CDI Cracks Down on Failure to Report Work Injuries

The California Department of Insurance (CDI) has issued a notice to remind insurers, employers and physicians about required reporting procedures.

State law requires any physician who treats an injured worker to complete a “Doctor’s First Report of Injury” and file it with the workers’ comp claims administrator (or the employer if self-insured) within five days of the initial exam. Unlike other workers’ comp forms such as the Employers’ First Report (Form 5020) and the Employee Claim Form (DWC-1), which have exemptions for first aid cases, physicians must complete and file a report with the claims administrator for every work injury and illness they treat, even first aid cases where the employee does not lose time from work. After receiving a Doctor’s First Report, the claims administrator has five days to file it with the Division of Labor Statistics and Research.

The physician reporting requirements apply to medical doctors, osteopaths, dentists, psychologists, acupuncturists, optometrists, podiatrists, and chiropractors. Failure to file a timely report can lead to a civil penalty, but the CDI and the Department of Industrial Relations report that some employers have cut improper deals with physicians so the employer can dictate how injuries or illnesses are classified and reported by the doctor. In addition, some employers have improperly requested that the physician send the Doctor’s First Report to them, but not to the claims administrator, even when an injury clearly is beyond first aid.

The CDI Fraud Division says such deals are being marketed as a way for employers to reduce or minimize increases in workers’ compensation premiums, but notes that they may result in criminal violations, both for premium fraud and fraudulent denial of workers’ compensation benefits to injured workers.