Current through Reg. 47, No. 249; December 28, 2021
(1) Upon issuance
of an insurance policy or certificate of membership in a self-insurance fund or
a renewal certificate thereof, the insurer or self-insurance servicing agent
shall furnish the employer a sufficient number of typewritten or printed
compensation notices, commonly referred to as the "broken arm poster." The
compensation notice shall be printed on paper or cardboard stock 11 inches by
17 inches, and have the same form and content as Form DFS-F4-1548, "Workers'
Comp Works For You Poster", (Rev 3/10), or Form DFS-F4-2026,
"Compensación por accidentes de trabajo labora para usted Poster," (Rev.
03/10), which are incorporated herein by reference. As an alternative to having
the Anti-Fraud Reward Program language in the poster itself, the employer may
elect to attach the Anti-Fraud Reward Program Notice to the poster on a
separate piece of paper, with the same form and content as Form DFS-L2-1549,
"Anti-Fraud Reward Program Notice", (Rev 12/02), which is incorporated herein
information shall, in addition to subsection (1) above, be included on the
compensation notice if the employer is insured through a commercial insurer:
(a) The name and address of the employer;
(b) The name and address of
the insurer, the employer's current workers' compensation insurance policy
number, the effective date of coverage of that policy and the expiration date
of the policy.
following information shall, in addition to subsection (1) above, be included
on the compensation notice if the employer is self-insured through a
(a) The name and address
of the employer;
(b) The name of
self-insurers fund to which the employer belongs;
(c) The employer's membership
(d) The effective date of
(e) The service
agent employer's account number.
(4) The compensation notice may also include
such other information, in addition to information required by subsections (1),
(2), and (3) above, as the insurer or self-insurance fund may desire concerning
accident reports, the names of physicians, or other pertinent
insurers, self-insurers or self-insurance funds may obtain an electronic
version of the art work for the compensation notices from from the Division's
website at http://www.myfloridacfo.com/WC/.
Fla. Admin. Code Ann. R.
FS. Law Implemented
New 11-20-79, Amended
4-15-81, 1-2-86, Formerly 38F-6.07, Amended 2-2-00, Formerly 38F-6.007, Amended
3-26-03, Formerly 4L-6.007, Amended 1-30-11, Amended by
Register Volume 42, Number 021, February 02, 2016 effective