The Florida Division of Workers’ Compensation (DWC) holds payers accountable when they engage in a pattern or practice of arbitrarily or unreasonably denying or reducing medical bill payments.
To enforce accountability, the DWC may:
- Order Repayment: The DWC can compel the payer to repay the appropriate amount to the health care provider.
- Impose Fines: The DWC can assess an administrative fine of up to $5,000 for each instance of improper denial or reduction.
- Award Costs and Fees: The DWC may award the health care provider costs, including reasonable attorney's fees for prosecuting the petition.
How to File a Petition
Providers must use the Petition for Resolution of Reimbursement Dispute process, outlined in 3 steps below.
Step 1: File the Petition (within 45 days)
Providers must petition the DWC to resolve the dispute within 45 days of receiving notice of payment disallowance or adjustment (EOR).
Providers must use Form DFS-F6-DWC-3160-0024 to file the petition, and submit
Florida |
Statute/Rule |
Statute |
|
Section |
440.20 Time for payment of compensation and medical bills; penalties for late payment. |
Subsection Text |
440.20 (7) (f) Any carrier that engages in a pattern or practice of arbitrarily or unreasonably disallowing or reducing payments to health care providers may be subject to one or more of the following penalties imposed by the department: 1. Repayment of the appropriate amount to the health care provider. 2. An administrative fine assessed by the department in an amount not to exceed $5,000 per instance of improperly disallowing or reducing payments. 3. Award of the health care provider’s costs, including a reasonable attorney fee, for prosecuting the petition. |
daisyBill Solution
daisyBill analytics track how many days each claims administrator takes to pay your bills for injured workers’ treatment.
REQUEST DEMO