Florida Form DWC-25 (officially DFS-F5-DWC-25) is the standardized medical treatment and status report that treating physicians use to update a workers’ compensation carrier and employer on an injured worker’s condition. It does four things at once: requests authorization for a treatment plan, reports the worker’s current medical status, documents the date of maximum medical improvement, and records any permanent impairment rating.1Florida Department of Financial Services. Florida Workers’ Compensation Uniform Medical Treatment/Status Report Form The form is incorporated by reference in Florida Administrative Code Rule 69L-7.720, which also points to a companion instruction sheet, Form DWC-25-A, with field-by-field guidance for physicians and recognized practitioners.2Legal Information Institute. Florida Admin Code Ann R 69L-7.720 – Forms Incorporated by Reference for Medical Billing, Filing and Reporting
Filing Deadlines You Cannot Miss
Florida Statute 440.13(4)(a) drives the schedule. After the first treatment of an injured worker, the physician must send a preliminary notice of the injury and treatment to the employer or carrier by the close of the third business day after that first visit. A complete report follows within 15 days of that preliminary notice. After the initial filings, the carrier or employer may request progress reports at intervals no shorter than three weeks apart.3The Florida Senate. Florida Code 440.13 – Medical Services and Supplies; Penalty for Violations; Limitations
Three business days is tight. Most offices build the preliminary notice into intake for any patient who identifies an injury as work-related. Missing that window does not extinguish the claim, but a late notice gives the carrier grounds to challenge the treatment charges. The 15-day deadline is where the full DWC-25 typically lands, carrying the diagnosis codes, treatment plan, and work-status assessment the carrier needs before authorizing ongoing care.
Completing the Form
The form instructs providers to “legibly and accurately complete all sections of this form, limiting their responses to their area of expertise.” Form DWC-25-A (revised January 2015) contains the official field-level instructions. The entries fall into three working groups.
Claim Identification
The top of the form collects the insurer’s name and address, the injured worker’s full legal name, date of birth, Social Security number, the employer’s name, and the date of accident. These fields tie the report to an existing claim file. A single transposed digit in the Social Security number can cause a carrier’s system to reject the filing or route it to the wrong adjuster. Cross-checking against the original first report of injury saves rework on both ends.
Clinical Findings and Treatment Plan
The clinical section requires the physician to describe the worker’s condition using ICD-10-CM diagnosis codes. These codes follow the official ICD-10-CM Coding Guidelines published by CMS and the National Center for Health Statistics, and their use is required under HIPAA for all healthcare settings.4Centers for Medicare and Medicaid Services (CMS). ICD-10-CM Official Guidelines for Coding and Reporting The carrier cross-references these codes against medical necessity guidelines when deciding whether to authorize the requested treatment.
Below the diagnosis codes, the physician lays out the treatment plan. This is the section that triggers the authorization decision. It might include physical therapy sessions, specialist referrals, diagnostic imaging, prescription medications, or a surgical recommendation. Vague plans invite denial. The more specific the request (number of sessions, type of imaging, name of specialist), the faster the carrier can act on it.
Work Status and Functional Limitations
A dedicated section asks the physician to spell out what the employee can and cannot do physically: lifting limits, standing restrictions, limitations on repetitive motion, and prohibitions on specific activities. These entries decide whether the worker returns to full duty, gets modified or light-duty assignments, or stays off work entirely.1Florida Department of Financial Services. Florida Workers’ Compensation Uniform Medical Treatment/Status Report Form
Employers use these restrictions to decide whether they have a role that fits. If the physician writes “no lifting over 10 pounds” but the worker’s regular job involves 50-pound loads, the employer either offers a different position or the worker stays on temporary disability benefits. Ambiguous restrictions like “limited activity” without numbers create disputes that can reach a Judge of Compensation Claims.
Maximum Medical Improvement and Impairment Rating
At some point the treating physician determines that the worker has reached maximum medical improvement, the date after which further recovery from the injury can no longer reasonably be anticipated based on reasonable medical probability.5Florida Senate. Florida Code 440.02 – Definitions The MMI date goes on the DWC-25, and when applicable, so does a permanent impairment rating.
