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First Aid Claims: California issues reminder on a nationwide reporting rule
March 23, 2017
Remember: first aid claims count. That’s the gist of a recent regulatory clarification issued in California explaining reporting requirements for workers’ compensation insurers to include small medical only and first aid claims, even if they are paid by an employer. This requirement is not new, nor is it a California-only requirement. While California took the step to issue such a reminder, this claims reporting requirement is actually applicable in all states, and California’s reminder gives us all a reason to reacquaint ourselves with the rule and why it’s important. California’s clarification, issued by the Workers' Compensation Insurance Rating Bureau of California and backed by the California insurance commissioner, emphasizes that all workers’ compensation claims with paid medical treatment must be reported. This development has two distinct implications for employers:
Employers should report all paid medical claims, including minor injuries that require first aid to their claims administrators.
Reporting small medical only and first aid claims when they hadn’t previously been reported may, in certain cases, increase an employer's experience modification factor. That may have an impact on workers’ compensation premium, as well as contractual agreements that require the disclosure of loss experience.
The California Labor Code 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." For the purposes of reporting, small medical only claims include those involving only the provision of first aid.Why is the WCIRB issuing this clarification? Relatively few small medical-only claims are likely to be paid by a commercial insurer, as they are often well within a company’s deductible and, thus, not reported by the company to their insurer or claims administrator. Nevertheless, workers comp insurers in California, and the other 49 states, are required to report all claims for which medical treatment costs are incurred - whether those costs are paid by an insurer or an employer. Many of these claims are not reported, however, and this definitely has consequences, which are worthy of consideration.For one, the WCIRB has expressed concerned that some employers derive an advantage in their experience modifications by not reporting such claims, and they are working on ways to address this concern. Additionally, it is not uncommon for a first aid claim to develop into a larger reportable claim. Early notification – when an injury requires only first aid – may help the insurer or third party administrator more effectively manage the potential workers’ compensation claim, potentially leading to a better outcome.