Workers' Compensation First Aid Claim Reporting

by Jerry Becerra on January 25, 2017

Many businesses have a “First Aid” program to help their businesses control losses that impact their workers’ compensation experience modifications. “First Aid” means 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.

Many businesses pay these small claims themselves to avoid reporting them to their insurance carrier, thereby reducing their claims frequency and reducing the impact those claims have on their experience modification.

Effective January 1, 2017, the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) Workers’ Compensation Uniform Statistical Reporting Plan requires that all workers’ compensation medical payments be reported to the WCIRB, including “first aid” claim payments, which are defined by Cal. Lab. Code § 5401(a) (West 2016).

This means that all first aid claims, regardless of whether payment is made by you or your insurance company, need to be reported to the WCIRB. Your workers’ compensation insurance carrier will require that all medical losses, including first aid payments as defined under Labor Code 5401(a), be reported as policyholder losses.

If you have questions about being compliant with the new regulations, please contact us.

Jerry Becerra, CPCU