There has been and still is confusion regarding the new rule that went into effect January 2017 on the reporting of medical only claims. I was involved in a webinar sponsored by the Independent Insurance Agents and Brokers of California last week, and took some notes so that I could clarify some of the misunderstandings regarding the new law on First Aid Claim Reporting. Here are some of the highlights:
Employers cannot determine what a First Aid claim is anymore; only a doctor can make that determination;
Doctors must report and file any and all claims when treating an injured employee;
The WCIRB cannot provide any counsel concerning what is and is not a First Aid claim;
Medical costs incurred of any kind, no matter who pays the bill, must be reported to the employer’s workers’ compensation insurance company, and in turn it will be reported to the WCIRB, which will affect the employer’s experience modification factor.
If the employer gives to his employee a bandage and sterile wipes to cover a scrape or cut, requiring no other attention, it need not be reported since there was no cost involved. Employers must be careful to use this process sparingly so they do not get into trouble.
There will be an endorsement presented to the state this year asking that the first $250 in medical costs not be reported to the WCIRB in order to help keep experience modification factors down.
If your current agent is not explaining these types of changes to you so you are being kept up to date, please consider giving Warren G. Bender Co., your RCAC endorsed broker, a chance to review your insurance coverage. We might be able to make a difference in your coverage and pricing, and will certainly keep you up to date on changes in the industry that affect your bottom-line.