Effective Jan. 1, 2017, all insured employers within the state of California must report all claims to their carrier or Third Party Administrator for which medical treatment costs are incurred. This includes reporting of first aid claims.
On Oct. 14, 2016, the California Insurance Commissioner approved the regulatory filing by the Workers’ Compensation Rating Bureau of California (WCIRB). Among the amendments to the California Workers’ Compensation Uniform Statistical Reporting Plan-1995 (USRP) effective Jan. 1, 2017, is clarification of the requirement to report first aid claims and the amount paid to the medical provider for such treatment, regardless of whether an employer or the insurer pays the cost of medical treatment.
Every physician treating an injured employee must send copies of the Doctor’s First Report of Occupational Injury or Illness to the Workers’ Compensation insurance carrier within five days of the initial examination.
What is a first aid claim?
California Labor Code Section 5401 defines “first aid” as “any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters and so forth, which do not ordinarily require medical care. Such one-time treatment and follow-up visit for the purpose of observation is considered first aid even though provided by a physician or registered professional personnel.”
An employer is not required to record a “first aid” claim on their OSHA 300 log.
Please refer to page 3 of the OSHA 300 booklet for additional first aid descriptions.
As your insurance broker, the Warren G. Bender Co. recommends that employers report all claims, including “first aid”, in which a physician or other professional medical provider provides medical treatment, to their carrier or Third Party Administrator within the 5-day reporting requirement. Since all paid medical costs must now also be reported to the carrier (who will report them to the WCIRB), we are recommending that the carrier or Third Party Administrator also pay these medical bills. They will utilize the California Official Medical Fee Schedule that may result in reduced medical costs.
We encourage you to prevent injuries with a safety plan that focuses on reducing your work place hazards and to ensure compliance with your Injury and Illness Prevention Plan (IIPP).
We further encourage you to mitigate and manage all claims with a Return To Work program that accommodates any work restrictions during recovery. By maintaining a collaborative relationship with your designated medical provider, your claims administrator, and most importantly, with your injured employee, you can mitigate risk and cost of your Workers’ Compensation program.
Impact of this change on costs and X-Mod rating
If you have previously paid your “first aid” claims directly to the medical clinic, these costs must now be reported to the carrier and will impact your future Experience Modifier.
The WCIRB Bulletin No. 2016-25, dated Nov. 10, 2016, summarizes these changes.
Penalties for non-compliance
Any employer or physician who fails to comply with the submission of the Doctor’s First Report for first aid claims may be assessed a civil penalty of not less than $50 nor more than $200 by the director if a pattern or practice of violations or a willful violation is found.
An insurer that fails to report first aid claims may be in violation of California Insurance Code Section 11755, which prohibits willful withholding information from or knowingly giving false or misleading information to the commissioner or to any rating organization, which will affect the rates, rating systems or premiums for Workers’ Compensation insurance.
For more information, please contact Warren G. Bender Co. at (916) 380-5300.