The Workers’ Compensation Insurance Rating Bureau (WCIRB) recently clarified the reporting requirements for first aid claims. Effective January 1, 2017, employers and insurers will be required to report all first aid claims, regardless of whether the employer or insurance carrier paid for the first aid medical services. You can view the WCIRB announcement here.
Here is what you need to know:
First aid is defined as any one-time treatment and one follow-up visit of minor scratches, cuts, burns, splinters, or other minor industrial injury. Only the treating physician may classify an injury as first-aid.
Has the law CHANGED requiring employers to report first aid claims to the carrier? Yes.
WHEN are employers required to report first aid claims to the carrier? Always, beginning January 1, 2017.
The reporting of first aid claims has been an ongoing debate. The Insurance Commissioner recently approved amendments to the California Workers’ Compensation Uniform Statistical Reporting Plan. By explicitly citing first aid in the definition of medical claims and the reporting of first aid losses, the amendments clarify the intent of the regulations. This reporting also includes payments not made by the insurer (i.e., self-pay claims).
So, must you always file a first aid report with your carrier? YES, beginning January 1, 2017.
Will there be any financial benefit to self pay first aid claims any more? No.
“Any and all claims, including those involving first aid…must be reported…” for Unit Statistical filing. What happens if an employee is off work for the day of the injury and I don’t pay lost time?
The carrier will document the claim as “Medical Only” and not first aid due to the uncompensated time off work. Alternatively, if the employer pays the balance of the day and the employee returns to regular duty the next day, Zenith will document the claim as a first aid claim.
Must I report every incident/injury now even if the employee refuses treatment? No.
Document the event in house and the employee’s refusal of treatment. Some employers prefer to report all events to the carrier, but be sure to write on the claim – “FOR REPORTING PURPOSES ONLY” if no treatment is sought. This will prevent a reserve from being placed on the claim.
Must first aid claims be recorded on the Cal-OSHA #300 log? No.
The insured is required to record all occupational injuries or illnesses, other than first aid, on the Cal-OSHA log.