Fla. Admin. Code Ann. R. 69L-5.207 - Outstanding Liabilities Reporting
(1)
Current Self-Insurers and Former Self-Insurers, other than Governmental
Entities, shall report their outstanding self-insured workers' compensation
liabilities for all entities covered under the self-insurance authorization on
Form DFS-F2-SI-20 (Report of Outstanding Workers' Compensation Liabilities),
effective 08/09, as incorporated by reference. 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.
This includes all outstanding liabilities of Former Self-Insurers for which the
Current Self-Insurer is the Successor Entity. Form DFS-F2-SI-20 (Report of
Outstanding Workers' Compensation Liabilities), effective 08/09, shall be
accompanied by a loss run substantiating all amounts reported on the form, be
signed by an Authorized Representative of the Self-Insurer or its Qualified
Servicing Entity, and be submitted no later than 120 days after the end of the
self-insurer's fiscal year. 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. The evaluation date
shall not be prior to the end of the self-insurer's latest fiscal year. Failure
to submit the required Form DFS-F2-SI-20 (Report of Outstanding Workers'
Compensation Liabilities), effective 08/09, or material understatement or
concealment of loss reserves, shall constitute good cause for revocation of the
self-insurance authorization in addition to civil penalties specified in Rule
69L-5.217, F.A.C.
(2) FSIGA Members shall submit Form
DFS-F2-SI-20 (Report of Outstanding Workers' Compensation Liabilities),
effective 08/09, to the:
Florida Self-Insurers Guaranty Association, Inc.
1427 E. Piedmont Dr., 2nd Floor
Tallahassee, Florida 32308
Notes
Rulemaking Authority 440.38(1), (2), (3), 440.385(6), 440.525(2), 440.591 FS. Law Implemented 440.38(1), (2), (3), 440.385(1), (3), (6), 440.525 FS.
New 3-9-10.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.