The 2nd thing that a California investigator needs…

The 2nd document that a worker's compensation investigator should obtain from the claims adjuster before beginning their investigation is a completed Form 5020, known as the Employer's First Report of Injury or Illness.

Employer's First Report of Injury or Illness (Form 5020)

California law requires all employers to report to their claims administrator within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident or requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death. In addition to the completing of the 5020, every serious injury, illness, or death must be reported immediately by telephone or other means to the nearest office of the California Division of Occupational Safety and Health.  Once the Form 5020 is reported to the claims administrator, the claims administrator must report the information contained in the document to the California Department of Insurance via EDI (Electronic Data Interchange) per Title 8, California Code of Regulations Section 14002.

It is important for the investigator to note that this form contains confidential information that should only be disclosed to persons who are entitled to this information as per CCR Section 14300.35, 14300.30, & 14300.40.  The investigator should make sure they protect the confidential information from being disclosed to a party who is not permitted to view or learn of the information.

The Employer's First Report can provide the investigator a wealth of information to assist them in developing their investigation into the facts of the incident which resulted in injury or illness.  The form contains 39 boxes of information divided into three sections:  The Employer, The Injury or Illness, & The Employee.

In the employer section, the investigator should pay particular attention to box 4 and box 6.  Box 4 tells the reader of the document the nature of the employer's business.  Box 6 tells of the reader the type of employer (i.e. Private Employer or various public employers).  The nature of the employer's business (i.e. restaurant, hotel, construction company, etc.) will inform the investigator what range and types of employees the employer likely has working for them.  Knowledge of the employer type will assist the investigator in identifying possible special issues that will need to be investigated to provide the information to the adjuster so they may make the appropriate determinations on liability and benefit eligibility.  These issues may include (applicability of Educational Code Benefits, applicability of presumptions of injury for certain employee types, applicability of Labor Code Section 4850 benefits, etc.)

The second section is the injury or illness section (boxes 7-29).  This sections contains a wealth of information that can be used in the process of investigation.  Of course, I recommend the investigator verify the information contained in the document with the person who completed the document as well as independently corroborate the information from other sources.  This section tells the investigator and/or the claims adjuster the basic information relating date and time of injury, place of injury, whether or not there was any lost time, has the employee returned to work, when was the employer's first date of knowledge of the injury, whether or not any chemicals or equipment was involved in the injury, description of the activity the injured worker was performing at the time of injury, a description of how the injury or exposure occurred, the name of the physician or medical facility that treated the injured worker, and whether or not the employee was treated in the emergency room or if they were hospitalized overnight.  All of the information is crucial to the proper adjusting of a California Worker's Compensation claim.

The final section of the 5020 is the employee section (boxes 30-39).  The employee section provides basic demographic information for the injured worker that includes their name, date of birth, Social Security Number, address, phone number, employee status, usual work hours, occupational title, date of hire, salary/wages, and whether the injured worker is eligible for other means of compensation (i.e. tips, lodging, meals, bonuses).

The investigator should obtain a copy of this document from the employer if they did not receive one from the claims adjuster.

The Employer's First Report of Injury or Illness is one of the documents mandated by state law and regulation to be housed in a paper or electronic claim file and available for inspection by state regulatory audit agencies.

Should any of the readers have any questions about this document, please feel free to post your question to the blog or e-mail me directly.  Thank you for your interest in this subject.

Stay tuned for the next installment of this California Worker's Compensation Claim Investigator Series.  Should you wish to be notified of any new postings on this blog, please subscribe on the right hand column.

Leaving No Stone Unturned!

Ryan D. Clock, The Precision Detective