Friday, February 18, 2011

How long should it take for a First Report of Injury to be submitted?

A story out of Jefferson City, Missouri, got me thinking about how long it should take an employer to file the first report of injury in worker’s compensation systems. Because timely prevention activity, claim decision making, and payment all depend on reporting, it stands to reason workers’ compensation agencies would be concerned about late reporting.

The Missouri story starts out as follows:

A-G Reaches Settlement Over Worker's Comp Violations
Attorney General Chris Koster said today he has reached agreements with two companies who violated Missouri’s workers’ compensation law by knowingly failing to report worker injuries to the Division of Workers’ Compensation within the prescribed time frame.

In Missouri, the prescribed time for an employer to submit the first report of injury (commonly called FROI in many states) is defined by the Workers' Compensation Law (Missouri Revised Statutes Chapter 287 Section 287.380.1)

“Every employer or his insurer …shall within thirty days after knowledge of the injury, file with the division … a full and complete report of every injury or death to any employee for which the employer would be liable to furnish medical aid, other than immediate first aid which does not result in further medical treatment or lost time from work…”

In practice, employers in many U.S. states buy their workers’ compensation insurance from an insurance company and the insurance company staff or a third party administrator (TPA) manages the claim. Whether the employer or the insurer or the TPA informs the state agency of the time-loss injury, it must be done promptly. In Missouri, the promptness standard is set at 30 days.

The news story goes on to say that two TPAs who were the ones who were repeatedly delaying. In many jurisdictions, the TPA claims managers are located in a different state, and that was the case in this story. As part of their contracts with various firms, the TPAs had taken on the responsibility of filing the first report of injury to the State workers’ compensation agency. The Missouri “Division of Workers’ Compensation” requires the data to ensure timely and appropriate treatment of injured workers and to make certain workers and their families are fully aware of their rights. More generally, that FROI can be used as a prevention tool to protect other workers from similar injuries.

Rather than go to Court, the two TPAs settled with the Attorney General who was prosecuting the case. The two offending TPAs agreed to pay the state just over $100Kbetween them and to admit to violating the law. They also agreed to remain in compliance for two years and to take necessary steps to prevent recurrence of future violations.

Not every state applies a penalty for late filing of the first report of injury. To the best of my knowledge, Alabama, Arizona, Colorado, Michigan and North Dakota are among those that don’t, but I don’t have any data on how compliant employers are in these states with the statutory reporting time (typically 7 or 14 days). Wisconsin has a 14-day standard and publishes an indicator which currently shows more between 74 and 77% of first reports of injury being received promptly.

In Canada, the timeframe for reporting an injury varies from province to province but three- and five-day standards are common. The AWCBC posts the reporting requirements and the penalties prescribed for late reporting and other offenses at the following links:

Ohio reports that 74.5% of FROIs are received within that state’s 7-day time limit. This is impressive but some other states do even better. Maine requires the FROI within 7 days after the employer receives notice or knowledge of an employee lost-time injury. The state has an 85% compliance target but was tracking closer to 90% in mid 2010. My understanding is that Maine applies a $100 penalty for each late filing (beyond 7 days) of the first report of injury.

Minnesota assesses progressively higher penalties for late filing of the first report of injury (typically beyond 10 days of the first day of disability) with each violation. The first offense in any 12 month period attracts a warning but penalties go up after that for each subsequent offense ($125, $250, $375, $500 for five or more offenses). In 2009, the state assessed 694 penalties totalling more than $309,000 for late filing of the first report.

Other states have even more aggressive levels. I understand Texas has a 10-day limit with a fine of up to $25,000 per day for violations although I could not confirm if any firms had to pay anywhere near that amount.

Does the threat of financial penalties increase timely reporting behaviour? I could not find any comparative figures on compliance or penalties but am interested in any data you may have on this topic. I think the Missouri story and published compliance rates from Maine and Ohio certainly send important messages about the seriousness with which these states take the timely reporting of injuries.

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