Florida Form P-5.0700 is the Notice of Election of Payment of Permanent Total Disability Benefits in Lieu of Reemployment Services that an injured worker files with the Florida Division of Workers’ Compensation when the worker chooses ongoing PTD-style benefits instead of vocational reemployment services. The form locks in a long-term financial choice that affects monthly checks, retraining rights, and offsets against Social Security Disability under Florida Statute § 440.491.
Each year, the Bureau of Employee Assistance and Ombudsman Office fields more than 30,000 calls from injured workers, and a meaningful share involve confusion over whether to elect PTD-style payments or pursue retraining through the Reemployment Services unit. Filing P-5.0700 incorrectly can delay benefits for weeks, trigger a denial letter from the carrier, or waive rights you did not mean to give up.
Here is what you will learn in this guide:
- 📝 What every box and signature line on Form P-5.0700 actually asks for
- ⏰ The deadlines tied to Maximum Medical Improvement (MMI) and the 60-day carrier report under § 440.491
- 📂 The exact attachments, IDs, and prior filings to gather before you start
- 👤 Three real-world walk-throughs from a roofer, a CNA, and a long-haul driver
- ⚖️ How the election interacts with SSDI offsets, Medicare set-asides, and impairment income benefits
What the Form Is and Who Must File It
Form P-5.0700 is a one-page election notice used inside the Florida workers’ compensation system. The injured worker signs it to say, in writing, that the worker chooses to receive permanent total disability (PTD) benefit payments rather than enrolling in the state’s reemployment (vocational rehabilitation) services. Once the Division of Workers’ Compensation accepts the form, the carrier processes PTD checks and the Reemployment Services file is closed.
The form exists because Florida law gives injured workers a choice when their treating physician places them at MMI with a permanent impairment that prevents a return to suitable gainful employment. Under Fla. Stat. § 440.15(1), PTD pays 66 2/3% of the average weekly wage. The reemployment track under § 440.491 funds training and placement services instead. P-5.0700 is the formal way to pick the first path and waive the second.
The primary filer is the injured worker. An attorney of record may sign on the worker’s behalf when authorized, and a court-appointed guardian may sign for an incapacitated claimant. Employers and carriers do not file this form for the worker, but the carrier receives a copy and uses it to adjust benefit coding. The Office of the Judges of Compensation Claims may also receive a copy when the file is in active litigation through the JCC e-filing portal.
The form’s revision date is printed in the lower left corner of the official PDF. Always confirm you are using the current revision before filing, because the Division updates form numbers and barcodes periodically. An outdated revision may be rejected and returned by mail, costing you 10–14 days.
Before You Start: Documents and Information You Need
Gather every item below before you open the PDF. Filling out P-5.0700 with missing data is the leading reason claimants resubmit the form.
- Your full legal name as it appears on your Social Security card, because the Division cross-checks names against the carrier’s wage records and a mismatch flags the file for manual review.
- Date of injury (DOI) in MM/DD/YYYY format, because the DOI controls which version of Chapter 440 applies and which AWW calculation governs your check.
- Claim number / OJCC case number assigned by the carrier and, if litigated, the Office of the Judges of Compensation Claims, because the Division indexes the form by claim number.
- Employer’s legal name and FEIN at the time of injury, because the carrier links your election to the correct policy period.
- Carrier name, claims office address, and adjuster contact, because the carrier must receive a copy the same day you file.
- MMI date and impairment rating from your authorized treating physician’s DWC-25, because PTD eligibility hinges on a documented MMI with a qualifying impairment.
- Average weekly wage (AWW) from the DWC-1a wage statement, because PTD pays 66 2/3% of AWW and the Division checks math.
- Photo ID (Florida driver’s license or state ID) and Social Security number, because the Division verifies identity before changing benefit type.
- Notary access for jurisdictions that require notarization of the signature line.
- Prior election or revocation notices, because the Division will reject a duplicate election if a prior P-5.0700 is already in the file without a valid revocation.
Where to Get the Form and How to Access It
The official form lives on the Division’s Workers’ Compensation Forms page under Division 69L of the Florida Administrative Code. Download the PDF directly from the Division site rather than third-party blogs, because outside copies are sometimes outdated or watermarked in ways that make them unreadable to the Division’s scanner.
