First Aid: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

As strange as it may seem, the rules under California’s workers’ compensation act pertaining to “first aid injuries” are becoming more and more complex. Instinctively thought of as minor injuries which could be handled directly by the employer without the necessity of reporting an injury to their workers’ compensation insurer or requiring formal claims administration, “first aid” claims now often require one or both such actions.   

To begin with, let’s review the definition of “first aid.” Per 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 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.”

While both the workers’ compensation system and Cal-OSHA acknowledge the applicability of the definition set out in LC 5401(a), in practice they do not implement the statute in the same way. As a result, confusion often arises as employers acting in good faith conclude that a non-reportable injury under workers’ comp is likewise non-reportable under Cal-OSHA, and vice-versa.  But that’s not the case.

To demonstrate this point, here are six injuries where the reporting requirement is not the same under each system:

Prior to 2017 California employers were not required to report first aid claims to their workers’ compensation insurer.  That changed on January 1, 2017, when first aid claims became reportable even if the medical bills were paid by the employer.  First aid rules were further amended to impose a civil penalty of no less than $50 nor more than $200 per injury for failure to report. 

From a workers’ compensation insurance standpoint, the mandatory reporting of “first aid” injuries caused the loss experience of many employers to suffer and to see their premium costs to increase which, expectedly, caused an uproar amongst them. Ultimately, because of increasing complaints, the state found it necessary to amend the rules effective 1/1/19, and although first aid injuries must still be reported, the first $250 of cost for each such claim is not considered in the calculation of an employer’s total premium cost.

Despite the above amendments, even when dealing with a “first aid” injury, per CCR 9785(e), a physician is still required to submit a “Doctor’s First Report of Occupational Industrial Injury or Illness” report (form DWC-5021) to the claim administrator within five days of the initial exam. The administrator is then required to determine if the injury resulted in a first aid injury or one of a more serious nature, in which case, an employer’s premium cost will likely grow.