Proof of Claim (SDF-1) Process

Our goal is to ensure that the process of filing a Proof of Claim (SDF-1) is as straightforward as possible; however, the outline below is not legal advice. The instructions below are provided in an effort to assist you in the accurate and timely submission of your Proof of Claim (SDF-1). Dates of accident occurring on or after January 1st, 1998 are barred from recovery by the SDTF.

For Dates of Accident through December 31st, 1993
What you need to establish your claim with the SDTF:

There are four fundamental elements that must be demonstrated before reimbursement can be obtained from the SDTF. Those four elements are:

1. The injured worker must have had a pre-existing permanent impairment Section 440.49(4), F.S.);
2. The employer must have known of the preexisting permanent impairment prior to the accident for which reimbursement is being sought and reached an informed conclusion that the preexisting permanent impairment was likely to be a hindrance or obstacle to employment (Section 440.49(1)(f)1. (F.S., 1993);
3. The new injury must result in a new disability and the new disability must merge with the preexisting disability. Merger is defined in Section 440.49(2)(b)2, F.S. (1993);
4. There must be payment of permanent compensation such as wage loss, permanent total disability or death.

The maximum limits on the recovery for dates of accident through December 31, 1993 are as follows:

Benefit Type	Maximum Reimbursement can not exceed:
Temporary Total and Medical:	50% of the first 10,000; 100% of all benefits paid in excess of $10,000.
Permanent Impairment:	60% of impairment benefits paid.
Wage Loss:	60% of wage loss benefits paid in the first 5 years; 75% of wage loss paid after 5 years.
Permanent Total:	100% of permanent total disability benefits paid after the first 175 weeks.
Death:	75% of all death benefits paid; 75% of all funeral expenses paid.

 

For Dates of Accident January 1st, 1994 through December 31, 1997
What you need to know to establish your claim with the SDTF:

There are three fundamental elements that must be demonstrated before reimbursement can be obtained from the SDTF. Those three requirements are as follows:

1. The injured worker must have had a listed pre-existing permanent impairment (Section 440.49(6) (a) 1-26, F.S.);
2. The employer must have had knowledge of the preexisting permanent impairment prior to the occurrence of the new accident (Section 440.49(6) (a), F.S.); and
3. The new injury must result in a new disability which merges with the preexisting disability. Merger is defined in Section 440.49(2)(c), F.S.

For dates of accident on January 1, 1994 through December 31, 1997, there is a $10,000 deductible after which recovery limits are as follows:

Benefit Type	Maximum Reimbursement can not exceed:
Temporary Total, Temporary partial, Medical and attendant care:	50% of all payments.
Impairment benefits:	50% of impairment benefits paid.
Supplemental Wage Loss:	50% of wage loss benefits paid.
Permanent Total:	50% of permanent total disability benefits paid.
Death:	50% of all death benefits paid and 50% of all funeral expenses paid.

 

What you must do to establish your claim with the SDTF:

In order to establish a claim with the Special Disability Trust Fund, the carrier may provide written notice, as specified by Florida Administrative Rule 69L-10.009. The carrier must also file a completed Proof of Claim (SDF-1), along with all documentation required to establish the Proof of Claim (SDF-1).
The Notice of Claim can be filed with the SDTF separately or with the Proof of Claim (SDF-1). The Notice of Claim can be filed by the carrier or its representative (generally a lawyer) and may be in the form of a letter. The Notice of Claim must include the following elements and be filed with the SDTF at the address listed below:

1. Name of the employee;
2. Social Security Number of the employee;
3. The name and address of the employer;
4. The date of the accident;
5. The name and address of the carrier
    

Dirección Postal

Special Disability Trust Fund 200 East Gaines Street Tallahassee, Florida 32399-4223

 

Filing a Proof of Claim (SDF-1)

Whether the Notice of Claim is filed separately, or with the Proof of Claim (SDF-1), a claim is not ripe for review until a completed Proof of Claim, as well as all documentation required by DFS Form DFS-F1-SDF-1 (Rev. 3-09), has been received. However, if the Notice of Claim is filed separately from the Proof of Claim (SDF-1), the Proof of Claim (SDF-1) must be filed within 1 year after the date on which the Notice of Claim is received by the SDTF.

The required documents, which are described in the instructions that accompany the Proof of Claim (SDF-1), must be organized according to the schedule under which they are identified. The five schedules are summarized below for your convenience:

• Schedule A:  Evidence of a Pre-existing medical condition;
• Schedule B:  Details of the accident for which reimbursement is claimed;
• Schedule C: Evidence of the employer’s knowledge of the pre-existing medical condition prior to the accident for which reimbursement is claimed;
• Schedule D: Relevant court orders; Notices of Action/Change Forms (DWC-4); Request for Wage Loss Forms (DWC-3); and, most recent Progress/Final Report Form (DWC-13) showing all benefits paid;
• Schedule E:  Copies of any record on appeal, if relevant to your claim.

You can learn more about the documents that must be included with your completed Proof of Claim (SDF-1) in the following SDTF statute and rule:

• 69L-10.011 (Informed Conclusion of Pre-existing Conditions for Proof of Claim)
• 440.49(3), (6) and (7), Florida Statutes
   

Time and Procedure for Filing Claims with the SDTF

There are time limitations for filing a claim against the SDTF that are determined by the date of accident for which the claim is to be established. A summary of the time limitations is provided below. 

Date of Accident:	Time Limitations for Filing a Claim
Prior to July 1, 1987	Claim must be filed with the SDTF within 60 days after the date of the first payment of permanent benefits
On or after July 1, 1987	Claim must be filed within 2 years after the injured worker first reached maximum medical improvement (MMI), or the payment of permanent benefits, whichever is later.

 Once submitted to the SDTF, the completed Proof of Claim (SDF-1), and all required documentation, will be placed in-line for review. Once the Proof of Claim (SDF-1) has been placed in-line for review, the SDTF will either notify the carrier, in writing, of any incomplete elements of the claim, or make a formal determination regarding the claim. Any incomplete claim will not be reviewed by the SDTF until the missing information or document has been provided, to the SDTF, by the carrier.

The carrier will receive written acceptance or denial, once the SDTF has completed its review of the fully completed Proof of Claim (SDF-1). The SDTF’s acceptance is an offer of reimbursement on the reviewed Proof of Claim, which must be accepted in writing as stated in 69L-10.014, FL Admin Code. Once the  offer has been accepted, the carrier can now annually submit a request for reimbursement of benefits paid on the claim. For denied claims, the carrier will be afforded appeal rights, which will be stated in the SDTF’s written denial.

If you would like to know more about the process for filing a Reimbursement Request (SDF-2 ), please read the next section, the Reimbursement Request Process.