You can complete the form on a computer using Adobe Acrobat Reader, which is free. Typing your entries into the PDF is preferred over handwriting because the Division’s optical character recognition (OCR) reads typed entries with far fewer errors. If you must handwrite, use blue or black ink and print in block letters.
Some county-level claimant assistance offices and the Employee Assistance Office (EAO) will print a paper copy for you on request. The EAO ombudsmen will not fill the form out for you, but they will explain each line at no cost. Their toll-free number is 1-800-342-1741.
If your claim is in litigation, your attorney typically pulls the form from the Division site and pre-populates the header from the OJCC case caption. Self-represented (pro se) filers can do the same by copying the caption from any prior order in the file.
Step-by-Step: How to Fill Out Form P-5.0700 Line by Line
The form is organized into a header (caption), a body (election language), and a signature block. Each subsection below walks one field, in the order it appears, with all six expansion elements: plain English, how to answer, example entry, nuance, common mistake plus consequence, and a misconception.
Box 1 — Injured Employee’s Full Legal Name
The first box asks for your full legal name. Enter your first name, middle name, and last name exactly as they appear on your Social Security card. Use all capital letters and avoid nicknames or abbreviations.
For example, MARIA ELENA LOPEZ writes her name on the line as printed, with one space between each name. If you have a suffix such as Jr. or III, place it after the last name with a space.
A common nuance is hyphenated or recently changed names. If you married after the date of injury and changed your last name, write the name on your current Social Security card and add the prior name in parentheses, like MARIA LOPEZ (FORMERLY MARIA RIVERA). This prevents confusion when the carrier matches your election to wage records filed under the prior name.
The most common mistake is writing a nickname like Lena instead of Maria Elena. The direct consequence is that the Division’s OCR cannot match the file, and the form bounces back with a deficiency letter that adds 7–14 days to processing.
A frequent misconception is that the name on your driver’s license is the right name to use. It is not. The Division matches against Social Security Administration records, so the SSA name controls.
Box 2 — Social Security Number
This box asks for your nine-digit SSN. Type it as XXX-XX-XXXX with hyphens. Do not leave any digits blank.
For example, Marcus Johnson writes 123-45-6789. The Division uses the SSN to confirm identity, link prior filings, and coordinate with the SSA on offset calculations.
A nuance: workers without an SSN who file under an Individual Taxpayer Identification Number (ITIN) should write the ITIN in the same format and add (ITIN) to the right of the number. The Division accepts ITINs for benefit administration.
The common mistake is transposing digits. The consequence is severe: the carrier may issue PTD checks under the wrong identity, and recovering them requires a written correction and adjuster sign-off. A misconception is that you can leave the SSN blank “for privacy.” You cannot. The Division cannot process an election without it.
Box 3 — Date of Injury
This field asks for the date your work injury occurred. Use MM/DD/YYYY format with leading zeros, like 03/14/2023.
For example, Carlos Mendez, a roofer who fell from a ladder on March 14, 2023, writes 03/14/2023. The DOI is critical because Chapter 440 has been amended over the years, and the version of the statute that controls your case is the one in effect on your DOI.
A nuance arises with repetitive trauma or occupational disease claims, where there is no single accident date. In that case, write the date the worker first reported the condition or first sought medical care, whichever came first. The carrier’s DWC-1 First Report of Injury usually lists this date.
The common mistake is writing the date you first missed work instead of the date of injury. The consequence is the wrong AWW and impairment rules apply, and the Division will reject the form. A misconception is that the DOI is the date of MMI. It is not. MMI goes in a different box.
Box 4 — Claim Number
This box asks for the carrier’s claim number and, when applicable, the OJCC case number. Type both, separated by a slash, like WC-2023-04567 / 23-012345JFK.
For example, Jamal Williams writes FL-WC-99887 / 24-007654DAL. The claim number lives in the upper right of every adjuster letter, the DWC-25, and prior PFBs.
The nuance is that some self-insured public employers use internal claim formats with letters and dashes. Copy the format exactly. Do not strip dashes or spaces.
The common mistake is using the policy number instead of the claim number. The consequence is the form is filed against the wrong record, the carrier never sees it, and benefits are not adjusted. A misconception is that the claim number is the same as the OJCC case number. They are usually different, and you should list both.
Box 5 — Date of Maximum Medical Improvement (MMI)
This field asks for the date your authorized treating physician determined you reached MMI. Pull the date from the DWC-25 and enter it in MM/DD/YYYY format.
