Effective January 1, 2017, all employers MUST report the cost of all claims for which any medical care is provided and medical costs incurred. This will now include those involving first aid treatment, even if the insurer did not make the payment. All in-force workers’ compensation policyholders will be affected by this new law beginning January 1, 2017, regardless of the policy’s effective date. This means if you cut your finger at work and require peroxide and a band aid or bang your leg and grab an ice pack and ace bandage, it will need to be reported.
A recent memo from the California Department of Insurance and State Compensation Insurance Fund (SCIF) was sent to SCIF policyholders and Doctors. The memo said:
“The definition of First Aid is ‘any one time treatment of minor scratches, cuts, burns, splinters, or other minor industrial injury.’ This definition is found in Section 5401 of the Labor Code.
The law requires all physicians to complete and submit the Doctor’s First Report (Form 5021) within five (5) working days to the workers’ compensation carrier or directly to the claims administrator for the self-insured employer. This law applies to all workers’ compensation injuries, including first aid, whether or not an Employee Claim Form (DWC-1) has been filed. The Doctor’s First Report should not be sent first to the employer. To assist in this process, the employer should promptly respond to every physician’s request to identify their claims administrator.
The Department of Insurance announcement, which we have enclosed, states that offending physicians and employers are subject to fraud prosecution. Therefore, State Fund urges all physicians and employers to comply with these requirements.
Upon receipt of the Doctor’s First Report, State Fund will send a copy to the Department of Industrial Relations as required. At that point, State Fund will determine whether the injury/illness meets the Labor Code definition of first aid. If it does, the Doctor’s First Report will be sent to the employer along with related bills upon confirmation that the employer wishes to make payments for the first aid treatment.”
As an employer, if you don’t report these to your Workers Comp carrier and you’re caught you face fines of $50 to $200 per incident. When you do report them you’ll be facing an increase in Worker’s Comp premiums as your ex-mod increases.”
As an employee beware, the accident prone person may be targeted for release. And don’t try and do your employer a favor by not reporting on the job minor cuts and bruises, as you can see, there’s trouble for you both in that case.
For more information, visit: https://www.workcompcentral.com/columns/show/id/g269v04o694792gh12j17e