(1) It shall be the sole responsibility of
Current Self-Insurers and Former Self-Insurers to provide for competent persons
to service their self-insurance program in the areas of claims adjusting,
safety engineering and loss control. This shall be done through either the use
of their own employees, who are determined by the Department to have experience
in these areas, or by contracting with a Qualified Servicing Entity approved by
the Department to provide these services. A list of Qualified Servicing
Entities may be obtained by contacting the Department at:
Department of Financial Services
Division of Workers' Compensation
Bureau of Monitoring and Audit/Self-Insurance
1579 Summit Lake Drive
Tallahassee, FL 32317
(2) Current Self-Insurers and Former
Self-Insurers choosing to use their own employees to provide these services
must obtain prior approval from the Department and shall submit Form
DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09,
as incorporated by reference, within thirty (30) days of a change in servicing
arrangement and at least every three (3) years thereafter. Resumes of employees
with experience in these areas must be provided for approval.
(3) Current Self-Insurers and Former
Self-Insurers contracting with a Qualified Servicing Entity must submit a
completed Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers),
effective 08/09, within thirty (30) days of entering into a servicing contract.
For expiring contracts renewed with the same Qualified Servicing Entity, a
completed Form DFS-F2-SI-19 must be submitted within thirty (30) days after the
expiration date of the contract being renewed. For contracts that are
continuous or have terms greater than three (3) years, Form DFS-F2-SI-19 must
be submitted no later than three (3) years and thirty (30) days from the date
of submission of the prior Form DFS-F2-SI-19.
(a) For Governmental Entities, Form
DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09,
shall be obtained from and submitted to the:
Department of Financial Services
Division of Workers' Compensation
Bureau of Monitoring and Audit/Self-Insurance
1579 Summit Lake Drive
Tallahassee, FL 32317
(b) For FSIGA Members, Form DFS-F2-SI-19
(Certification of Servicing for Self-Insurers), effective 08/09, shall be
obtained from and submitted to the:
Florida Self-Insurers Guaranty Association, Inc.
1427 E. Piedmont Dr., 2nd Floor
Tallahassee, Florida 32308
(4) Failure to submit the required Form
DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), effective 08/09,
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.
(5) In the event that self-insured claims are
transferred to a new Qualified Servicing Entity or the self-insurer assumes
responsibility for provision of these services in-house, the previous Qualified
Servicing Entity shall provide an accounting of all claims files and claims
data sufficiently detailed to permit the new Qualified Servicing Entity or the
self-insurer to establish accurate claims, reserving, and accounting
data.
