On Nov. 10, 2016 the California Workers' Compensation Rating Bureau (WCIRB) issued Bulletin No. 2016-25 which requires all insurers to report all claims, including first aid claims and small medical only claims, under amendments to the California Workers' Compensation Uniform Statistical Reporting Plan-1995 (USRP). This Client Advisory provides an overview of the change and outlines how Old Republic Contractors Insurance Group (ORCIG) and its third-party administrator, Gallagher Bassett (GB), will help our affected clients ensure compliance.
What is the Goal and Scope of the New Reporting Requirement?
California's overriding goal is to develop a comprehensive, accurate picture of workplace safety and related costs. To that end, the financial data of small medical only/first aid injuries has been the subject of ongoing regulatory interest because of a concern that some of these injuries go unreported. California Labor Code Section 5401(a) defines first aid claims as:
"(A)ny one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, and so forth, which do not ordinarily require medical care. Such 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."
Note the new rule requires insured employers to report first aid claims, regardless of size, where medical treatment has been obtained, rather than incidents where first aid supplies such as band aids are used.
ORCIG and GB Processes to Ensure Compliance and Anticipated Impact
ORCIG and GB already set up medical only claims for the majority of cases where first aid is provided. Because the new requirement states that insured employers must now report any incident where there is medical treatment, there could be a slight increase in claim volume. Common scenarios and costs that may not have been captured or reported previously include but are not limited to when:
First aid treatment is given by an external provider, who is paid by the employer and/or reimbursed under the workers compensation insurance program in place.
First aid treatment is provided at an employer clinic.
In both these scenarios, the injury and costs of treatment must now be reported to ORCIG and GB. Significantly, there are no minimum or maximum thresholds for first aid treatment costs specified in the new requirement. Consequently, the safest and most cost effective course for clients is to have ORCIG and GB set up claims for all first aid treatment claims, no matter how minor, so that carriers have the information required to report to the WCIRB. This approach ensures that our clients comply with the letter and the spirit of the requirement, and avoid statutory penalties. ORCIG and GB will continue to monitor the changes to first aid and small medical only claims in California.
For more information on this regulatory change, please contact your ORCIG Claims Director.