ARTICLES

Workers’ Comp and the ‘First Aid’ Controversy by Barry Rosenblum, D.O.
Early Return to Work Programs Reduce Work Comp Costs By Barry S. Rosenblum, D.O.

An Advertising Supplement ToThe San Fernando Valley Business Journal
May 13, 2002

Workers’ Comp and the ‘First Aid’ Controversy by Barry Rosenblum, D.O.

As an occupational medicine physician I am frequently asked by the employer of the injured worker, “can this be a first aid case?” This question is asked because employers want to control as much of their minor medical expenses as possible by paying for these claims in order to reduce their loss experience modification. Historically this would have prevented a rise in insurance premium rates. However, the experience rating formula calculation has been changed and frequency of claims may now have a diminished effect on premiums within certain insurance companies. Therefore, employers should discuss this issue with their insurers to determine if paying for these claims is still cost-effective.

A first aid injury is defined in Labor Code 4600 as any one-time treatment of minor scratches, cuts, burns, splinters, or other minor industrial injury. ‘Minor industrial shall not include serious exposure to a hazardous substance as defined in a subdivision (i) of section 6302.’ The California Code of Regulations 14311 states that any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, and so forth, which do not ordinarily require medical treatment, may be considered first aid even though provided by physician, nurse or other health care professional. All other injuries are considered Medical Treatment and are record able per OSHA guidelines, therefore, requiring the employer to provide the injured worker with an Employee’s Claim Form and submit an Employer’s Record of Occupational Injury on form 5020 Rev.6, or by computer media. The physician must submit a Doctor’s First Report of Injury on form 5021 Rev.4, or on computer media, on every case, including first aid injuries within five working days after initial examination, with the employer, if self-insured, or to the employer’s insurer, as the case may be.

Although the many examples of first aid provided by OSHA guidelines are beyond the scope of this article, the following cannot be considered first aid: prescription medications, other than one initial dose, fractures noted on x-rays, suturing of wounds, surgical removal of foreign bodies from the skin or eyes (other than by means of irrigation or use of swabs, tweezers or other simple means), injections (other than tetanus shots), and restricted work status.

The definitions of first aid cases, although seemingly quite clear, can be quite confusing and controversial. Both employers and physicians have erroneously labeled some occupational injuries as first aid only to find that ongoing care beyond the follow-up visit was needed, thereby placing them in a non-compliance situation with regard to the labor code reporting requirements. This may have been done intentionally by employers wanting to limit their frequency of reporting, or by physicians wishing to remain in favor with their employer-clients in order to continue receiving referrals for treatment of occupational injuries. On the other hand it may have been as a result of confusion due to an ambiguous clinical situation on the part of either party. Nevertheless, such practices could be perceived as insurance fraud by insurers and associated enforcement agencies.

The best advice to be offered to employers and physicians with questions and concerns regarding first aid cases and reporting requirements is to discuss these issues with a qualified occupational health care physician or visit one of the OSHA websites.

An Advertising Supplement to the San Fernando Valley Business Journal
Health Care and Fitness
April 2, 2001

Early Return to Work Programs Reduce Work Comp Costs
By Barry S. Rosenblum, D.O.

Workers Compensation costs are increasing faster than non-work related medical costs that translate into higher work comp insurance premiums for employers. This year some businesses will be facing premiums that are fifty percent higher than last year’s premiums! This is due in part to the complexity of our workers compensation system and to increasing fraud and litigation in our society. Employers therefore must continue to push for more legislative reforms and promote health and safety programs in the workplace. Nevertheless, occupational injuries will continue to occur and these workers must be accommodated by their employers. Establishment of an Early Return to Work Program for the injured worker has been an effective way to minimize lost time days and thereby help control work comp costs.

An early return to work program (ERWP) was initiated at Johns Hopkins Hospital and Associated Schools of Medicine, Baltimore, Maryland, in 1992, which demonstrated a significant reduction (55%) in lost work day cases after the program was instituted. To be effective, an ERWP should incorporate a team approach involving the participation and cooperation of a qualified and cost effective Occupational Medical Services Provider (physician), the injured worker, and human resources individuals including supervisors, safety professionals and the workers compensation insurance company. Involvement of nurse case managers, industrial hygienists and individuals trained in ergonomics, further facilitate the return to work process.

Components of the ERWP include careful team planning, training of all supervisors and accommodation of the injured employee. After examination and treatment of the injured or ill employee, the occupational physician reviews the employee job task description and completes a Return to Work Form, which specifically describes any work restrictions. This form is then reviewed with the employee and subsequently with a pre-designated employer team representative, such as a store manager or department supervisor, and when available, a nurse case manager.

The goal is to return the individual to work without risking any adverse health effects. Of course some injuries may be too severe to allow for an early return to work, which then initiates either a temporary total or permanent disability status. Human resource individuals attempt to develop alternative work assignments in order to accommodate the restrictions set forth by the physician. This may include physical modification of the employee’s original job, such as limiting bending, lifting, standing, etc., or merely modification of the number of hours per shift that the individual may work. At times temporary transfer within the company to a new job is required.

Obstacles that may impede an early return to work and accommodation of the employee include a supervisor’s unwillingness to modify a job, or fear that the assignment may exceed the physical limitations outlined by the physician. Workers may be skeptical that the supervisor will adhere to these recommended work limitations. At times ridicule by co-workers who observe the injured individual working at a less physically demanding job for an extended period of time, while receiving the same pay rate as theirs, creates additional social pressures at the work site. This is why teams members must work together to facilitate this whole process, which in turn gives credence to the program and reaffirms to the injured worker that all attempts are being made to allow him or her to remain a valued and productive member of the work force.

In summary, a well-structured early return to work program is only one component of a company’s comprehensive effort to control the rising workers compensation costs, but it undoubtedly has an overall positive effect.

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