For example, Aisha Patel, a CNA with a torn rotator cuff, lists her MMI as 11/02/2025 because that is the visit date on her orthopedist’s DWC-25 marked “MMI Yes.”
A nuance: if you have multiple body parts and they reached MMI on different dates, use the latest date, because PTD election follows the overall MMI determination. Attach all DWC-25s as proof.
The common mistake is using the date of the doctor’s appointment where MMI was discussed but not declared. The consequence is the carrier disputes the election as premature, and benefits are not converted. A misconception is that only a doctor of medicine can declare MMI. Under § 440.15(3), a physician (MD, DO, chiropractor where authorized, etc.) declares MMI within their scope.
Box 6 — Permanent Impairment Rating (PIR)
This box asks for your whole-body permanent impairment rating expressed as a percentage. Type the number followed by a percent sign, like 18%.
For example, Carlos Mendez writes 22% because his orthopedist assigned a 22% whole-body impairment after his lumbar fusion.
The nuance is the difference between body-part rating and whole-body rating. P-5.0700 uses whole-body. If your DWC-25 lists 30% to the lumbar spine, you must convert that to whole-body using the Florida Uniform Permanent Impairment Rating Schedule that applies to your DOI.
The common mistake is writing a body-part rating instead of whole-body. The consequence is the Division flags an inconsistency with the DWC-25 and returns the form. A misconception is that any impairment rating qualifies for PTD. It does not. PTD requires a showing that the worker is permanently and totally unable to engage in at least sedentary employment within a 50-mile radius, per § 440.15(1)(b).
Box 7 — Election Statement and Checkbox
This is the heart of the form. The box contains the statutory election language and a checkbox you must mark to confirm your choice. Read the paragraph carefully, then mark the box stating that you elect PTD benefits in lieu of reemployment services under § 440.491.
For example, Jamal Williams reviews the paragraph and checks the box marked I elect to receive permanent total disability benefits and waive my right to reemployment services.
The nuance is that the election is generally final. While Florida case law allows narrow revocation in some circumstances, you should treat the checkbox as permanent for planning purposes. Talk to a lawyer or an EAO ombudsman before checking it.
The common mistake is checking both boxes (electing PTD and electing services) when the form has dual options. The consequence is the form is void and must be re-signed. The misconception is that you can pick PTD now and add reemployment services later. Once you waive services, the Division closes the vocational file.
Box 8 — Mailing Address
This field asks where the Division and carrier should send correspondence. Type your full street address, apartment or unit number, city, two-letter state, and ZIP+4, like 4218 NW 22ND ST, APT 7B, MIAMI, FL 33142-3105.
For example, Aisha Patel writes 112 OAKMONT LN, ORLANDO, FL 32801-4422. If your benefits are direct-deposited, the address still controls 1099 mailing.
The nuance is P.O. boxes. The Division accepts P.O. boxes for correspondence, but if you also want street delivery (for example, for a check by overnight courier), include both with the street address listed first.
The common mistake is using a temporary address (motel, friend’s home) without filing a change-of-address later. The consequence is missed correspondence and possible benefit suspension. The misconception is that the carrier already has your address. The Division updates only what you write here, not what is in the carrier’s file.
Box 9 — Phone Number and Email
This box asks for a daytime phone and an email address. Type the phone in (XXX) XXX-XXXX format and the email in lowercase.
For example, Carlos Mendez writes (305) 555-0142 and carlos.mendez@example.com. The Division uses these to contact you for deficiencies before issuing a rejection letter.
The nuance is that some pro se filers do not have email. Leave it blank rather than borrowing someone else’s, because email triggers electronic notice that you may not see.
The common mistake is listing a disconnected phone. The consequence is missed deficiency calls and a slower process. The misconception is that the Division will only mail you. They often call first to fix small errors.
Box 10 — Attorney Information (If Represented)
This block asks for your attorney’s name, Florida Bar number, firm, address, phone, and email. If you are pro se, write N/A across the block.
For example, Janet Brooks, represented by attorney David Kim, Esq., Fla. Bar No. 0123456, lists his firm at Kim & Associates, 800 Brickell Ave, Suite 200, Miami, FL 33131.
The nuance is that listing an attorney creates a notice obligation: the carrier must send all benefit correspondence to the attorney. Do not list a non-attorney advocate here.