Florida uses the 1996 Florida Uniform Permanent Impairment Rating Schedule. The rating is expressed as a percentage of impairment to the body as a whole, and it directly controls how long the worker receives impairment income benefits. For accidents on or after October 1, 2003, the schedule is:6The Florida Senate. Florida Code 440.15 – Compensation for Disability
- 1–10 percent impairment: 2 weeks of benefits per percentage point
- 11–15 percent impairment: 3 weeks per percentage point
- 16–20 percent impairment: 4 weeks per percentage point
- 21 percent and above: 6 weeks per percentage point
Impairment income benefits begin the day after MMI or the expiration of temporary benefits, whichever comes first, and once the carrier learns the rating, it has 14 days to start paying them.7Florida Department of Financial Services. Division of Workers’ Compensation – Impairment Income Benefits Because a single percentage point can add weeks of payments, the rating on the DWC-25 is one of the most consequential numbers in the claim. Clinical findings should be documented thoroughly enough to support the rating if it is later challenged.
Where to Send the Form
The completed DWC-25 goes to both the insurance carrier and the employer. Florida law requires transmission to both.3The Florida Senate. Florida Code 440.13 – Medical Services and Supplies; Penalty for Violations; Limitations Most offices transmit electronically through the carrier’s provider portal, secure fax, or encrypted email. Standard mail is acceptable but eats into the deadlines. If the employer receives the form before the carrier does, the employer is responsible for forwarding it promptly.
The blank form is available in Word format on the Florida Department of Financial Services website, along with the DWC-25-A completion instructions.1Florida Department of Financial Services. Florida Workers’ Compensation Uniform Medical Treatment/Status Report Form Offices that generate the form through an electronic health record system should confirm the output matches the official format. Carriers occasionally reject submissions that omit required fields or rearrange sections.
Handling Protected Health Information
The DWC-25 contains protected health information, but HIPAA does not block sending it. Under 45 CFR 164.512(l), a covered entity may disclose PHI as authorized by and to the extent necessary to comply with workers’ compensation laws, without a separate patient authorization.8eCFR. 45 CFR 164.512 – Uses and Disclosures for Which an Authorization or Opportunity to Agree or Object Is Not Required The disclosure must still be limited to the minimum information necessary for the workers’ compensation purpose. Unrelated medical history from the same chart does not belong attached to the DWC-25.
On the employer’s end, the ADA requires that medical information received through the workers’ compensation process be kept separate from the employee’s regular personnel file. Access should be limited to supervisors and managers who need the work-restriction information to arrange modified duties, and to insurance or workers’ compensation personnel handling the claim. In practice, that means a locked file or an encrypted digital folder rather than the general HR file.
If the Worker Disagrees with the Report
An injured worker who disagrees with the physician’s findings on the DWC-25 (the diagnosis, restrictions, MMI date, or impairment rating) has options, but they follow a statutory path rather than an informal one.
The simplest step is a one-time change of physician. Under Florida Statute 440.13(2)(f), the injured employee may submit a written request to the carrier for one change of treating physician per accident. The carrier then has five days to authorize an alternative physician who is not professionally affiliated with the original. If the carrier misses that window, the employee may select a physician on their own, and that provider is considered authorized as long as the treatment is compensable and medically necessary.3The Florida Senate. Florida Code 440.13 – Medical Services and Supplies; Penalty for Violations; Limitations
When two physicians disagree about the medical evidence, the need for treatment, or the employee’s ability to return to work, either party, or the Judge of Compensation Claims on the judge’s own initiative, may request an Expert Medical Advisor. The request must be in writing, and the JCC has 15 days from receipt to act on it. If the parties cannot agree on who should serve, the JCC picks one from the state’s certified list. The EMA’s opinion is presumed correct unless rebutted by clear and convincing evidence, a high legal standard that is difficult to meet.9Florida Senate. Florida Code 440.13 – Medical Services and Supplies; Penalty for Violations; Limitations A worker who refuses to attend an EMA evaluation forfeits compensation for the period of noncompliance, so skipping the appointment is not a workable response even when the employee disputes the process.