California: small medical only and first aid claims
If you’re an employer with workers’ compensation exposures in California, it’s important to understand the implications of the recent Uniform Statistical Reporting Plan (“USRP”) amendments regarding reporting obligations for small medical only and first aid claims.
About the recent amendments to the California USRP
The California Insurance Commissioner recently approved amendments to the California Workers’ Compensation Uniform Statistical Reporting Plan – 1995 (USRP), which became effective Jan. 1, 2017. These amendments reflect the Insurance Commissioner’s decision to clarify that insurers must report the cost of all claims for which any medical care is provided and medical costs are incurred, including those involving first aid treatment as defined in California Labor Code Section 5401(a). This reporting obligation applies even if the insurer did not make the payment for medical treatment and regardless of whether a Workers’ Compensation Claim Form (DWC 1) was filed.
The California Workers’ Compensation Insurance Rating Bureau (WCIRB), a provider of actuarially based information and research, advisory pure premium raters, and other educational services, has issued Bulletin No. 2016-25, which discusses the amendments. On Feb. 16, 2017, to help provide additional guidance, the WCIRB held a webinar titled “First Aid Claims Reporting and Potential 2019 Changes to Experience Rating” discussing the changes related to the reporting of first aid claims. The bulletin also reiterates that there are no special or unique coding requirements related to the reporting of claims meeting the definition of first aid under the Labor Code.
In order to help ensure compliance with workers’ compensation reporting obligations, employers should notify their insurance provider of all injuries in which medical treatment is rendered and costs are incurred, including first aid treatment, regardless of who paid for the treatment.
Please review our "Frequently asked questions" below for more information.
Frequently asked questions
Do you need to report a first aid claim that involves the injured worker getting a bandage or aspirin from the first aid kit?
The WCIRB has advised that these types of medical costs do not need to be reported. In addition, costs associated with triaging of a worker’s injuries do not need to be reported.
If an employer contracts with a medical care provider for first aid treatment of injured workers, do these claims need to be reported?
If there is medical treatment rendered and costs incurred, Zurich is required to report the claim to the WCIRB. This includes injuries treated by established clinics as well as mobile or on-site services.
Will first aid claims be coded differently by Zurich?
No. Claims will continue to be coded as they have been in the past.
Are customers able to continue to pay their own billing for treated workers or is the treatment provider required to bill Zurich directly?
The customer can pay the bill and submit it to Zurich for reimbursement or have the provider submit the bill directly to Zurich.
How does this affect experience modification ratings?
The WCIRB implemented changes to the calculation of the California Experience modification effective Jan. 1, 2017. Any claims with incurred loss dollars will affect the calculated experience modification. An increase in an employer’s total incurred loss dollars could result in a higher experience modification.