How do I handle First Aid Claims under Workers Compensation?
This is a question we’re asked to address frequently. Since the WCIRB (Workers compensation Rating Bureau in California) changed the rules on this in 2019, it seemed worthwhile to post an updated quick-reference guide on the topic.
Also worth noting is that the definition of First Aid according to Workers Comp, differs from how OSHA defines it, so I’ll highlight that so it’s clear what the obligations are according to each.
I. Workers’ Compensation First Aid claims
Any one-time treatment, and any follow up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injuries, 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.
Ok, but what about all the other issues that arise when an employee seeks treatment two or fewer times? What if they are prescribed medication that isn’t over the counter, or taken off work, or given work restrictions for a few days between visits?
Answer: both of these examples would drive the claim out of a First Aid designation, even if all the other criteria are met.
Typically, if the treatment meets the criteria of First Aid, the treating physician will say so on their medical report. Even if they don’t, claims adjusters are trained to spot these types of claims. As with any definition with complex factors, there are gray areas. However, due to the rule changes discussed below, you will no longer need to be concerned with whether a claim is designated as First Aid for workers’ compensation claim purposes.
Many employers are aware they need to keep an OSHA 300 log of their occupational injuries. OSHA does not require First Aid claims to be logged for reporting purposes. So, how does OSHA define First Aid?
- Using non-prescription medications at non-prescription strength.
- Administering tetanus immunizations.
- Cleaning, flushing, or soaking wounds on the skin surface.
- Using wound coverings, such as bandages “Band Aids”, gauze pads, etc. or using Steri-strips or butterfly bandages.
- Using hot or cold therapy
- Using any totally non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts. etc.
- Using temporary immobilization devices while transporting an accident victim (splints, slings, neck collars, or backboards).
- Drilling a fingernail or toenail to relieve pressure or draining fluids form blisters.
- Using eye patches
- Using simple irrigation or a cotton swab to remove foreign bodies not embedded in or adhered to the eye.
- Using irrigation, tweezers, cotton swab, or other simple means to remove splinters or foreign material from areas other than the eye. Using finger guards
- Using massages
- Drinking fluids to relieve heat stress
Even if a claim meets these criteria, and the employee seeks medical treatment, you are still required to file the claim with your insurance carrier.
What effect do these differences have for employers?
I. Workers Compensation
Prior to the 2019 rule changes (from the WCIRB), employers would frequently pay for First Aid claims out of pocket to avoid having the costs count against them for X-Mod and/ or insurance premium purposes. Now that all claims are reduced by $250, which most First Aid claims do not exceed, it may now make sense to have the carrier pick up the costs. This is because the WCIRB does not have a First Aid designation that helps your business with regard to their X-Mod formula. The way premiums and X-Mods are calculated is another topic for another article, but if your firm pays for medical cost associated with a First Aid claim, those payments are still required to be reported to the insurance carrier so they may pass it along to the WCIRB.
Using their formula, the first $250 on all claims are excluded, whether you pay for them or the carrier does.
You should be reporting all claims where your employee seeks medical treatment where a Doctor’s First Report (Form 5021) is generated—including First Aid.
It is important to note that employers are NOT required to provide a DWC-1 to the injured worker on First Aid claims (Labor Code §5401(a)), nor are they required to submit an Employer’s First Report (Form 5021) on First Aid claims (Labor Code § 6409.1)—although they still need to report the claim as outlined.
About the Author
Larry St. John is a 20+ year veteran of insurance and risk management for the construction and electronic security industries.
He can be reached at LStJohn@eclipseinsurance.com