Recently approved by the California State Insurance Commissioner, new reporting requirements went into effect on January 1, 2017 related to first aid and small medical only claims. Moving forward, all employers are now required to report the total cost of any claims for which medical care is provided or costs are incurred.
Regardless of whether the employer makes a payment or not, these costs must be reported, even for simple first aid. The new regulation went into effect for all policyholders of workers’ compensation plans on January 1st, regardless of the effective date of that policy.
This change affects first aid treatments, which refer to any one-time treatment and then any follow-up visits for observation on things like burns, cuts, small splinters or scratches, or other small injuries that would not normally require extensive medical care. If medical care of any kind of provided, the injury is likely affected by the updated regulations.
NON-COMPLIANCE PENALTIES TO BE ASSESSED
Doctor’s First Reports must be filed by all employers for these first aid claims. If they are not properly reported, a civil penalty of between $50 and $200 may be assessed. These fines will be issued by the WCIRB director based on the nature of the violation. Patterns of non-compliance, willful ignorance of the new regulations, or regular routine violations will all result in these fines.
For those that already report all such claims that involve medical treatment, there will be little or no change, and no additional cost associated with your claims. If you are paying your own medical costs for these smaller first aid claims, it’s strongly encouraged for you to comply with the new law by submitting claims through the American Claims Management (ACM) system to avoid violation penalties.
ENSURING COMPLIANCE WITH UPDATED REGULATIONS
For changes such as these new guidelines from the Insurance Commissioner, it’s important to know exactly what is required of your business. If you have questions, please reach out to Radius Insurance any time to speak with a member of our team. You can also subscribe to our newsletter – we post such changes and WCIRB Bulletins regularly to help you stay abreast of the most recent requirements.
To read the full WCIRB bulletin, click here, or contact a member of the Radius team to learn more.
