WCIRB Issues Amendment to First Aid Claims Reporting

Insurers required to report costs of all claims requiring medical care

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SAN DIEGO, November 28, 2016 - Effective January 1, 2017, insurance carriers will be required to report first aid claims to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) for statistical purposes.  The WCIRB has always intended for carriers to report first aid claims, as noted by their previously distributed bulletins, but regulatory language left room for varying interpretations.

On October 14, 2016, Insurance Commissioner, Dave Jones, approved several of the WCIRB’s proposed regulatory changes as they apply to the California Workers’ Compensation Uniform Statistical Reporting Plan. The approved amendments clarify carriers must report the cost of all claims for which any medical care is provided, regardless of whether the carrier or employer paid for the medical services, including those involving first aid treatment.

First Aid is defined by California Labor Code 5401(a) as:

“Any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care.  This 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.  “Minor industrial injury” shall not include serious exposure to a hazardous substance as defined in subdivision (i) of Section 6302.”

In order for carriers to be in compliance with the newly approved amendments, it is anticipated they will require all First Aid claims be reported by their policy holders. There are some carriers who may still allow employers to pay out-of-pocket costs associated with a First Aid claim. Those expenses will need to be disclosed to the carrier to meet the WCIRB’s reporting requirements.  Paying out-of-pocket for these claims, however, may actually increase an employer’s costs. Carriers have access to applicable network rates and the Official Medical Fee Schedule for treatment, which could reduce the amount paid on a First Aid claim. An employer does not typically have access to a discounted rate when paying directly to the provider.

The WCIRB is also considering issuing a credit of the first $250 of all claims from the experience rating calculation to encourage the timely reporting of First Aid claims. If this credit plan is adopted, the change is not expected to be implemented until 2019.

As of the date of this publication, OSHA and the Labor Code have not made any changes to their language for reporting criteria. Employers are encouraged to follow the interpretation and direction of their carrier partner when it comes to reporting first aid claims.

WCIRB’s Bulletin on Reporting First Aid Claims can be found here:

http://www.wcirb.com/sites/default/files/bulletins/2016-25_reporting_small_medical_only_first_aid_claims.pdf

For questions, please contact your Barney & Barney service team, or:

Tiffany Baca, Director, Workers’ Compensation Claims
tiffanyb@barneyandbarney.com
858-587-7165