Morgan’s Tip of the Week – Reporting Claims


I have had a few clients lately ask me if a claim should be reported and denied or should it just be a “record only”.  See below for what must be reported..and penalties and for not doing so.  This is from our CEU, Tips on Handling the Late Reported Claim if you would like more information.  

Types of Injury – for reporting purposes, the administrative rules divide injury severity into four classes: (1) first aid; (2) medical only; (3) lost time; and (4) death.

  1. First Aid – Employers do not need to report first aid cases to their carrier, but they must maintain the information listed below.[Fla. Admin Code R. 69L-3.002(13) (1/10/2005)].

a.  First aid cases involve injuries that are treated on-the-job without paid medical treatment and that do not disable the injured employee for more than one shift. 

b.  The employer must record and maintain the following information from the employee: name; Social Security number or other ID number; date and time of the accident/injury; occupation of employee; who the injury was reported to and when; description and cause of accident; the injury that occurred and the affected body part; and location address of accident, if different from the employer’s address. [Fla. Admin Code R. 69L-3.004(1)(a) (1/10/2005)].

  1. Medical Only Claims – Employers must report medical only cases to their carrier on a DWC-1 form within seven (7) days after knowledge of the injury. [440.185(2) and Fla. Admin Code R. 69L-3.002(20)].

a.   Medical only cases involve injuries that require paid medical treatment, but do not cause the employee to lose more than seven (7) days of work.

b.   Failure to file the DWC-1 form with the carrier within the seven day time limit subjects the employer to a fine of up to $500.00.

c.   The minimum fine is $100.00 for up to a seven-day delay in reporting; and if the filing is more than 28 days late, then the maximum $500.00 fine applies.

  1. Lost Time Claims – Employers must report lost time cases to their carriers on the DWC-1 form within seven (7) days after knowledge of the injury. [440.185(2) Fla. Admin Code R. 69L-3.002(19)]

a.   Lost time cases involve injuries that cause the employee to lose more than seven (7) days from work, and include any injury entitling the employee to indemnity benefits.

b.   These cases also include disabling injuries to covered volunteer workers, although such workers are ineligible for indemnity benefits because they have no earnings.

c.   Employer’s must also file the 13-week wage statement within 14 days after knowledge of the accident or injury involving lost time or when a medical only case become lost time. [Fla.  Admin Code R. 69L-300.46]

a.   Upon receipt, the carrier msut compare the First report of Injury (DWC-1) to the Wage Statement (DWC-1a) to confirm that the employee’s name, SSN, and other identifying information, and the date of injury on the two forms are consistent.

  1. Death Claims – when an injury results in death, the employer must, before filing the DWC-1, notify the Division within twenty-four (24) hours, by telephone or other means

a.   In addition, the employer must notify the carrier within seven (7) days. [440.185(3) and Fla. Admin Code R. 69L-3.004(2)(d)].

A.  Penalties for Employers

If an employer fails or refuses to report an accident, the employer is subject to an administrative fine of up to $500.00 for such failure or refusal [§440.185(9) Fla. Stat. (10/1/2013)].

And here is a case showing how an Employer can actually lose WC immunity by failing to report claims:

Ocean Reef Club, Inc. v. Wilczewski and Leon, 99 So.3d 1 (Fla. 1st DCA 2012). 

            The Claimants, Wilczewski and Leon, worked in a beauty salon as a nail technician and hair stylist.  They both alleged continual exposure to toxic fumes used in the salon caused them to experience asthma like symptoms.  Both stated they reported their injuries to a supervisor, although the supervisor never advised the Carrier of the complaints.  The Claimant then filed a civil suit for damages against the Employer, who in turn then notified the Carrier of the claims.  The Employer moved for summary judgment in the civil action claiming immunity from tort action due to exclusive remedy of workers’ compensation. The parties agreed the Claimants advised the Employer of their injuries, however the Employer argued the Claimants had a duty to report the injuries to the Carrier as well.  The trial court denied the motion for summary judgment finding immunity did not apply given the facts of the case.

The First DCA agreed and upheld the lower court’s ruling.  The court opined that where an employer fails to satisfy its duty to inform the carrier of potential claims for workers’ compensation benefits, the employer is estopped from raising an immunity defense to a civil claim based upon the same.  Thus, the Claimants were permitted to move forward in their civil negligence claims. 

Morgan Indek | Partner