AN IMPORTANT ANNOUNCEMENT FOR EMPLOYERS, PHYSICIANS AND INSURERS CONCERNING FIRST AID TREATMENT FOR WORKERS’ COMPENSATION INJURIES
First aid treatment is included as medical care that all employers must provide for their injured employees. In conjunction with the Department of Industrial Relations, Division of Workers’ Compensation, CDI wants to remind all employers, physicians, insurance carriers and self- insurers of the need to comply with Section 6409(a) of the California Labor Code.
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.
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 workers.
Source: California Department of Insurance