Workers Compensation – First Aid Claims. What’s that?

California Employers have an option to self-pay certain Work Comp coverage claims themselves.
Some employers know this already, (even though they may not know the complete outline of the program). Other employers don’t know about it at all. I’m hoping all will benefit from learning some specifics about it.

The short definition of a first-aid claim: The employer pays the bill.

What! Why should I, the employer, pay the bill? I have insurance for that!

Agreed, you do have coverage for every injury suffered by your employees.
However, if your policy is experience-modified/experience-rated, and you have a nice mod,
don’t you want to keep it that way? The first-aid option allows your mod to stay un-affected by the small claim(s). They don’t count against you.

Even a small claim can have an effect on your mod. And if you’re in the kind of business that exposes your staff to regular cuts, abrasions and the like, you can really benefit from using the First-aid option. It also helps to have a nearby Industrial Medicine provider, (don’t bring your employee to the local Kaiser or hospital).

Make sure the clinic/provider knows that they should send the bill to you.
It even helps to have one of your staff visit the clinic and establish the billing with you.

Ok, so now the more official version, with actual list of typical and accepted First-aid treatments:

First Aid Claims (California Only)

In California, employers are permitted (under specific guidelines) to directly pay for their first-aid claims. This practice may have a positive effect in minimizing the impact on future experience modifications, and reduce the future cost of premiums. Employers should carefully evaluate if this is a desirable element of their workers compensation program.

Definition:

First aid, as defined by the California Labor Code and Regulations, is any one-time treatment, and any follow-up visit, for the purpose of observation of minor scratches, cuts, burns, splinters or other minor occupational injuries, 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 by other registered professional personnel.

Reporting:

All First Aid claims should be reported to your Workers’ Compensation Claims Office as a precautionary measure.

Examples of First-Aid Treatment:

The following are generally considered first-aid treatments:

• • Application of Antiseptics during the first visit to medical personnel
• • Treatment for first-degree burns
• • Application of bandage(s) during any visit to medical personnel
• • Use of elastic bandage(s) during first visit to medical personnel
• • Removal of foreign bodies not embedded in eye if only irrigation is required
• • Removal of foreign bodies from wound if procedure is uncomplicated, and is, for example, removed by tweezers or other simple technique
• • Use of non-prescription medications and administration of a single dose of prescription medication on first visit for minor injury or discomfort.
• • Soaking therapy on initial visit to medical personnel or removal of bandages by soaking
• • Application of hot or cold compress(es) during first visit to medical personnel
• • Application of ointment to abrasions to prevent drying or cracking
• • Application of heat therapy during first visit to medical personnel
• • Use of whirlpool-bath therapy during first visit to medical personnel
• • Negative X-ray diagnosis
• • Observation of injury during visit to medical personnel

The administration of tetanus shot(s) or booster(s), by itself, is not considered a medical treatment. However, if these shots are given in conjunction with more serious injuries they should not be considered First Aid. Injuries involving loss of consciousness, restriction of work or motion, or transfer to another job are also not First Aid.

So those are some facts about First Aid injury claims. It’s still recommended, (and actually required) that
all claims are reported to your carrier. However, First-Aid injuries will not be counted against your policy if you pay the medical bills.

Your agent/broker should be familiar with this process and assist you.
Also, he/she should work with your carrier to make sure the claim is classified as First-aid only.

Hopefully you have found the First-aid claims process to be helpful to yourself as the employer and to your injured employee.

Please feel free to add your comments, thoughts or experiences with handling of First-aid claims.