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.