First Aid Claim Reporting Required for Insured Entities Beginning January 1, 2017

The California State Insurance Commissioner has signed an order amending the California Workers’ Compensation Uniform Statistical Reporting Plan which now requires insured employers to report first aid claims to their claims administrators. The rule will go into effect on 1/1/17.

Classifications of Claims:

There are generally 4 types of workers’ compensation claims:

  • Incident Only Claims: An incident only report is not technically a claim but rather a documentation of an incident that does not result in any treatment or disability.
  • First Aid Claims: The California Labor Code describes first aid claims as one involving a onetime treatment and subsequent observation of a minor injury. Some examples of first aid treatment are antiseptics, bandaging and non-prescription medication.
  • Medical Only Claims: A medical only claim is one that involves treatment which exceeds the definition of first aid but does not involve any indemnity exposure. A medical only claim can have up to 3 days of lost time.
  • Indemnity Claims: Indemnity claims are those involving any exposure to indemnity benefits (temporary or permanent disability).

History of and Reason for the Ruling:

Many employers have had a practice of handling their own First Aid claims; paying for the minor treatment themselves and not reporting the claims to their claims administrator. This was done to positively affect the experience modification and keep premiums lower.

The Workers’ Compensation Insurance Rating Bureau (WCIRB), which is responsible for collecting data and advising the Department of Insurance on pure premium rates, has found that the practice of not reporting First Aid claims gives policyholders an unfair advantage in the marketplace. As such, the WCIRB recommended that the Insurance Commissioner require First Aid data be collected.

What This Order Means for You:

If you have an insurance policy: Beginning January 1, 2017 you must report any claim which involves treatment or lost time from work to Athens Administrators.

If you are self-insured: This ruling does not apply as you do not pay premiums. You may decide whether to pay for your First Aid claims in-house or report them to Athens Administrators. If you have a question as to whether a claim meets the criteria of First Aid or not, please call your Claims Examiner or Claims Supervisor.