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Not all work-related injuries require a workers’ compensation claim. The severity of an injury marks the difference between a recordable injury (opening formal claim that involves follow-up visits and an impairment rating), and the simple application of first aid.
Most first aid injuries can be recognized and treated on the spot, but the doctor always has the full authority to determine whether or not to open an injury claim. Read on to learn about how this decision is made.
First aid (noun) – treatment of a condition or an injury that arises at work, not requiring recording for a workers’ compensation claim. Note: This is a non-standard definition, and is used within this context for being contrary to a ‘recordable injury’
Recordable injury (noun) – an injury severe enough to require a doctor to open a workers’ compensation claim, typically impairing the workers’ ability to perform their duties
Narrator: Welcome to the California Work Comp Report, a podcast hosted by Arun Croll and Claire Williams, featuring Dr. John Alchemy.
Dr. John Alchemy: Hello everyone, my name’s Dr. John Alchemy, and welcome to today’s podcast on recordable injuries for California state workers’ compensation. Today is July 12th, 2015. Thanks for joining. Today we’re going to talk about recordable injuries in California workers’ compensation.
We’re talking about this topic because, in general, the concept of recordable injuries is not always well understood by the stakeholders in workers’ compensation. For example, what is a recordable injury, and what does it mean for the injured worker and the employer? Well, we’re going to cover all this and more in today’s talk. For full details, you can check out California labor code 14300.7.
To begin our talk, we’re gonna start with the difference between first aid and a recordable injury. First aid, as you will learn, has many specific issues that determine if the report can be called “first aid” or not. The difference between first aid and a recordable injury is whether or not a true claim is created with the insurance carrier, and therefore becomes recordable.
It’s important to mention here that any injured worker presenting for an evaluation for a doctor’s first report, where a determination for first aid versus recordable injury will be made, does require the completion of the doctor’s first California form. In addition, services performed by the physician at this visit must be paid in accordance with the official medical fee schedule.
It is not correct for an employer to pay cash to the physician’s office for an evaluation, even if the determination is made that the injury is first aid. The correct procedure is for the doctor to see the patient, make a determination of first aid, complete the doctor’s first report, and forward that off to the employer’s insurance company for documentation purposes. The insurance company is then billed for the official medical fee schedule, and not the employer.
Okay, so back to today’s talk. I’m gonna start with five items that are never considered first aid. This means that they are always recordable injuries.
The first is death. Any employee who dies as a result of a work injury, by definition, is not first aid. That one’s pretty straightforward.
Second item: Any missed days away from work. If the injury results in any time away from work, this is not first aid.
Item number three: Restriction. This means that the employee, as a result of the injury, cannot perform at least one of the essential task functions of the job.
Number four, the injury requires “medical treatment,” and we’ll talk a little bit more about that as we explore first aid items farther along in the talk.
And finally, number five, loss of consciousness. So if the employee loses consciousness, for any reason, for any length of time, this is to be considered a recordable injury.
Now let’s move onto first aid definitions. In this section of the talk, we’re going to explore what the fine nuances are between first aid and required medical treatment. Remember, these items are essential in determining if the injury is going to be recorded or not. Again, all doctor’s firsts need to be completed, regardless of the doctor’s determination, if the injury is only first aid, or if it’s recordable.
We’re going to go over 13 essential definitions of first aid.
Item one: Observation or counseling. This means that the employee is brought in, maybe needs a time of observation, such as they felt dizzy in the field because it was hot and they didn’t have anything to drink. And perhaps they are watched and given some oral hydration, they feel fine at the conclusion of the observation time, and receive counseling such as ways to avoid heat stroke in the field. Example, rest, going into shade regularly, and drinking plenty of fluids on a regular basis.
Number two, conducting a diagnostic procedure only. This would include tests such as X-ray, blood tests, and medications, only used for non-diagnostic purposes. For example, if an injured worker has contused or hit their arm on something and the doctor just wants to make sure that it’s only a bruise, an X-ray may be indicated. And if no fracture is found, and no other indications that would make the injury recordable, then the claim could be first aid with a diagnostic test.
Similarly, the injured worker maybe feels that they have a piece of dust or sand blown into their eye. When they go into the exam room, the doctor does need to use prescription medication to put into the eye to make it more comfortable for the exam. Now remember, this is a prescription medication, but it’s only being used for diagnostic purposes. And then the doctor can perform the eye examination and make a determination if the injury is first aid or recordable. In this instance, the use of the medication is not to be considered a recordable event.
Item number three, non-prescription medications at non-prescription strength. This means that if an injured workers comes in and they have a bruise or hit their arm, that the doctor can provide or recommend over-the-counter medications, but only at label strength.
This one is a tricky one, because if you come into my office and you’ve banged your arm, and I tell you to take Advil, but I tell you to take four pills of Advil at once instead of one, as the label suggests, then I am no longer telling you to take an over-the-counter medication because I’m recommending that you take it at a prescription strength.
Number four, administering tetanus. So if you come in for an injured scratch on your arm and you haven’t had a tetanus shot in the last ten years, my office is able to prescribe and order that injection, but it’s only for prophylactic purposes and therefore would be considered only for first aid.
Number five, the cleaning of a wound. You come in with a scratch on your arm or some type of surface laceration, and if my office only needs to perform a cleansing of the wound, soap, water, irrigation, that is first aid.
Number six, how is the wound closed? Wound coverings are specific as to what makes a claim first aid and what does not. If you have a skin wound and it only requires a bandage or a gauze, or maybe a butterfly bandage to bring the edge of the wound together, or Steri-Strips, that is a first aid wound closure. If the office actually has to get out the laceration tray and do sewing, the claim is no longer first aid.
Number seven, braces and supports. If I provide an injured worker, on the first visit, a non-rigid support such as an elastic bandage, a wrap or a soft back belt, that’s not considered a recordable event.
However, if I do need to provide you a splint with a rigid internal device, that makes the claim now recordable. So remember, any rigid supports designed to immobilize a joint are considered medicable recordable treatment [not first aid].
Number eight, draining fluid. So if there is a collection of blood under your fingernail or toenail that requires a hole be obtained to relieve the blood, that is only first aid. Similarly, if there’s a large blister from a first aid blister or burn, that blister can be drained and called first aid. Again, all other criterias we’ve discussed up to this point have to be met for it to remain first aid.
Number nine is the use of an eye patch.
Number ten is removing a foreign body from an eye using only irrigation or a cotton swab. If I have to use a needle or a hand burr, which is a small device that spins to remove some of the cornea to remove the embedded foreign body, the claim is no longer first aid.
Number eleven, finger guards. If I provide you a finger guard only for the purposes of protecting soft tissue, but not for the purposes of immobilizing a joint, that is a first aid treatment.
Number twelve, the use of massage, which would not include the formal prescription of physical therapy, chiropractic or acupuncture.
And then number thirteen, to review an earlier example, drinking fluids for the relief of heat stress.
This concludes our podcast on first aid and recordable injuries. To learn more, please visit our blog at rate-fast.com, and remember you can review first aid requirements by visiting the California labor code 14300.7. I’m Dr. Alchemy, and thank you for joining us for today’s podcast.
Narrator: Thank you for joining us for this episode of the California Work Comp report. We look forward to next week and continuing our discussion of work comp claims in California. Questions or comments? Got a great workers’ compensation story to share? Find us on Twitter at @ratefast or at rate-fast.com.