the following it shall be considered a demonstration of a lack of competency:
a. A repeated pattern or practice of questionable claims-handling techniques pursuant to Section 440.525 or 440.20, F.S.;
b. A repeated pattern or practice of unreasonably controverting claims;
c. A repeated pattern or practice of failing to pay compensation orders as required by statute; or
d. A repeated pattern or practice of arbitrarily or unreasonably disallowing or reducing payments to healthcare providers pursuant to Section 440.13(7)(f), F.S.
(b) A completed Form DFS-F2-SI-27 (Biographical Statement and Affidavit), effective 08/09, as incorporated by reference, for each owner and member of management, along with a brief resume. Copies of this form are available at the Division of Workers’ Compensation, Bureau of Monitoring and Audit, Self-Insurance Section, 1579 Summit Lake Drive, Tallahassee, FL 32317.
(c) Independent background investigation reports on the owners and management performed by a company approved by the National Association of Insurance Commissioners (NAIC).
(d) Proof that the applicant has a sufficient number of workers’ compensation claims adjusters licensed by the State of Florida and loss control and safety engineering personnel employed on a full-time basis to meet the needs of all self-insurers with which it intends to contract. The following information shall be submitted for each employee:
1. A copy of their Florida Adjusters License, for the adjusters.
2. A copy of a current resume for loss control and safety engineering personnel.
(e) Proof of a physical location within the State of Florida separate from the client’s location. If the Qualified Servicing Entity is a subsidiary of the self-insurer that it services, then the physical location may be the same as that of the self-insurer.
(f) Proof that they have within the State of Florida, an insurance professional qualified in the field of workers’ compensation and authorized to act in all matters concerning the company’s claims-handling;
(g) A statement signed by an officer of the company that the Qualified Servicing Entity utilizes only authorized rehabilitation services pursuant to Florida Statutes § 440.491(7);
(h) Two (2) letters of recommendation from prior or current customers;
(i) A statement detailing the record handling and maintenance practices; and,
(j) A copy of the standards and procedures used to develop safety programs for their clients if applicable.
(2) Entities that are insurance companies licensed to write workers’ compensation insurance by the Florida Office of Insurance Regulation shall include the following in the application package:
(a) A completed Form DFS-F2-SI-22 (Qualified Servicing Entity Application), effective 08/09; and,
(b) Proof of their certificate of authority.
(3) The entity submitting an application must have no outstanding penalties or fines owed.
(4) The entity submitting an application must be approved by the Department before engaging in business in Florida as a Qualified Servicing Entity.
Rulemaking Authority 440.38(1), (2), (3), 440.385(6), 440.591 FS. Law Implemented 440.38(1), (2), (3), 440.385(1), (3), (6) FS. History-New 3-9-10.