Consideration for First Aid / Self-Pay Claims
“First Aid” claims are sometimes called “self-pay” claims, as the employer can choose to pay the claim instead of reporting it. Employers have the option to pay the medical bill out of pocket IF the employee did not physically lose time from work beyond the work shift in which the accident occurred and received no more than 2 medical treatments. The injury should not result in permanency (for example facial scars or injuries involving bones, ligament, or tendon injuries). Some other points to consider:
- First aid is not intended for soft tissue injuries such as a neck, back, hip and joint injuries. Example of first aid claims includes lacerations, foreign body in the eye, nail bed injuries, etc.
- If you have any questions if the injury is work related, do not pay it as first aid. Report the claim timely so an investigation can be completed and a denial filed timely if it’s warranted.
- If the claim goes beyond first aid you must advise us immediately otherwise we may be subjected to penalties.
- Employers are required to keep a record of all injuries, including first aid, for 18 years. Please complete a first aid form and forward it to our office for documentation purposes only.
- Advise the medical provider to bill you directly.
- Medical bills would be paid per the NY Workers Comp Medical Fee Schedule. When the bill is received it can be forwarded to our office to audit the bill.
The benefits of first aid / self-pay are that the claim is kept out of your loss history and Experience Modification Rating (EMR) but it is important that you only self-pay claims that are allowed as First Aid claims under the Law. Self-paying incorrect claims can end up increasing the cost of the claim substantially.
Your Keevily Claims Team is available to guide you with a self-pay claim, please call us at 1-800-523-5516.