What is First Aid and how can it be managed?

What is First Aid and how can it be managed?

California Labor Code §5401(a): First Aid is defined as any one-time treatment, and any follow up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injuries, which do not ordinarily require medical care.

This 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.

OSHA further defines First Aid outlining 14 factors, which can be found in the OSHA 300 log.

Effective Jan. 1, 2017, all insured employers within the state of California must report all claims to their carrier or Third Party Administrator for which medical treatment costs are incurred. This includes reporting of first aid claims. If you have previously paid your “first aid” claims directly to the medical clinic, these costs must now be reported to the carrier and will impact your future Experience Modifier. 

So how does this effect California employers?

Prior to this law, many employers had a “First Aid Policy” with their medical provider. This policy provided the employer the opportunity to pay First Aid injuries (as determined by the Medical Professional) rather than report the injury to the Carrier to have the claim processed.

By having the employer pay the cost, the claim would be reported to the Insurance Carrier, however it would be reported at $0. This effectively helped reduce potential Workers’ Compensation costs as the Experience Modification formula was derived by the claim dollars, and not frequency of claims.

As of January 1, 2017, your insurer may require you to submit the dollar amounts paid by the employer for all injured workers seen at the clinic for First Aid claims. The doctor is still required to submit a Doctor’s First Report of Injury (DFR or 5021) to the carrier. Some medical providers (Kaiser, Coventry) will no longer bill the employer directly for First Aid claims.

How can employers reduce their First Aid costs?

First, establish a first aid program within your company.

Are there designated supervisors or lead employees that are First Aid / CPR trained?

If a First Aid injury happens, don’t immediately rush the employee to the Medical Provider (note: use proper judgment when evaluating the injury and necessity of medical care). If warranted, treat the employee locally or consider using a First Aid Medical Service provider such as Onsite Health & Safety or a telephonic triage nurse provider such as Workcare.com or Medcor.com or Coventry/NT24.

Second, designate a dedicated Supervisor (recommend HR) to track all First Aid injuries on a First Aid log. Considering you have 5 days to report the injury to the carrier, follow up with the injured employee during this time period to ensure the injury has not progressed.

If the injury worsens, refer them to the Medical Provider and submit the claim to the Insurance Carrier.

If the injury is healing, continue to stay in communication with the employee to ensure they are healthy and fit for work.

By managing your first aid injuries internally, employers can mitigate the additional injury expense and injury frequency that is reported to the Insurance Carrier.

ESM has effectively helped employers reduce their injury frequency by establishing a First Aid Management program. Injury frequency as reported on the loss runs has decreased by 30+% compared to prior years where all First Aid injuries (including extremely minor injuries) were reported. This program has helped the employer reduce their overall injury frequency goals.

Reminder, strict oversight must be in place and a decision to refer to the Medical Provider must be determined within 5 days of the Date of Injury (DOI). Late reporting of injuries to the Insurance Carrier can have a negative impact on your Workers’ Compensation Premiums

ESM’s General Recommendation for all employers:

ESM recommends that employers report all claims, including “first aid”, in which a physician or other professional medical provider provides medical treatment, to their carrier or Third Party Administrator within the 5-day reporting requirement.

  • This reporting regulation was clarified by the Insurance Commissioner on 10/14/16.

Since all paid medical costs must now also be reported to the carrier (who will report them to the WCIRB), we are recommending that the carrier or Third Party Administrator also pay these medical bills.

  • They will utilize the California Official Medical Fee Schedule that may result in reduced medical costs.

 

 

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