Clarification of First Aid Treatment Reporting

By Loretta Macktal, Executive Assistant to the Vice President, Government Relations

Capitol Update, Jan. 21, 2005 Share this on FacebookTweet thisEmail this to a friend

An important announcement on first aid treatment for workers’ compensation injuries may affect CMTA members. After conferring with the Department of Industrial Relations (DIR) and Division of Workers’ Compensation (DWC), the California Department of Insurance issued a reminder for employers, physicians and insurers to comply with Section 6409(a) of the California Labor Code.

The announcement noted that:

First aid treatment is included as medical care that all employers must provide for their injured employees. Section 6409(a) requires a physician who treats an injured employee to file a DFR (Doctor’s First Report of Injury) with the claims administrator for every work illness or injury, even first aid cases where there is no lost time from work. Although the Labor Code contains "first aid" exceptions for the Employers’ Report (Form 5020) and the Employee Claim Form (DWC-1), there is no such exception for the DFR. The insurance carrier (or the employer if the employer is self-insured) must forward these DFR’s to the Department of Industrial Relations. There is no "first aid" exception to this statute.

Also according to the announcement:

CDI and DIR believe there are improper arrangements in place between some medical providers and employers that allow the employer to dictate how injuries are to be classified by the physicians. In some cases, and at the request of the employers, the physicians send the "Doctors First Report of injury" (DFR) only to the employers and not to the insurance carriers. This arrangement occurs even though the injuries clearly are beyond first aid. This agreement is often marketed to employers as a way to keep premiums from rising or to lower them. Such marketing practices are both improper and may also contribute to possible criminal violations related to premium fraud and the fraudulent denial of workers’ compensation benefits to injured worker.

Current penalties for workers’ compensation fraud include fines up to $150,000 and up to five years in prison. Recent legislation focused more on employer fraud by requiring more oversight by the Labor Commissioner and providing additional funding for enforcement. It is imperative that employers take heed of the announcement and review their current practices in order to insure that they are in compliance with the law.
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