Worker's Compensation Insurance

5 First Aid Treatment First aid treatment is included as medical care that all employers must provide for their injured employees. In conjunction with the DWC, the California Department of Insurance (CDI) wants to remind all employers, physicians, insurance companies 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 “Doctor’s First Report of Occupational Injury or illness” (DFR) with the claims administrator for every work illness or injury, including first aid cases where there is no lost time from work. Although the Labor Code contains “first aid” exceptions for the Employer’s Report (Form 5020) and the Employee Claim Form (DWC-1), there is no such exception for the DFR. The insurance company (or the employer if the employer is self-insured) must forward DFRs to the DIR. The 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 DFR only to the employers and not to the insurance companies. 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 improper and may contribute to possible criminal violations related to premium fraud and the fraudulent denial of worker’s compensation benefits to injured workers.