The common mistake is listing a paralegal’s name. The consequence is invalid service. The misconception is that listing an attorney binds the attorney to the case. It does not; only a separate Notice of Appearance does that.
Box 11 — Signature of Injured Employee
This is the dated signature line. Sign in blue or black ink. Print your name beneath. Date in MM/DD/YYYY format.
For example, Jamal Williams signs his cursive signature, prints JAMAL R. WILLIAMS, and writes 01/15/2026.
The nuance is electronic signatures. Florida accepts e-signatures on workers’ compensation forms when the platform meets the Uniform Electronic Transaction Act requirements. DocuSign and Adobe Sign qualify.
The common mistake is signing without dating. The consequence is the form is unfiled and returned. The misconception is that a typed name in the signature box is enough. It is not unless an e-signature platform applied a verifiable seal.
Box 12 — Notary Acknowledgment
Some Division offices require notarization. The notary block asks for the notary’s name, commission number, expiration, and seal.
For example, Aisha Patel signs in front of a Florida-commissioned notary who completes the block with seal and signature on 11/15/2025.
The nuance is remote online notarization (RON). Florida allows RON under § 117.201–305, and the Division accepts properly executed RON acknowledgments.
The common mistake is signing the form before going to the notary. The consequence is the notary must reject and re-administer the oath. The misconception is that any out-of-state notary works. The notary must be commissioned where the signature is given, and Florida-based filings are typically notarized in Florida.
Three Filled-Out Examples Using Real Scenarios
Scenario 1 — Carlos Mendez, Roofer With a Lumbar Fusion
| Form Section | What Carlos Enters |
|---|---|
| Full legal name | CARLOS A. MENDEZ |
| SSN | 234-56-7890 |
| Date of injury | 03/14/2023 |
| Claim number / OJCC case | WC-2023-04567 / 23-012345MIA |
| MMI date | 09/22/2025 |
| Permanent impairment rating | 22% |
| Election checkbox | ✓ PTD in lieu of reemployment services |
| Mailing address | 4218 NW 22ND ST, APT 7B, MIAMI, FL 33142 |
| Phone / email | (305) 555-0142 / carlos.mendez@example.com |
| Attorney | David Kim, Esq., Fla. Bar No. 0123456 |
| Signature / date | Carlos A. Mendez / 10/03/2025 |
| Notary | Notarized 10/03/2025, Comm. HH-112233 |
Scenario 2 — Aisha Patel, CNA With a Rotator Cuff Tear
| Form Section | What Aisha Enters |
|---|---|
| Full legal name | AISHA R. PATEL |
| SSN | 345-67-8901 |
| Date of injury | 06/10/2024 |
| Claim number / OJCC case | FL-WC-77821 / N/A (no litigation) |
| MMI date | 11/02/2025 |
| Permanent impairment rating | 14% |
| Election checkbox | ✓ PTD in lieu of reemployment services |
| Mailing address | 112 OAKMONT LN, ORLANDO, FL 32801 |
| Phone / email | (407) 555-0188 / a.patel@example.com |
| Attorney | N/A (pro se) |
| Signature / date | Aisha R. Patel / 11/15/2025 |
| Notary | Notarized 11/15/2025, Comm. GG-998877 |
Scenario 3 — Jamal Williams, Long-Haul Driver With a TBI
| Form Section | What Jamal Enters |
|---|---|
| Full legal name | JAMAL R. WILLIAMS |
| SSN | 456-78-9012 |
| Date of injury | 08/05/2022 |
| Claim number / OJCC case | WC-2022-99887 / 22-009988JAX |
| MMI date | 12/18/2025 |
| Permanent impairment rating | 35% |
| Election checkbox | ✓ PTD in lieu of reemployment services |
| Mailing address | 2901 RIVER OAK DR, JACKSONVILLE, FL 32207 |
| Phone / email | (904) 555-0177 / jwilliams@example.com |
| Attorney | Maria Gonzalez, Esq., Fla. Bar No. 0987654 |
| Signature / date | Jamal R. Williams / 01/15/2026 |
| Notary | Notarized 01/15/2026, Comm. HH-554433 |
How to File the Completed Form
You may file P-5.0700 by mail, in person, by fax, or through the Division’s secure document portal where eligible. Each channel has its own delivery rules, and you should always retain a date-stamped copy as proof of filing.
