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California Compliance

Reporting of Claim by Employer  6409.1 14001, 10140

Within one working day of receipt of a claim form DWC-1, the employer shall date the claim form and provide a dated copy of the form to the employee and the employer's claims administrator.

California state law requires that the employer submit Form 5020, Employer's Report of Occupational Injury or Illness within 5 days to report every employee industrial injury or occupational illness that results in lost time beyond the date of injury or that results in medical treatment other than First Aid. (see note below)

Section 6409(a) requires a physician who treats an injured employee to file a "Doctor's First Report of Injury" (DFR) 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 DFRs to the Department of Industrial Relations, Division of Labor Statistics and Research (the address is listed at the top of the form). There is no "first aid" exception to this statute.

NOTE: The Insurance Commissioner recently approved amendments to the California Workers’ Compensation Uniform Statistical Reporting Plan—1995 (USRP) effective January 1, 2017, to clarify the reporting requirements for small medical only or “first aid” claims.

Employers are required to report costs incurred for any and all medical related care, including the cost of “first aid” treatment, even when employers do not ask their workers’ compensation carrier (“insurer”) to cover or reimburse the medical related costs incurred.  These costs must be reported to their insurer.

California Labor Code Section 5401 defines “first aid” 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, is considered first aid even though provided by a physician or registered professional personnel.”  Employers are referred to the WCIRB Bulletin (Nov. 10, 2016).

Workers’ compensation carriers are required to report these medical costs to the WCIRB of California.