Qualified Servicing Entity Applications and Recertifications

A Qualified Servicing Entity (QSE) may provide carriers with claims adjusting, loss control or safety engineering services. Insurance companies and other business entities (non-insurance companies) who are interested in becoming a QSE must follow the application process below:

Application Process

• The QSE application process for a business who’s primary business is not an insurance company must file Form SI-22 Qualified Servicing Entity Application as required by rule 69L-5.229(1)(a), F.A.C.
• The application process for an insurance company that also wants to be a QSE must file Form SI-22 Qualified Servicing Entity Application as required by rule 69L-5.229(2), F.A.C.
  • QSE/TPA Identification Form (Attachment)
  • Service Agreement Form (Attachment)

Annual Recertification Requirements

All approved Qualified Servicing Entities are required to annually recertify with the Division of Workers’ Compensation. A QSE must submit a completed Form SI-23 Qualified Servicing Entity Annual Report no later than March 1st. (69L-5.230(11), F.A.C.)