Greetings,

There is quite a bit of confusion as to what timeframe an adjuster has to respond to a request for benefits under
Florida law. And the answer is..it depends how they ask and who is asking.

Good Faith Letter: There is no requirement an adjuster responds to these (UNLESS it contains a request for a 1-
time change, and then you must respond in 5 calendar days from when the carrier received it). Why are these
sent then? Under 440.192(4), a claimant cannot file a PFB unless they can certify they made a “good faith” effort
to resolve the dispute first. A “good faith” effort arguably doesn’t have to be in writing, it could be as minimal as a
voicemail left for you. A Good Faith Letter is a heads up to you that a PFB is soon to follow, but it doesn’t trigger a
required response.

Petition for Benefits: There is some confusion on this because the statute is inconsistent. Under 440.192(8) it says
within 14 days after the PFB a carrier must respond. However, under 440.34(3)(d) no attorney fees are due or
owing until after 30 days from when the carrier receives the PFB. Many carriers take the position that it is 14 days,
and that is a safe way to go, but there are times you may need a few more days to make sure you are answering
correctly. As long as a denial of any benefit is rescinded prior to 30 days after a PFB, no attorney fees are due or
owing. Penalties, interest and costs may be due on any benefits requested if they are late, regardless of the PFB
response time.

And even though you have 14/30 days to respond, the 5 days still applies for a 1-time change.
Request From an Authorized Doctor’s office: Under 440.13(3) (d) and (i), the carrier must respond to a request
from an authorized provider in 3 days if the treatment costs less than $1,000 or 10 days if more than $1,000 or
we waive the right to challenge medical necessity. The statue and caselaw do not require that you make a
decision in 3/10 days, just respond. We are investigating is a response. If the carrier doesn’t respond, we can still
challenge that the accident is not the Major Contributing Cause of the treatment, but we can’t say the claimant
does not need the treatment.

The 3/10 days does not apply if the request comes from opposing counsel or the claimant, receipt from the
doctor’s office directly triggers the time clock.

If anyone wants to learn more about these fun topics, our firm has a CEU we can schedule for your company.
Morgan Indek | Managing Partner