Fla. Admin. Code Ann. R. 69L-5.221 - Safety Program Premium Credit
Current through Reg. 47, No. 249; December 28, 2021
(1) In order for self-insurers to receive up
to a two percent (2%) credit on the computation of premiums used in the
determination of the assessments for the Workers' Compensation Administration
Trust Fund, the Special Disability Trust Fund and the Florida Self-Insurers
Guaranty Association, Inc., they must state that they have established a
workplace safety program in accordance with Section 440.1025, F.S.
(2) The statement must be completed using
Form DFS-F2-SI-9 (Self-Insurer Certification of Workplace Safety Program
Premium Credit) effective 08/09, as incorporated by reference, and shall be
filed annually sixty (60) days prior to their Anniversary Rating Date. Copies
of this form are available at the Division of Workers' Compensation, Bureau of
Monitoring and Audit, Self-Insurance Section, 2012 Capital Circle, S.E.,
Hartman Building, Tallahassee, FL 32399-4224. The completed Form DFS-F2-SI-9
(Self-Insurer Certification of Employer Workplace Safety Program Premium
Credit) effective 08/09, shall be mailed to the:
Department of Financial Services
Division of Workers' Compensation
Assessments Unit
200 East Gaines Street
Tallahassee, Florida 32399-4221
(3) Certifications not received prior to the
Anniversary Rating Date shall be applied pro rata as of the date the
certification is received at the Division.
Notes
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