WC California - Small Urgent Care Visits - Good or Bad

[cbevington]

I have a California client with Workers Comp. He does light industrial.

He has been sending his guys to a local urgent care facility for minor things like cuts, particle in the eye, headaches, etc.... He has been paying out of pocket. He averages about 4 to 5 visits per year.

I called the WC carrier and asked them if he should be running this through them. They gave me the text book answer of "All claims must be reported."

Naturally my client is concerned that if he files a bunch of small claims they are going to jack up his premium at renewal. And they will have a long paper trail to justify it.

Urgent Care visits average between $500 and $1000. Employees that go there typicaly return to work the next day with no further incident.

Second concern - he had one guy that injured his arm and had to go to the clinic a total of four times over several days for the same incident. Something like this seems like it could turn into a bigger issue.

So does he pay Urgent Care the $2,000 to $3,000 out of pocket every year and avoid using his WC, or should he file these with WC and not be so concerned about premium increases?

Any advice is welcome.

Thank you.

Christian Bevington

[earlybird]

As a former claims person, although not in CA, I suspect that the employer is violating CA law by not reporting the injury to the Industrial Commission or whatever it is called in CA. That would subject him to fines.

Also, he already has a problem as a result of not reporting injuries, particularly the one with the recurring treatment for the injured arm. He may have materially prejudiced the insurance carrier's investigation and handling of the employees claim. Coverage for the employer's defense may be jeopardized.

In most states, workers comp is the "sole remedy" available to employees for job related injuries. The WC law restricts the amounts that are recoverable by the employee, to the WC benefits of the state, vs. having an employee sue the employee in court.

Finally, you as the agent must be careful. You are an agent of the insurer by contract (although CA might be different) and thereby with holding underwriting and claim information from the carrier. "Knowledge to the agent is knowledge to the insurer." E&O premium all paid up?