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First Aid Injuries
First aid is medical care that all employers must provide to their employees. The difference between first aid and medical treatment is based on the type of treatment an employee receives. It does not depend on whether the treatment is provided by a physician or another licensed health-care professional.
The California Labor Code, Section 5401(a) defines first aid as “any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and follow-up visit for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel, and can be self-insured.
IMPORTANT: Self-insuring your first aid claims helps control your experience modification and workers’ compensation premiums.
Treatment is not considered first aid in either of the following circumstances:
Employer/Employee Reporting Not Required for First Aid
Another difference between first aid and medical treatment is the employers and employees reporting responsibilities.
Specifically, “What is First Aid?
For the purposes of Workers Compensation, “first aid” means the following:
It is advisable to put your First-Aid Program policies and procedures in writing. Contracting with an occupational injury specialist like Concentra makes this process easy. Policies and procedures should be communicated to all employees, including those workers who may not read or speak English. Language barriers should be addressed both in instructing employees on first-aid policies and procedures and when designating individuals who will receive first-aid training and become the on-site first-aid providers.
Need help setting up your program? No problem – just contact your E-Comp professional for assistance!
Without any uncertainty whatsoever, easily the least expensive form of insurance that provides medical benefits, death benefits and more for work related injuries.
1. Death Benefit: Contains a substantial death benefit for certain survivors. Example: California provides surviving spouse a death benefit of $250k, and additional payments for dependent children.
2. Lost Wages/Disability Benefits: Pays for wage loss due to work related accidents, injury and disease. Up to 2/3rd of your salary subject to the maximums in your state.
3. No Deductibles or Co-Payments: There are no deductibles or co-payments for work related injuries that require medical treatment.
For covered, work related injuries, 100% medical, drug, hospitalization, first aid, transportation, physician expenses, pharmacy, therapy, home care, prosthetics, follow up care – all medically related expenses, often Including chiropractic, acupuncture and even holistic medicine are paid by workers compensation benefits.
4. No Lifetime Caps for Medical: Work related claims are not subject to regularly high stop-loss amounts like medical/health plans are.
5. Choose your Doctor: Physician of your choice with pre-designation for workers’ compensation covered medical visits.
6. 24 Hour Coverage, even foreign travel: 24 hour protection not limited to your state but includes coverage for travel to all states including foreign business travel when you have a work related injury.
7. Retraining: Incorporates a limited “Supplemental Job Displacement Benefit.”
8. Extra Costs: Has provisions that allow the spouse or “significant other” of an injured worker to collect for the extra expenses that are often incurred as a result of the incapacity of the breadwinner due to a job related accident or injury.
9. Burial Payments: For a work related injury that results in a death, a burial benefit is paid, amount subject to your states guidelines.
10. Cost: The premium basis to cover officers is capped, subject to your states guidelines. You can do a quick Internet search for what the minimum and maximum payroll caps for officers are in your state to estimate your premium. Or call Granite for more information.
Effective immediately, all California fully insured medical plans (grandfathered and non-grandfathered plans) will now provide transgender benefits for fully insured individuals. In accordance with California state regulatory requirements, coverage will be provided according to terms and conditions of the plan that apply to other covered medical conditions, including medical necessity requirements, utilization management, and exclusions for cosmetic services. This coverage will include medically necessary services related to gender transition such as transgender surgery, hormone therapy, psychotherapy visits, and vocal training.
In California, the general overtime provisions are that a nonexempt employee 18 years of age or older, or any minor employee 16 or 17 years of age who is not required by law to attend school and is not otherwise prohibited by law from engaging in the subject work, shall not be employed more than eight hours in any workday or more than 40 hours in any workweek unless he or she receives one and one-half times his or her regular rate of pay for all hours worked over eight hours in any workday and over 40 hours in the workweek. Eight hours of labor constitutes a day’s work, and employment beyond eight hours in any workday or more than six days in any workweek is permissible provided the employee is compensated for the overtime at not less than:
1. One and one-half times the employee’s regular rate of pay for all hours worked in excess of eight hours up to and including 12 hours in any workday, and for the first eight hours worked on the seventh consecutive day of work in a workweek; and
2. Double the employee’s regular rate of pay for all hours worked in excess of 12 hours in any workday and for all hours worked in excess of eight on the seventh consecutive day of work in a workweek.
There are, however, a number of exemptions from the overtime law. An “exemption” means that the overtime law does not apply to a particular classification of employees. There are also a number of exceptions to the general overtime law stated above. An “exception” means that overtime is paid to a certain classification of employees on a basis that differs from that stated above.
There are a number of types of employees who are affected by these exemptions. Some of these include: employees subject to a validly adopted alternative workweek schedule; employees of a hospital or an establishment which is an institution primarily engaged in the care of the sick, the aged, or the mentally ill or defective who reside on the premises; employees of a ski establishment during any month when Alpine or Nordic skiing activities are being conducted; live-in employees and several more. Each of these has different exemptions for different reasons and as an employer you should make sure you know who is exempt and who is not. For more information on these exemptions, please click here.
The basic tenet of Workers Compensation Insurance is to respond to employee injuries sustained on the job, resulting from the work the employee was hired to perform. My how the rule has been stretched!
Polly was hired to test finished pieces of electronic equipment. One morning, she spilled boiling water over herself while making coffee in the break room. Sure the injury was sustained on the job, but was she hired to make coffee or test electronic equipment? Claim denied — but for the “Positional Risk Doctrine;” a legal doctrine stating that “mere presence on the job” is sufficient if the employee is injured!
How about Heather, who while working diligently at home for her company, popped downstairs to get a cup o’ tea tripped over the ironing board that had been left out, and broke her ankle? Work related? Workers Comp? Possibly, maybe, likely! What about the “Employee Personal Comfort Doctrine,” yet another legal device that states that claims arising from employee personal comfort are deemed to be arising from employment! Surely getting a nice warm cup of tea to break the monotony of the work day would fall within such a doctrine?
So where do we go from here?
Indeed those who work at home are subject to the same Workers Compensation rules, regulations and benefits as those who leave home and go to work. As employers are required to provide a safe working environment at their place of business, so must employers provide a safe place for workers who work at home. Is the employee working at the kitchen table or at an ergonomically approved work station? Have you or your Workers Compensation insurer inspected the home office(s) of your worker(s)? It’s not optional.
For employers, the rules for those who work at home or on the road, are no different than for those who work at the office, plant or place of business – safety is a must, ergonomics paramount and “working at home rules” such as, but not limited to implementing a daily record of tasks that were performed, or a journal of the workday accomplishments or the use of readily available electronic sign-in/out/task software programs are imperative for the effective evaluation of the circumstances of an actual or alleged workplace injury. The task is not onerous and it’s essential toward maintaining a safe working environment and control of the ever increasing cost of Workers Compensation insurance.
Mike Mansel, MA
Certified Insurance Counselor
Granite Insurance Brokers