January 2024 – Workers’ Compensation – Rules on First Aid Claims Reporting
THE CALIFORNIA Workers’ Compensation Uniform Statistical Reporting Plan requires that employers report small, medical-only first-aid claims to their insurance carrier.
Many employers fail to report these claims as they consider them too small since the worker doesn’t lose any time from work and they don’t have to go to a doctor. Under Rating Bureau rules, employers are required to report the cost of all claims for which any medical care is provided and medical costs are incurred — including those involving first aid treatment — even if the insurer did not make the payment.
The term “small medical-only claim” is also used to refer to first aid claims.
For workers’ comp purposes, that also means that the injured worker did not miss work because of the injury. Besides these rules, there is a very good reason for reporting these claims because what starts as a first aid claim can develop into a larger claim over time. At that point, if you never reported the claim in the first place, coverage issues may arise.
Additionally, any physician attending any injured employee must send copies of the Doctor’s First Report of Occupational Injury or Illness to the workers’ compensation insurance carrier or employer within five days of the initial examination. The insurer or employer must submit the physician’s report to the Department of Industrial Relations (DIR) within five days of receipt.
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 DIR if a pattern or practice of violations or a willful violation is found.
FIRST AID CLAIM EXAMPLES
• Abrasions and cuts that require cleaning, flushing, or soaking.
• Using hot or cold therapy for a muscle injury.
• Drilling a fingernail to relieve pressure, or draining fluid from a blister.
• Removing foreign bodies from the eye using only irrigation or a cotton swab.
• Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs, or other simple means.