Florida Administrative Code
60 - DEPARTMENT OF MANAGEMENT SERVICES
60Q - Division of Administrative Hearings
Chapter 60Q-3 - MEDICAL MALPRACTICE ARBITRATION
Section 60Q-3.005 - Initiation of Arbitration Proceedings

(1) All parties agreeing to arbitration shall execute and file with the Office of the Clerk a request for arbitration substantially in the following form:

"We hereby agree to submit to arbitration under Sections 766.201-.212, Florida Statutes, and Chapter 60Q-3, Florida Administrative Code, the determination of the amount of damages arising from the following medical incident: (Describe the medical incident briefly, specifying dates and the categories of damages sought).

We further agree that the determination of the amount of damages be submitted to a three-member panel constituted or reconstituted in accordance with Sections 766.201-.212, Florida Statutes, and Chapter 60Q-3, Florida Administrative Code.

We further agree that we will faithfully observe this agreement, that we will abide by and fulfill any award rendered by an arbitration panel, and that a judgment of a court having jurisdiction may be entered on the award, provided only that the liability of any insurer shall be subject to applicable insurance policy limits."

(2) The request for arbitration shall contain the name and address of each party joining in the request and shall also state the name and address of each party who, although not joining in the request, was named in a notice of intent to initiate litigation served in connection with the controversy.

(3) No filing fee is required in order to initiate arbitration.