At the beginning of the year (2017), a decision by California’s Insurance Commissioner clarifies the term “first aid” and requires California employers to report first aid and small medical only claims whether the cost of medical treatment is paid by an employer or an insurer. Any cost incurred must be reported regardless of whether the employer or the insurer paid the claim.

The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) was concerned that failure to report first aid claims by some insurers gave their clients an unfair advantage.

What is First Aid according to WCIRB?

“Any one-time treatment, and any follow-up visit for the purpose of observation of minor scrapes, cuts, burns, splinters and so forth, which do not ordinarily require medical care. Such one-time treatment and follow-up and visit for the purpose of observation are considered first aid even though provided by a physician or registered professional personnel.”

How does this impact you?

  • Insured employers paying medical costs for first aid and medical treatment must now report those claims and its costs.
  • There is no cost impact for employers who already report all claims.
  • The clarification puts every insurer on the same level.
  • The reporting requirements for these first aid claims is the same for any medical only claim. But the employer doesn’t need to report a first aid claim on their OSHA 300 log.
  • Every provider who treats a WC injury must report the injury to their insurance carrier within five days of first contact.
  • If the insured employer has paid first aid claims internally and not reported those claims or costs for medical treatment for those claims, they will incur increased costs for claim administration.

Whether you’re in California or not, reporting all claims, major and minor, is best practice any time medical treatment is performed. To lessen risk and lower your premiums, adopt safety plans that reduce the possibility of injuries. These moves are your first line of defense against WC claims, plus it helps you, your organization and your employees. 

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How to report a claim: https://www.insuredsolutions.net/faq/client_faq/posts/injury2claim.php

Report claims to Insured Solutions:  https://www.insuredsolutions.net/clients.php.

For questions, contact Steve Petty at steve.petty@insuredsolutions.net.

 

 

Sources:

https://www.sedgwick.com/news/Client%20bulletins/WCIRB%20of%20California%20requires%20reporting%20of%20all%20insured%20first%20aid%20claims%20beginning%20Jan.%201,%202017.pdf

http://wgbender.com/reporting-first-aid-requirements-effective-january-1-2017/

Insured Solutions: Kayla Park

Tamera Shaw is a freelance writer for Insured Solutions based in Louisville, Kentucky. She writes fiction and enjoys amateur photography. She happily shares her life with husband Ron, daughter Cate and sage cat, Sophie, who grudgingly shares her home with the newest member of our family – Nieko, our new kitten.