Fla. Admin. Code R. 69L-10.007

Current through Reg. 50, No. 222; November 13, 2024

Section 69L-10.007 - Notice of Claim

A Notice of Claim for reimbursement from the SDTF shall be filed with the SDTF, Division of Worker's Compensation, 200 East Gaines Street, Tallahassee, FL 32399-4223. The Notice of Claim may be filed by letter form and shall include the following:

(1) Name and social security number of the employee;

(2) The name and address of the employer;

(3) The date of the accident;

(4) The name and address of the insurance carrier, self-insurance fund or employer on whose behalf the claim is made.

Fla. Admin. Code Ann. R. 69L-10.007

Rulemaking Authority 440.49(7)(a) FS. Law Implemented 440.49(7) FS.

New 4-19-92, Amended 8-18-93, Formerly 38F-10.007, 4L-10.007.