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Governmental Self-Insured Employers

Governmental Self-Insured Employers

Governmental self-insured employers are defined in Section 440.38(6), F.S. If a governmental employer meets this definition and has submitted an application to self-insure for workers’ compensation, it shall be deemed self-insured under the terms of this chapter unless they elect to procure and maintain insurance through the private market.

Below is important information regarding the self-insurance regulatory process, assessment rates, annual maximum compensation rates, EDI filings (medical, indemnity and policy information), audit, and other carrier regulated activities.

Self-Insurance Regulations

Claim Administration



Reemployment Services


Intersection of workers comp and federal laws difficult to manage

Intersection of workers comp and federal laws difficult to manage


Following the presidential election workers compensation legal experts say they are in wait-and-see mode with regard to the recent uptick in U.S. Equal Employment Opportunity Commission complaints.

“Everything with the EEOC may be off because of the election results this week,” said Chicago-based Jeff Nowak, co-chair of the labor and employment practice group with Franczek Radelet P.C., in a webinar hosted Thursday by the Disability Management Employer Coalition on Thursday.

The webinar focused specifically on how workers comp intersects with the Americans with Disabilities Act Amendments Act and the Family and Medical Leave Act, and provided tips on how to avoid penalties, fines and lawsuits.

Mr. Nowak, who said he is watching whether the EEOC will be the priority for Donald Trump’s administration that it has been for other administrations, said a number of pending complaints and rulings are highlighting the difficulty for employers who want to both comply with federal laws and get injured employees back to work.

Adopted in 2008, the ADAAA amended the ADA, which essentially bars employers from discriminating against people with disabilities in any aspect of employment-related activities. Under the FMLA, employers are required to give their employees up to 12 weeks of unpaid leave per year for specific reasons, including a serious health condition or to care for an immediate family member who has a serious health condition. According to experts, the two can intersect with workers comp and create EEOC complaints.

Panelists highlighted communication with employees as a better way to smooth the path to avoids costly litigation.

Dubbed the “interactive process” in worker comp, this communication requirement calls for each side of a claim to exchange of information in good faith. It is key to implementing ADAAA and FMLA requirements and state regulations that govern workers comp, experts say.

Communication is “the most critical element,” said Adrienne Paler, director of total health and productivity management, integrated disability and absence management for Sutter Health, a Sacramento, California-based health system. “We need to tailor it … what is the employee asking for? That’s a question to ask the employee.”

“The risk of litigation increases when an employer is ignorant about their obligations under ADAAA to engage in the interactive process … they are unwilling to think creatively what they can do to that job, what changes can they make to help the employee perform the job,” said Mr. Nowak.

Source: BusinessInsurance

FBI: Why So Many Organizations Vulnerable to Ransomware

FBI: Why So Many Organizations Vulnerable to Ransomware

Ransomware has been one of the highest-profile cybercrimes of 2016, and the FBI has been at the heart of many investigations. Jay Kramer, a supervisory special agent with the Bureau, discusses what he’s learned about defending against ransomware.

See Also: Secrets to a Simpler Security Incident Response

“[Organizations] are getting hit; they’re often catastrophic events, and that’s why we’re being as aggressive as we can be,” says Kramer, who supervises a squad of FBI agents and analysts in New York. The FBI’s primary goals: to ensure greater engagement between ransomware targets and the FBI as well as to improve general preparedness for these attacks.

One key challenge that healthcare entities, in particular, face is balancing the needs for speed and security. “There’s often a disconnect between the need for security and the need to get access to information quickly,” Kramer says. “They’re often at odds, and there’s an evolution underway in terms of rethinking some things … to make sure that networks are secure.”

In a video interview at Information Security Media Group’s Healthcare Security Summit in New York, Kramer discusses:

  • The growth of ransomware crimes;
  • Why entities remain so vulnerable after the crimes have received so much publicity;
  • How to work effectively with law enforcement to investigate cybercrimes.

Supervisory Special Agent Kramer joined the FBI in 1996. After several years in the criminal division of the FBI’s New York office, Kramer was selected to join the FBI’s Office of the Chief Division Counsel. In this role, Kramer helped analyze and solve complex issues of law and policy affecting both criminal and national security investigations. In 2010, he was selected to serve at FBI headquarters in its Office of Congressional Affairs. As a congressional liaison, Kramer worked closely with congressional oversight committees on issues related to proposed changes in federal law. In 2013, he was called upon to help stand up the FBI’s Cyber Law Unit in Chantilly, Va., and in 2014, he returned to the New York office, where he currently supervises a squad of agents and analysts conducting criminal cyber intrusion investigations.


Two special education suits at US Supreme Court

Two special education suits at US Supreme Court

There are two accepted cases at the United States Supreme Court that school pools, and others, may wish to monitor. Both could subject schools to additional federal lawsuits for monetary damages under the Americans with Disabilities Act (ADA). For a useful review of these and other cases, or to sign up for case updates, visit SCOTUSblog.

