69L-10.007. Notice of Claim

A Notice of Claim for reimbursement from the SDTF shall be filed with the SDTF, Division of Worker’s Compensation, 200 East Gaines Street, Tallahassee, FL 32399-4223. The Notice of Claim may be filed by letter form and shall include the following: (1) Name and social security number of the employee; (2) The name and address of the employer; (3) The date of the accident; (4) The name and address of the insurance carrier, self-insurance fund or employer on whose behalf the claim is made.