By mail. Send the original signed form to the Division of Workers’ Compensation, Bureau of Employee Assistance and Ombudsman Office, 200 East Gaines Street, Tallahassee, FL 32399-4226. There is no filing fee. Use USPS Certified Mail with Return Receipt for proof. Expect 10–14 business days for processing. Keep the green card and the certified mail receipt as your proof of filing.
In person. Walk the form to the Tallahassee Division office or to a regional EAO district office. Ask the clerk to date-stamp two copies and hand one back. There is no fee. Same-day filing is reflected in the Division database within 2–3 business days.
By fax. Some district offices accept faxed copies for urgent filings. Confirm the current district fax with the Reemployment Services team at 1-800-342-1741. Follow up with the original by mail. Keep the fax confirmation page.
Online portal. Where available, log into the Division’s secure document submission portal with your claim number and SSN. Upload a scanned PDF (under 10 MB). Print the confirmation receipt. Processing time is typically 5–7 business days.
In every channel, copy the carrier’s adjuster the same day you file with the Division. The carrier’s address is in the upper-right of any benefit check stub. The carrier needs the copy to recode benefits in its system.
What Happens After You File
After the Division receives the form, the Bureau reviews it for completeness, verifies the MMI and PIR against the DWC-25 in the file, and issues either an acceptance letter or a deficiency letter. Acceptance is typical when the form is clean. A deficiency letter lists the missing item and gives you 14 days to cure.
Once accepted, the Reemployment Services file is closed and a notation is added to your Division record. The carrier converts your benefit coding to PTD, which pays 66 2/3% of AWW plus a supplemental benefit for injuries before a certain DOI cutoff. PTD payments continue until age 75 in most cases under § 440.15(1)(b).
The election may trigger SSDI offset adjustments. The combined PTD and SSDI cannot exceed 80% of your average current earnings under federal offset rules, and either Social Security or the carrier (depending on which state has reverse offset) reduces accordingly. Your Medicare set-aside, if any, may need to be revisited because the projected future medical pays differently under PTD.
If you change your mind, revocation is narrow and fact-specific. File a written motion with the Office of the Judges of Compensation Claims and be prepared to show good cause.
Mistakes to Avoid When Filling Out the Form
- Writing a nickname in Box 1 instead of your SSA legal name, which causes a name-mismatch hold that delays processing 7–14 days.
- Leaving the SSN blank “for privacy,” which makes the form unprocessable and triggers a return letter.
- Using the date you first missed work as the DOI in Box 3, which assigns the wrong statutory version and AWW to your claim.
- Confusing the carrier claim number with the policy number in Box 4, which routes the form to the wrong file.
- Picking the visit date instead of the DWC-25 MMI date in Box 5, which lets the carrier dispute the election as premature.
- Listing a body-part rating instead of whole-body in Box 6, which triggers an inconsistency flag with the DWC-25.
- Checking both election options in Box 7, which voids the form and forces a complete re-signing.
- Using a temporary address in Box 8 without later updating it, which causes missed correspondence and benefit holds.
- Listing a paralegal’s name in Box 10, which produces invalid legal service on the firm.
- Forgetting to date the signature in Box 11, which the Division treats as an unsigned form and returns.
- Skipping notarization where the district requires it, which causes the form to be rejected as improperly executed.
- Failing to copy the carrier the same day, which delays the conversion of benefit checks by 2–4 weeks.
Do’s and Don’ts
Do’s
- Do download the form fresh from the Division forms page every time, because revisions roll out without announcement.
- Do type your entries into the PDF, because OCR is far more accurate on typed text than handwriting.
- Do attach the DWC-25 showing MMI and PIR, because the Division verifies the numbers in Box 5 and Box 6.
- Do certify your mailing, because USPS Certified Mail is the cheapest defensible proof of filing.
- Do speak with an EAO ombudsman before signing, because the call is free and they catch common errors.
- Do keep a full copy of the signed form, because the Division does not return originals.
Don’ts
- Don’t sign before you understand the waiver, because the election generally closes the door on reemployment services.
- Don’t backdate the signature, because the Division compares the signature date to the notary date and any DWC-25 dates.
- Don’t use white-out, because corrections by white-out are treated as alterations and rejected.
- Don’t leave Box 7 unchecked, because an unmarked election box means the form has no legal effect.
