The Workers’ Compensation Insurance Rating Bureau of California (or “WCIRB”) has always expected employers to report minor first aid and so-called “medical only” employee claims. However, it wasn’t until January 1, 2017 that the WCIRB codified this requirement. Take a look at why you should report all first aid and medical only claims, however minor, and the consequences of failing to report.
The Legal Position
Before the new rules came into force on January 1, 2017, employers typically took out a policy with their providers known as a “First Aid Policy”. This let employers pay the medical costs without reporting the costs to the insurance carrier and affecting their Experience Modifier.
Now, if you are an insured employer within the state of California, you must report all claims for which medical costs are incurred to your Workers’ Compensation insurance carrier. You must also report the amount paid for the treatment, whether or not you as the employer paid these costs.
The position remains the same for non-serious injuries; you do not have to record first aid claims in your 300 OHSA log. You must still record injury or illnesses which result in:
- Time off work
- Restricted work or transfer
- Loss of consciousness, however brief
- Medical treatment above and beyond first aid
The new law also places an onus on physicians to send the carrier a Doctor’s First Report of Occupational Injury or Illness within a set time frame.
But what’s meant by first aid and medical only claims, and how can you ensure your compliance with the new rules?
First Aid Claims and Medical Only Claims
Section 5401 of the California Labor Code defines first aid claims as being a one-time treatment and any follow-up visits to observe injuries which do not generally require medical care, such as minor cuts, scratches, burns, splinters, or minor industrial injuries. The definition, then, covers the full spectrum of personal injury claims types.
Medical treatment administered by qualified physicians or medical personnel still counts as first aid treatment.
Medical only claims are those claims or injuries for which medical treatment costs are incurred, regardless of whether the employer pays these costs and/or a Workers’ Compensation claim form gets filed.
Internal First Aid Policies and Reporting Requirements
Your company should have a transparent first aid program in place. This should be implemented if you have not already done so.
It’s a good idea to have at least some managers/leaders/employees who are fully CPR and first aid trained. That way, if an employee suffers an injury, a skilled member of staff can possibly administer treatment without sending the employee to an external care practitioner. This alleviates the need for you sending the employee to the policy Medical Provider.
First Aid Logs and Return to Work Programs
You should also log injuries in a First Aid Log so you can follow up with your employee within 5 days–the time you’ve got to report the injury to the insurer. An appropriate return to work program ensures employees are properly taken care of and helps you mitigate the number of injury claims reported to your carrier.
By following up with the employee, you can report the injury if the employee needs to be checked over by a physician or healthcare professional. If applicable, you should then report all medical costs incurred. We recommend that you report any and all injuries, however minor, if you are at all unsure. This is the best way to ensure you don’t fall foul of reporting requirements.
It’s also a good idea to focus on reducing your workplace hazards to mitigate the risks to your employees and, in turn, the cost of your insurance coverage.
Penalties for Non-Compliance
If you fail to report a first aid claim or medical only claim within the allotted timescale, you will be subject to financial penalties. You can expect a penalty between $50 and $200, depending on the seriousness of the injury and how often you fail to report.
Late reporting or failure to report will also likely have a negative effect on your Workers’ Compensation Premium. Do not hesitate to report injuries and costs accrued.
Personal Injury Claims
You should be aware that your employee may make a workers’ compensation claim for any work-related illness or injury.
- You must provide employees with a DWC 1, or Workers’ Compensation claim form, when they report any injury to you.
- You must complete the relevant section of this form and return it to your insurance company.
- Employees should receive the appropriate medical treatment for injuries or illnesses sustained.
This is particularly important now that there are strict reporting requirements in place. If you fail to report a first aid or medical only claim, and the injured employee then makes a claim for compensation, it will be duly noted that you failed to report the injury through the correct channels at the material time. This will make it harder for you to defend the claim.
You should also be aware that failures to offer employees a proper return to work program, a failure to keep in communication with them and a failure to uphold your duty of care to your personnel will be noted.
In summary, we recommend that all employers:
- Review their current first aid policies and ensure they have properly trained personnel to assess minor injuries when they occur.
- Ensure you have a proper, supportive return to work program in place.
- Report any and all first aid claims and medical only claims within the 5-day reporting window.
- Consult with an attorney or employment specialist if in any doubt as to your requirements and obligations.
At The House of Workers’ Compensation, our San Diego workers’ compensation lawyers, work comp lawyers, and work injury lawyers specialize in Workers’ Compensation claims and help injured and ill workers claim the compensation they deserve. For further information, please do not hesitate to contact us.
Disclaimer: This article is intended for informational purposes only and is not a substitute for legal advice. You should seek independent legal advice from your own attorney before acting on any of the information provided above.