The question in Fry v Napoleon Community Schools is whether families must exhaust procedures under the Individuals with Disabilities Education Act (IDEA) before suing under the ADA or Rehabilitation Act. Although IDEA does not allow for monetary damages, the other Acts do. Federal appeals courts are split on interpretations of whether procedures under IDEA must first be exhausted. After Fry’s request for accommodation was discussed with the school and denied in an Individualized Education Program (IEP) team meeting, her family filed a lawsuit in federal court rather than filing a due process hearing request with the State of Michigan.

The question in Endrew F. v Douglas County School District RE-1 is what level of educational benefit a child must receive to satisfy requirements under IDEA. At issue is whether “some educational benefit” is enough to satisfy IDEA or whether “meaningful educational benefit” is required. Again, federal appeals courts are split on interpretations of the benefit. Endrew F, a child with autism, was provided some educational benefit by the public school in which he was enrolled, but his parents disputed the IEP and its quality of education under the IDEA.


Can My Personal Information Be Protected?

Can My Personal Information Be Protected?

Personal Records Exempt from Public Disclosure

As provided by s. 119.071, Florida Statutes, certain information maintained by state agencies is exempt from public disclosure, and is therefore deemed confidential. This includes social security numbers, medical and financial information. Accordingly, the Florida Division of Workers’ Compensation protects the social security numbers, medical and financial information of injured workers obtained in the performance of its statutory responsibilities.

However, s.119.071(4) (d), Florida Statutes, additionally provides for the exemption of home addresses and telephone numbers from public disclosure for certain occupational groups as listed below. Note: Home addresses and telephone numbers of spouses and children of individuals who are covered by these occupational groups are also exempt from public disclosure.

Occupational Groups Who Qualify for Exemption

  • Active or Former Law Enforcement Personnel
  • Active or Former Correctional and Correctional Probation Officers
  • Active or Former Personnel of Department of Child & Family Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other criminal activities
  • Active or Former Personnel of Department of Health whose duties are to support the investigation of child abuse or neglect
  • Active or Former Personnel of Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement
  • Firefighters certified in compliance with s. 633.35, F.S.
  • Justice of the Supreme Court • District Court of Appeal Judges
  • Circuit Court Judges
  • County Court Judges
  • Current or former State Attorneys, Assistant State Attorneys, State Prosecutors, and Assistant State Prosecutors
  • General and Special Magistrates
  • Judges of Compensation Claims
  • Administrative Law Judges of Department of Administrative Hearing (DOAH)
  • Child support enforcement hearing officers
  • Current and former human resource, labor relations or employee labor relations directors, assistant directors, managers, or assistant managers of any local government agency or water management district whose duties include hiring and firing employees, labor contract negation, administration or personnel-related duties
  • Current and former Code Enforcement Officers
  • Current and former guardians ad litem as defined in s. 39.820, F.S.
  • Current and former juvenile probation officers, juvenile probation supervisors, detention superintendents, assistant detention superintendents, senior juvenile detention officers, juvenile detention officer supervisors, juvenile detention officers, house parents I and II, house parent supervisors, group treatment leaders, group treatment leader supervisors, rehabilitation therapists, and social services counselors of the Department of Juvenile Justice
  • Current or former public defenders, assistant public defenders, criminal conflict and civil regional counsel, and assistant criminal conflict and civil regional counsel
  • Current or former personnel of the Department of Health whose duties include, or result in, the determination or adjudication of eligibility for social security disability benefits, the investigation or prosecution of complaints filed against health care practitioners, or the inspection of health care practitioners or health care facilities licensed by the Department of Health
  • Current or former member of the Armed Forces of the United States, a reserve component of the Armed Forces of the United States, or the National Guard, who served after September 11, 2001.
  • Current or former nonsworn investigative personnel of the Department of Financial Services whose duties include the investigation of fraud, theft, workers’ compensation coverage requirements and compliance, other related criminal activities, or state regulatory requirement violations.
  • Current or former emergency medical technicians or paramedics certified under Chapter 401, F.S.

Section 119.071(5)(i)1., F.S., also exempts the following occupations:

  • Current and former U.S. Attorneys and Assistant U.S. Attorneys
  • Current and former Judges of U.S. Courts of Appeal, U.S. District Judges and U.S. Magistrates

Source: MyFloridaCFO

Rule Changes & Notices

Rule Changes & Notices


69L-7.501: The proposed rule is amended to adopt the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Manual”), as approved by the Three-Member Panel during a scheduled meeting held on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the Manual increases the per diem reimbursement rates for surgical and non-surgical hospital inpatient services and the threshold dollar amount triggering Stop-Loss reimbursement above reimbursement allowances specified in the 2014 Edition of the Manual, as adopted by the existing rule. The 2016 Edition of the Manual also provides an updated fee schedule for various categories of hospital outpatient services based on the Current Procedural Terminology (“CPT”) line level charge data, with an adjustment of the Maximum Reimbursement Allowance (“MRA”) based on the geographic location of the service provider.