- Don’t file without the carrier copy, because the carrier will keep paying under the old benefit code.
- Don’t rely on a fax-only filing, because some districts no longer accept fax for permanent record forms.
Pros and Cons of Filing on Your Own vs. With Help
Pros of filing pro se
- No attorney’s fee, which preserves more of your weekly check.
- Direct control over timing, which lets you file the day after MMI is declared.
- Faster small fixes, because you can call the EAO ombudsman directly.
- Fewer scheduling conflicts, since there is no third-party calendar to coordinate.
- Less paperwork on the front end, because no Notice of Appearance is required.
Cons of filing pro se
- No legal advice on whether PTD is genuinely better than reemployment services in your case.
- No representation if the carrier denies the election or disputes MMI.
- Greater risk of field-level errors that delay benefits.
- No advocate to negotiate SSDI offsets and Medicare set-aside revisions.
- Heavier administrative load on a worker who is already injured and stressed.
Pros of filing with an attorney
- Expert review of MMI, PIR, and AWW to confirm PTD is the right pick.
- Strategic coordination with SSDI, Medicare, and any third-party liability claim.
- Faster correction of carrier mistakes, because the attorney has direct adjuster contact.
- Stronger position if the case heads to the JCC for a hearing.
- Peace of mind for a permanently disabled worker focused on health.
Cons of filing with an attorney
- Attorney’s fees, generally a statutory percentage of contested past-due benefits.
- Slower timeline if the firm has a heavy caseload.
- Less day-to-day control over filing decisions.
- Some firms decline cases without significant litigation potential.
- Communication friction if the attorney is hard to reach.
Filing by Mail vs. Online Submission
| Channel | Key Tradeoffs |
|---|---|
| Mail (Certified) | Slower (10–14 days), but generates a tangible green card as proof |
| Online portal | Faster (5–7 days), but requires a scanner and a stable PDF under 10 MB |
| In person | Same-day stamp, but limited to office hours and travel cost |
| Fax | Fast send, but not all districts accept it for permanent record forms |
FAQs
Is Form P-5.0700 the same as the DWC-25?
No. The DWC-25 is the medical treatment and MMI report a physician completes, while P-5.0700 is the claimant’s election notice. They work together but are filed separately.
Do I need an attorney to file P-5.0700?
No. Pro se filers complete and file the form regularly, but a free call to the EAO ombudsman line at 1-800-342-1741 is strongly encouraged before signing.
Can I revoke the election after I file?
No. Revocation is not automatic and requires a written motion to the Judges of Compensation Claims with a showing of good cause under narrow case law.
Does electing PTD waive my right to medical care?
No. PTD election waives reemployment services only; authorized medical care under § 440.13 continues for life, subject to authorization rules.
Will my Social Security Disability check be reduced?
Yes. Combined PTD and SSDI cannot exceed 80% of average current earnings under federal offset rules, so either SSA or the carrier will reduce the smaller benefit.
Do I write my maiden name or married name in Box 1?
Yes to whichever is on your current Social Security card. If you changed names after the injury, add the prior name in parentheses to keep wage records aligned.
Can I leave Box 4 blank if I do not have an OJCC case number?
No. Always enter the carrier claim number in Box 4. Write N/A for the OJCC slot if your case is not in litigation.
Should I list the body-part rating or whole-body rating in Box 6?
No to body-part. Always enter the whole-body rating from the DWC-25, converted using the Uniform Permanent Impairment Rating Schedule that applies to your DOI.
Is notarization always required?
No. Some districts accept a witnessed signature, but notarization is the safest route and is required by some EAO offices, including remote online notarization under § 117.201–305.
Is there a filing fee?
No. The Division does not charge a fee to file P-5.0700 through any channel.
Can my spouse sign for me if I am incapacitated?
No unless your spouse is your court-appointed guardian or holds a durable power of attorney that expressly authorizes workers’ compensation filings.
How long does the Division take to confirm my election?
Yes, expect 5–14 business days depending on channel; online filings typically confirm in 5–7 days, while mailed filings take 10–14.
Does the carrier have to agree to my election?
No. The election is the worker’s right under § 440.491; the carrier processes it but does not approve it, although it may dispute the underlying MMI or PIR.
What if my employer is self-insured?
Yes, P-5.0700 still applies. File with the Division and copy the self-insured employer’s third-party administrator at the address on your benefit check stub.
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