Morgan’s Tip of the Week- Initial Packet
Greetings, I just had a very interesting question this morning regarding reporting of claims and when the E/C needs to send the initial packet/brochure to the claimant.
If an Employer files a “report only” or “First-Aid” only claim to the Carrier, does the carrier have to set up a claim and mail the claimant the initial packet? I’ll give you the technical answer and also the potential cautious answer.
Of course, adhere to the policies of your Carrier in how these are to be handled, but here is some background.
A First-Aid claim is when the claimant is treated on-the-job without paid medical treatment and that does not disable the injured employee for more than one shift. These claims are not required to be reported to the carrier (see below for the Admin code). The Employer does need to keep a record of the claim though.
When am “injury” is reported, the Carrier has 3 business days to mail/email the claimant the initial packet and informational brochure (see 440.185(3) below).
So, what does a Carrier need to do when an Employer reports (unnecessarily per statute) a First-Aid claim? It could be argued technically they do not need to set up a claim or mail the initial packet because the injury was not reportable.
Many First-Aid” claims turn into more, and then do need to be reported. In fact, I handled a claim not long ago where the Division of WC was fining an employer for late reporting. The claim was initially First-Aid, but then a few weeks after the accident the claimant requested treatment, and the claim was reported. The Division was claiming the Employer reported it more than 7 days after it occurred. I sent them the reporting requirements below and they pushed back with the Division (the Employer can’t be expected to see the future that a First-Aid claim would become reportable later!).
Arguably the same could be said for the Carrier. If they are just making note of a report only, they arguably don’t need to send the initial packet. However the Division could always take a different stance that the initial packet was late especially if the claim later evolves into an actual claim requiring treatment.
So, big picture, I do not think there is a per se requirement to send the initial packet and brochure on a report only of a First-Aid claim that is not set up as a claim. However I have seen these turn on us if the nature of the claim changes. It’s just a matter of the policy the carrier wants to establish on how to handle these. Neither would be technically incorrect.
Statutes and Admin code are below.
440.185(3) Within 3 business days after the employer or the employee informs the carrier of an injury, the carrier shall send by regular mail or e-mail to the injured worker an informational brochure approved by the department which sets forth in clear and understandable language an explanation of the rights, benefits, procedures for obtaining benefits and assistance, criminal penalties, and obligations of injured workers and their employers under the Florida Workers’ Compensation Law.
Employer Reporting Requirements
A. Types of Injury- for reporting purposes, the administrative rules divide injury severity into four classes: (1) first aid; (2) medical only; (3) lost time; and (4) death.
- First Aid – Employers do not need to report first aid cases to their carrier, but they must maintain the information listed below.[Fla. Admin Code R. 69L-3.002(13) (1/10/2005)].
a. First aid cases involve injuries that are treated on-the-job without paid medical treatment and that do not disable the injured employee for more than one shift.
b. The employer must record and maintain the following information from the employee: name; Social Security number or other ID number; date and time of the accident/injury; occupation of employee; who the injury was reported to and when; description and cause of accident; the injury that occurred and the affected body part; and location address of accident, if different from the employer’s address. [Fla. Admin Code R. 69L-3.004(1)(a) (1/10/2005)].
- Medical Only Claims – Employers must report medical only cases to their carrier on a DWC-1 form within seven (7) days after knowledge of the injury. [440.185(2) and Fla. Admin Code R. 69L-3.002(20)].
a. Medical only cases involve injuries that require paid medical treatment, but do not cause the employee to lose more than seven (7) days of work.
b. Failure to file the DWC-1 form with the carrier within the seven day time limit subjects the employer to a fine of up to $500.00.
c. The minimum fine is $100.00 for up to a seven-day delay in reporting; and if the filing is more than 28 days late, then the maximum $500.00 fine applies.
- Lost Time Claims – Employers must report lost time cases to their carriers on the DWC-1 form within seven (7) days after knowledge of the injury. [440.185(2) Fla. Admin Code R. 69L-3.002(19)]
a. Lost time cases involve injuries that cause the employee to lose more than seven (7) days from work, and include any injury entitling the employee to indemnity benefits.
b. These cases also include disabling injuries to covered volunteer workers, although such workers are ineligible for indemnity benefits because they have no earnings.
c. Employer’s must also file the 13-week wage statement within 14 days after knowledge of the accident or injury involving lost time or when a medical only case become lost time. [Fla. Admin Code R. 69L-300.46]
Upon receipt, the carrier msut compare the First report of Injury (DWC-1) to the Wage Statement (DWC-1a) to confirm that the employee’s name, SSN, and other identifying information, and the date of injury on the two forms are consistent.
- Death Claims – when an injury results in death, the employer must, before filing the DWC-1, notify the Division within twenty-four (24) hours, by telephone or other means
- In addition, the employer must notify the carrier within seven (7) days. [440.185(3) and Fla. Admin Code R. 69L-3.004(2)(d)].
B. Penalties for Employers
If an employer fails or refuses to report an accident, the employer is subject to an administrative fine of up to $500.00 for such failure or refusal [§440.185(9) Fla. Stat. (10/1/2013)].
Morgan Indek | Managing Partner