Mandatory Reporting of All Workers’ Compensation Claims
On October 14, 2016, the California Insurance Commissioner approved an amendment to the California Workers’ Compensation Uniform Statistical Reporting Plan – 1995 (USRP) requiring that the cost of ALL claims be reported. The amendment is set forth in Section II, Definitions, Rule 24, Medical Only or Medical Claims Only, and Section V, Loss Information, Subsection A, General Loss Reporting Instructions, Rule 1, Reporting Losses, of the USRP.
Effective January 1, 2017, insurers are required to report the cost of ALL claims to the WCIRB, including first-aid only claims that the employer has paid in full. In the past, when an employer paid the full cost of a first aid only claim, the claim was reported as having a zero value. Employers frequently paid the full cost of relatively inexpensive first-aid only claims to avoid an increase in premiums. Now, the full cost of the claim must be reported regardless of whether the employer or insurer paid for the treatment. The new regulation has removed the incentive for an employer to pay the full cost of first-aid only claims out-of-pocket.
Failure to report first-aid only claims paid by the employer is potentially a violation of California Insurance Code Section 11755. Violations of California Insurance Code Section 11755 will affect the rates, rating systems or premiums for workers’ compensation insurance and employer’s liability insurance incidental thereto and written in connection therewith.
Disclaimer: This newsletter is provided to share knowledge and expertise with our colleagues with the goal that all may benefit. The content of this newsletter is for general informational purposes only and is not intended to serve as legal advice or as a guarantee, warranty, or prediction regarding the outcome of any particular legal matter. Nothing contained within this newsletter should be used as a substitute for legal advice and does not create an attorney-client relationship between the reader and Trovillion, Inveiss & Demakis. Legal advice depends on the specific facts and circumstances of each individual’s situation. You should not rely on this newsletter without first consulting with a qualified, licensed attorney.