Cal/OSHA - Only Six Months to Adapt ...
The following Information Summarizes What
Will Become Law
in 2017. Be Prepared!
2017 Experience Modifications Are
Beginning in 2017, the Ex Mod will switch to a Variable Split Point Plan. Historically
experience rating was used as an incentive for employers to focus on safety. For many years,
the first $2,000 of each claim was "primary" and used to set Ex Mods. Only a portion of the
value of a claim over $2,000 was classified as "excess" and used. In 2010, the "primary" amount
was increased to $7,000 which increased costs for many smaller employers.
In reaction to unexpected 2015 Ex Mod increases for small
employers, if an employer had only a single claim reported in a 3-year period, the impact of
that claim was "capped"at a 25% increase in the Ex Mod. This formula will continue. 2017 sees a
change - the $7,000 amount for "primary" losses will be replaced with a new Split Point.
Split Point Ex Mod Rating:
In January 2017, the split point will be
used for Ex Mods using data from 2013-2014-2015. There will be a major focus will be on claims
frequency - safety and accident prevention becomes very important. The amount of a claim
used to set Ex Mod will vary by size of employer - from $4,500 for a small employer up to
$75,000 per claim for the largest employer.
2017 First Aid Claims
Get ready for new Plan to require inclusion
of "First Aid" claims in WCIRB experience. This is being proposed because some insurers, such
as State Fund, refuse to exclude first aid claims from reporting.
Conditions Considered to Be First
- Nonprescription drugs
- Tetanus shot
- Cleaning skin surface
- Bandages, gauze pads, butterfly
- Hot or cold therapy
- Non-rigid support
- Temporary immobilization
- Use of
an eye patch
- Relieving pressure from fingernail or draining a
- Removing object from eye by using
- Removing splinters with tweezers,
- Use of finger guards
fluids for heat stress
2017 Changes in Medical Treatments:
2017 Workers' Compensation Insurance Rating
Bureau (WCIRB) will propose that all claims where medical treatment is provided - including
"First Aid" - must be reported and included in Experience Modification calculations. If
that is the case,consider "nurse triage" before referral to primary treating physician.
Definition of Cumulative Trauma
& Why It Matters!
Cumulative Trauma Injury? Cumulative trauma injury (CT):
defined as an injury that was caused by repeated events or repeated exposures at work. Example,
hurting your wrist doing the same motion over and over or loss of hearing due to constant
Liabilities Relating to Cumulative
California Labor Code Section 5412, the date of injury for cumulative injuries is defined
as the date upon which the employee first suffered disability and either knew, or in the
exercise of reasonable diligence should have known, that such disability was caused by his
present or prior employment.
While a few years ago, cumulative trauma
claims were only a small portion of all workers' compensation claims, (under 10%) they have
grown in the past few years to the point where cumulative trauma claims make up over 18% of
all workers' compensation claims and are a major cost factor.
Defending CTI is costly & difficult because the burden of proof is shifted.
Instead of the claimant having to prove that an injury is work-related - as with a specific
injury - now employers have the burden of proving that the CT injury wasn't caused by
Important Steps to Take When a Worker is
- Take care of medical needs- first
aid, summon 911, or take to medical provider
- Take to Medical Network Provider (MPN) if care is needed (yes - have someone
drive them there!)
- Take or arrange for
transportation home, and ask if injured employee has any immediate personal or family
needs - EMOTIONAL SUPPORT IS VITAL
- If a serious injury,
death or hospitalization overnight has occurred - IMMEDIATELY call the Cal/OSHA
District Office.If one of your employees is taken from work by ambulance - FOLLOW
UP AT ONCE! FIND OUT THAT DAY WHAT HAPPENED - DID THEY STAY OVERNIGHT - IF SO -
- Ask employee what
happened.Have they had this type of injury before?
- Provide employee Workers' Compensation Claim form - DWC
- Follow and complete ALL the
questions on the "Employer's First Report of Injury" turn in to your workers' comp
insurer-within 24 hours, no later than seven days
accident investigation with photos of scene and of injured employee
- Return to Work program required if employee does not return to work day
Using a Medical Provider Network (MPN):
MPN gives employer "life of claim" medical
control and injured workers may only treat outside the MPN if there was denial of medical
care. Now there is a crack down on Chiropractors, who will not be permitted to serve as PTP
after the applicant has received the maximum 24 visits. That is Why you need to take your
injured worker to your selected medical provider.
Why Returning to Work Matters to Employees:
Good example of how the disability payment
works. If you earn $10/hour and work 40 hours a week, your weekly salary is $400.
If you are unable to work due to an injury, temporary disability for a week at 2/3rd of
your regular pay, or $264. If you hire an attorney, he costs up to 19% of what
your disability pays... which would be $50.16 and means that you will only clear $213.84
for the week. The equation is fairly clear: Return to work and earn $400 or don't return and
earn $213 or $264.
Value of Return to Work:
Employee: Earns full pay, (on
Temporary Disability earns only 2/3rds pay)
Employer: Avoids 2.25 times pay charged to his loss
experience for three years and saves $6,000 on a permanent disability claim. They
save on "intangible" value of lost earning capacity of claims and they have an
experienced employee on the job. This is all designed to put the employee back to work the next
To learn more about California Ex Mod Rating System
visit Our Website
Focus on safety-related HR issues,
HR-related matters & Cal/OSHA Safety guidelines. Please visit: www/calworksafety.com