Worker's Compensation

Conform To Expanding & More Stringent Worker's Comp Insurance Medical Treatment Laws  

Workers CompensationWorker's Compensation Issues, Accident Investigations, Employer Injury Reports, Return-to-Work Programs, and Nurse Consulting will all see changes in 2017.  New Federal OSHA Rule, Cal/OSHA has six months to adopt identical rule-reports will be publicly available.

  • OSHA will require electronic reporting of injury records
  • Changes to ex mod process
  • First aid claims - must to be reported & included in calculation
  • Increase in cumulative trauma claims
  • Importance of Medical Provider Networks
  • What to do if a work injury occurs

New Experience Modifications Will Use a Variable Split-Point Plan

Beginning in 2017, the ExMod will use a Variable Split Point Plan, previously, experience rating was used to encourage employers to focus on safety. For many years, the first $2,000 of each claim were “primary” and used to set ex mods, and only a portion of the value of a claim over $2,000 was classified as “excess” and used.  In 2010, the “primary” amount was increased to $7,000 which increased costs for many smaller employers.

Anticipated Worker's Comp Updates

Plan will require inclusion of “First Aid” claims in WCIRB experience.  It is being proposed because some insurers, such as State Fund, refuse to exclude first aid claims from reporting.  Included in this List:

  • Treat as First Aid (NOT reportable) - What is first aid?
  • Nonprescription drugs
  • Tetanus shot
  • Cleaning skin surface wounds
  • Bandages, gauze pads, butterfly bandages
  • Hot or cold therapy
  • Non-rigid support
  • Temporary immobilization
  • Relieving pressure from fingernail or draining a blister
  • Use of an eye patch
  • Removing object from eye by using irrigation
  • Removing splinters with tweezers, irrigation
  • Use of finger guards
  • Massages
  • Drinking fluids for heat stress
WCIRB Anticipated 2017 Changes

The Workers’ Compensation Insurance Rating Bureau (WCIRB) is proposing in 2017 that all claims where medical treatment is provided, including “First Aid” must be reported and included in Experience Modification calculations.  Considerations include:

  • If so, consider “nurse triage” before referral to primary treating physician.
  • Increase in Cumulative Trauma
  • Prior to 2009, cumulative trauma claims were less than 10% of all claims
  • In 2010 cumulative trauma claims were 11.8%
  • In 2014 cumulative trauma claims were 17.9% of all claims.
  • The average cost of a CT claim in 2014 was $38,000.
  • Cumulative trauma claims: Workers’ Comp Appeals Board limits “post termination claim” defense

Definition of Cumulative Trauma Injury

Cumulative trauma injury (CTI) is any injury that was caused by repeated events or repeated exposures at work. For example, hurting your wrist doing the same motion over and over or losing your hearing because of constant loud noise.

Defense to Cumulative Trauma Injury

A post offer, Pre-employment physical exam is the best defense against cumulative trauma claims – since it establishes a benchmark of physical condition.  Using a Medical Provider Network and “life of claim” medical control is also essential.   In addition, we recommend using the “Employer’s Bill of Rights” to obtain claim information, including medical records.

Date of Injury For CTI

California Labor Code Section 5412, the date of injury for cumulative injuries is that date upon which the employee first suffered disability and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment.

Defending CTI is Costly & Difficult

What makes these claims particularly difficult to defend is that the burden of proof is shifted. Instead of the claimant having to prove that an injury is work-related as with a specific injury, here employers have the burden of proving that the CT injury wasn't caused by their work. What To Do if a Worker is Injured:

First take care of medical needs – first aid, summon 911, take to medical provider.  If care is required, take them to a Medical Network Provider (MPN) and have someone drive them there!  Also, arrange for transportation home, and ask if injured employee has any immediate personal or family needs – Emotional support is vital.

If a serious injury, death or hospitalization overnight has occurred – IMMEDIATELY call the Cal/OSHA District Office.  If one of your employees is taken from work by ambulance – Follow up at once.  Find out that day what happened - Did they stay overnight - If so – Call CAL/OSHA.

Ask employee what happened and if they have had this type of injury before?  Then provide employee a Workers’ Compensation Claim form – DWC-1.  Be sure they complete ALL the questions on the “Employer’s First Report of Injury” and turn in to your workers’ comp. insurer best if within 24 hours and no later than seven days.

Then complete the accident investigation including taking photos of scene and of injured employee.  The Return to Work program used only when/if employee does not return to work day after injury.

Value of Return To Work

  • For Employee:  earns full pay, (on Temporary Disability earns only 2/3rds pay)
  • For Employer:
    o    Avoids 2.25 times pay charged to his loss experience for three years
    o    Saves $6,000 on a permanent disability
    o    Saves on “intangible” value of lost earning capacity of claim
    o    Has an experienced employee on the job Injured workers recover faster
  • Put the employee back to work the next day    

After An Injury

Unless the injured employee is hospitalized, they come to work tomorrow.  A representative from the company should them that night, ask about their condition. A company representative should greet them at work the next day, and inquire about how they are doing.

We advise employers on when it is time for an Open Workers' Compensation Case Intervention.  These consultations may include accident investigations, worker's comp issues, injury reports (preparation and follow-up) or compensation open case intervention.

Before you know it, these cases can go sideways and it is important to understand the law and be confident that you are taking the right steps when dealing with accidents, injuries or employee return-to-work programs.  Email Don to schedule a worker's compensation interview at your company today.

The team at Cal Work Safety has the background & experience to make your life much easier. Contact Don Dressler for more details at 949-533-3742.

Contact Us Today!

The team at Cal Work Safety has the background & experience to make your life much easier.