Dwc-4 Form 2016-2024

Dwc-4 Form: What You Should Know

The Florida Legislature provided that DWC workers are entitled to a copy of their DWS-F2-DWC-4. The Florida Workers' Compensation Rules contain an explicit requirement that a copy of the DWS-F2-DWC-4 be attached to the original DWS-F2-DWC-4, and each copy must include the correct medical certificate of the injured worker. The Florida Workers' Compensation Rules also contain detailed guidance about the notice of action, such as: Notice of Action Notice of Timely Actions, (DFS-F1-DFS-F3) ..........................pdf and Notice of Change of Medical Certificate of an Injured Worker, (DFS-F1-DFS-F4) ..........................pdf and Notice of Timely Actions (DFS-F1-DWS-F1) The Division of Workers' Compensation must include the medical certificate, or it is not required to submit a Notice of Action/Change (DFS-F2-DWC-4), even if a new medical certification is provided by the injured worker. In the case of a change in a medical certification, a Notice of Action/Change (DFS-F2-DWC-4) will be required. The following examples illustrate the requirements: Example 1 Injured worker changes his or her medical certificate (including the time interval between initial and follow-up examinations). After the medical documentation has been sent, and the injured worker receives the DWS-F1-DFS-F3, an DWC worker may submit two forms to obtain a new medical certificate: Form W-1 (change in medical certificate) form must be used to obtain a medical certificate. W-2 (new medical certificate, required) medical certificate must be accompanied by a new medical certificate, which must provide all the changes in the medical certificate. Form F-14 (new medical certificate or change in medical certificate) medical certificate must be accompanied by a completed Application for Change of Medical Certification, and must be signed, in duplicate, by the new medical certificate or a medical certified of the injured worker. In order to submit the application, the DSP, with approval from DWC-Determinations/DWC-Administration, may use “change form W-1” for a “new” medical certificate or “change form F-14” for a “change in medical certificate.

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