Is This a First Aid Claim?
Employers are looking for any advantage to keep loss experience numbers down and to control medical costs. Some would argue that the best claim is a closed claim. Others would point to prevention and safety efforts and say the best claim is one that never happened. Unfortunately sometimes the best safety plans don’t prevent an incident from happening.
How do you keep these unavoidable incidents from affecting your claims experience? A clear understanding of the parameters of a first aid claim is a great way to make sure only required claims are formally reported.
First Aid Claim vs. Reportable Injury
There can be confusion among employers regarding the difference between a first aid claim and reportable injury. Physicians often make assumptions about what is or is not first aid, leaving the decision to a qualified claims person to make the correct call. Certainly not every bump or bruise is a claim, but where do we draw the line?
To make a proper determination, the employer and their adjusting company must review the various guidelines that properly identify each component. Below are the key elements that require consideration:
OSHA Reporting Guidelines
The California Code of Regulations provides insight to the definition of medical treatment and other factors that take an injury from first aid to reportable claim status. A work-related injury or illness must be recorded if it results in one or more of the following:
- Days away from work
- Restricted work or transfer to another job
- Medical treatment beyond first aid
- Loss of consciousness
- A significant injury or illness diagnosed by a physician or other licensed health care professional
In essence, “first aid” means:
- Any one-time treatment, and any follow-up visit
- Treatment for minor scratches, cuts, burns, splinters, or other minor industrial injury
So what is “first aid” treatment? The most common forms of treatment recognized as first aid include:
- Using a nonprescription medication at nonprescription strength
- Administering tetanus immunizations (other immunizations, such as Hepatitis B vaccine or rabies vaccine, are considered medical treatment)
- Cleaning, flushing or soaking wounds on the surface of the skin
- Using wound coverings such as bandages, Band-Aids, gauze pads, etc.; or using butterfly bandages or Steri-Strips (other wound closing devices such as sutures, staples, etc. are considered medical treatment)
- Using hot or cold therapy
- Using any non-rigid means of support
- Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister
- Using eye patches
- Removing foreign bodies from the eye using only irrigation or a cotton swab
- Removing splinters or foreign material from areas other than the eye simple means
- Using finger guards
- Drinking fluids for relief of heat stress
A Final Consideration – “Claim” as a Verb
We often think of a “claim” as a noun; a claim file, comprised of medical documents, required benefits notices, and the like. When making a decision to view an injury as a claim or a first aid, remember that the word claim is also a verb. Someone may be raising their hand for benefits and ignoring that signal may leave you defenseless down the road. It is prudent to consider all outcomes when making this important decision.