What is Considered First Aid for Workers Compensation in California?

As an employer in California, you know that every one of your workers comp claims has an impact on your Experience Modification (Xmod).  Even the small ones.

In fact, because of the way the Workers Comp Insurance Rating Bureau (WCIRB) has designed the formula to determine your Xmod, the small claims – under $2,000 – can have a greater effect on it than the large ones.

It then follows that as an employer, you want to have the least amount of claims possible – large or small.

How do you accomplish this?

There are many way, but knowing about First Aid claims is a great way to start.

First, what is First Aid?

First Aid, as it pertains to workers comp, 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.

Here are some examples:

First Aid

NOT First Aid

  1. Minor cut
  2. Minor burn
  3. Splinter
  4. Minor eye injury
  5. Non-prescription medication
  6. Diagnostic test with negative findings
  7. One-time treatment with one follow-up visit
  1. Soft tissue injuries
  2. Major joint injury
  3. Prescription medication
  4. Diagnostic test with positive findings
  5. Loss time or modified work beyond date of injury

It is worth noting that if your employee needs additional care be beyond the one follow-up visit or if there is lost time from work beyond the employee’s work shift, the injury is no longer considered first aid.

Second, why does it matter?

Because First Aid claims don’t count as a claim when the WCIRB calculates your Xmod.  You read that correctly.  Your insurance company will send claim data to the WCIRB and when the WCIRB sees claims categorized as First Aid, they move right past it.

Keep in mind, your workers comp Medical Provider is required to report any and all activity about your employees’ injuries to your workers comp insurance company.  If your Medical Provider is doing its job well, it will report a First Aid injury as a First Aid injury, and your insurance company will mark it as such.

As an employer, armed with the knowledge of First Aid, it is worth your time to follow up with your Medical Provider as well as the insurance company to confirm that the First Aid incident is to remain as First Aid.  Occasionally mistakes happen, and you don’t want to pay the consequences of a First Aid claim being mis-categorized as a normal Medical claim.

One way you will know if an injury is being categorized as a Medical claim is if a claim adjuster requests you to complete an employee claim form (DWC-1) and/or an Employer’s Report of Injury (form 5020).  If you are asked to complete either of those, take it as a sign that the claim has either moved past First Aid, or is erroneously being treated as a Medical claim.  Question it!

Keeping your claims categorized accurately will have a beneficial effect on your Xmod, and keep your business running smoothly and efficiently here in the great state of California.

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ELI GILLESPIE

I’m the Commercial Producer and Manager at Gillespie Insurance Services. If you have questions or want to know more about First Aid for workers comp, please call me at 909-793-6878 or email at eli@giscoverage.com.