69L-7.100: The proposed rule amendment incorporates and adopts for use the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (“ASC Reimbursement Manual”), as approved by the Three-Member Panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the ASC Reimbursement Manual contains an updated list of the Maximum Reimbursement Allowances (“MRAs”) for various medical services provided to Florida’s injured workers.

69L-7.020: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The aforementioned manual is updated to incorporate the 2016 Medicare Conversion Factor and Resource Based Relative Value Scale (“RBRVS”) geographic-specific reimbursement levels used to determine Maximum Reimbursement Allowances (“MRAs”) for physician’s services and non-surgical hospital outpatient services provided to Florida’s injured workers.

A copy of the notice and link to the proposed Rules are below:

FL Workers’ Compensation Reimbursement Manual for Hospitals, 2016 Edition
FL Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2016 Edition
FL Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition


Hurricane Matthew’s path shifts, expected to pummel Haiti

Hurricane Matthew’s path shifts, expected to pummel Haiti

Hurricane Matthew’s projected path has shifted slightly, bringing it closer to Florida’s east coast later this week, but forecasters say their predictions are still fairly uncertain.

And even if Matthew gets close to the coast, it’s too early to say what exactly Florida will see.

“Right now it looks like the worst of it is going to be over the Atlantic,” said Matt Volkmer, meteorologist with the National Weather Service in Melbourne. “We’re just going to have to watch to see how close the track comes.”

Matthew has been creeping north toward Jamaica and Haiti today as a powerful Category 4 storm, bringing 140 mph winds and possibly life-threatening rain to the island countries.

Hurricane warnings have been issued for both Jamaica and Haiti, along with parts of Cuba and the southeastern Bahamas, according to the National Hurricane Center in Miami.

Rain had already started lashing parts of Jamaica, which could see as much as 15 inches of rain during the next few days. Forecasters say it’s Haiti, though, that will most likely see the worst of the storm.

Matthew is expected to reach southern Haiti by tonight and could produce up to 40 inches of rain in some spots, raising concerns about life-threatening flooding and mudslides, according to the Hurricane Center.

Cuba also is expected to see possibly-dangerous amounts rain when Matthew crosses the lightly populated southeastern tip of that country on Tuesday. The storm should then be in the Bahamas by Wednesday and heading up Florida’s east coast on Thursday.

Latest predictions show Matthew moving almost parallel to the coast and staying offshore. Volkmer said local impacts will vary depending on how close Matthew gets to the state.

Strong rip currents, high storm surge and large swells are probable, he said. There’s also a chance the coast could see tropical storm force winds.

“For right now, there’s still a great deal of uncertainty but the probability to see tropical storm force winds have been increasing a little bit,” Volkmer said.

Volusia County officials have already started preparing for possible impacts by moving unsecured signs and lifeguard towers, so they won’t get swept away or damaged.

Gov. Rick Scott has urged Floridians to get ready, just in case Matthew turns toward the state.

“This storm is catastrophic, and if it hits our state, we could see impacts that we have not seen in many years,” he said in a statement released Sunday. “Even though the storm’s projected path is just east of our state, no one should take this lightly.”

As of 11 a.m., Matthew was 275 miles southwest of Port Au Prince, Haiti and moving north at 6 mph, according to the Hurricane Center. The storm’s winds decreased overnight to 130 mph from a high on Friday of 160 mph. The winds speeds have changed a little this morning, but Matthew has remained a Category 4 storm since Saturday.

Even still, the Hurricane Center warns that such a powerful storm can cause “severe damage” to homes and other structures, while toppling trees and power poles. “Catastrophic damage will occur” with a Category 4 storm, the Hurricane Center says.

Officials with Haiti’s civil protection agency said there were roughly 1,300 emergency shelters across the country, enough to hold up to 340,000 people. Authorities broadcast warnings over the radio telling people to swiftly heed evacuation warnings, trying to counter a common tendency for people to try to stay in their homes to protect them during natural disasters.

Teams of civil protection officials walked the streets of Les Cayes and other areas urging residents to secure their homes, prepare emergency kits and warn their neighbors. They also evacuated people from some outlying islands.

After passing Jamaica and Haiti, Matthew was projected to reach Cuba. The center was expected to pass about 50 miles east of the U.S. Navy base at Guantanamo Bay, where authorities evacuated about 700 spouses and children of service members on military transport planes to Florida.

Matthew is expected to weaken back to a Category 2 storm by Friday, according to the Hurricane Center. If it stays on its current projected path, it will then head toward the Carolinas this weekend.

The Associated Press contributed to this report.

SOURCE: OrlandoSentinel