(1) For purposes of calculating penalties to be assessed against employers pursuant to Florida Statutes § 440.107, the Division shall use Form DFS-F4-1595, https://www.flrules.org/Gateway/reference.asp?No=Ref-15434, Penalty Calculation Worksheet, revised 01/23, which is hereby incorporated by reference.
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    (2) Copies of Form DFS-F4-1595, Penalty Calculation Worksheet, are available from the Department of Financial Services, Division of Workers’ Compensation, 1579 Summit Lake Drive, Tallahassee, FL 32317.
Rulemaking Authority 440.107, 440.591 FS. Law Implemented Florida Statutes § 440.107. History-New 12-29-04, Amended 10-18-07, 4-12-15, 3-21-17, 7-18-23.

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