Workers Comp First Aid Claims

Reporting of Small Medical Only or First Aid Claims
The Insurance Commissioner recently approved amendments to clarify the reporting requirements for small medical only or first aid claims. Effective January 1, 2017, all employers MUST report the cost of all claims for which any medical care is provided and medical costs are incurred. This now includes those involving first aid treatment, even if the insurer did not make the payment. All inforce workers’ compensation policyholders will be affected by this new law beginning January 1, 2017, regardless of the policy’s effective date.

“First Aid” means any one-time treatment, and any follow up visit for observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care.

Penalties for Non-Compliance

Any employer who fails to comply with the submission of a Doctor’s First Report for first aid claims may be assessed a civil penalty between $50 and $200. Any possible fines will be issued by the WCIRB director should a pattern or practice of violations or a willful violation be found.

There is no cost impact for employers who already report claims that involve the rendering of medical treatment. Employers currently paying their own medical cost for first aid claims should be encouraged to comply to the change in law and submit those claims for handling through American Claims Management (ACM). Payment of medical bills utilizing the Official Medical Fee Schedule (OMFS) may result in reduced medical costs.

Read the WCIRB Bulletin for more information >>

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