SUBJECT: FIRST AID CLAIM REPORTING
The purpose of this notice is to inform you that the Workers’ Compensation Insurance Rating Bureau (“WCIRB”) California Workers’ Compensation Uniform Statistical Reporting Plan (the “Plan”), effective January 1, 2017 requires that all workers’ compensation medical payments be reported to the WCIRB, including “first aid” claim payments, which is defined by Cal. Lab. Code § 5401(a) (West 2016), as follows:
. . . . “[F]irst aid” means any one-time treatment, and any follow up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, 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.
This means that all first aid claims, regardless of whether payment is made by you or us, need to be reported to the WCIRB. In order for us to be in compliance with the law, we will require that all medical losses, including first aid payments as defined under Labor Code 5401(a), be reported as policyholder losses.
We pay first aid claims at the applicable contract rate for network services or the Official Medical Fee Schedule (“OMFS”) for non –network services. Policyholders that pay bills directly may pay more than the contract rate or the OMFS which increases the amount reported for medical losses to the WCIRB. First aid medical losses will be considered when an employer’s experience modification is calculated and will be included on loss runs.
Please provide us with any and all medical bills that are paid by you on this workers’ compensation claim, regardless of whether they are first aid bills or not, along with any medical report(s) and documentation of payment, for appropriate review and reimbursement.
Courtesy of Republic Indemnity Insurance