All posts tagged reporting

Companies Struggle with Benefits Compliance

More and more employers are being overwhelmed by all of the compliance requirements associated with managing employee benefits.

The Guardian Life Insurance Company of America’s “Benefits Balancing Act” study found that 60% of employers are feeling overwhelmed with the increased complexity of managing their benefits programs. One of the main reasons for the additional burden is the Affordable Care Act, with its myriad of compliance and reporting requirements.

The employer mandate and the documentation and new filing requirements with the IRS are high on the list of compliance issues, as are evolving Family Medical Leave Act (FMLA) and ERISA requirements.

Interestingly, larger firms with 100 or more employees are having the hardest time, with 70% saying they are especially challenged by installing new coverages, changing carriers and employee communications and enrollment.

The shackles of compliance are so great that it’s the number one benefits-related concern for nearly 30 % of employers, the study found. In fact, 70% said that their firms are not equipped to keep up with the steady changes in federal and state laws governing employee benefits.

The top areas of compliance concern are:

  • The ACA excise tax (“Cadillac tax”)
  • Changes to paid parental leave laws
  • ACA employer mandate
  • ERISA requirements
  • State and local FMLA requirements


In terms of administration the top concerns are:

  • Employee communications and education
  • Adding new benefits or changing plans and insurers
  • Establishing electronic data interchanges
  • Account management and service delivery
  • Claims and employee customer service
  • Enrolling employees


What companies are doing

As the regulatory landscape has shifted so dramatically over the last seven years, many employers have opted for outsourcing their benefits compliance.

This may be an especially smart move for smaller employers, which often do not have in-house benefits administration resources.


Among employers outsourcing at least some benefits activities, the study found that:

  • 50% use the services of a broker
  • 25% use an insurance company
  • 25% use a third-party vendor (enrollment firm, HR services firm or a private exchange)

Report, Investigate Near Misses to Improve Safety

Man nearly steps on a banana peel on a city street.

One of the most important workplace safety tools that you can put to use is the reporting of near misses and correcting the factors that led to such a close encounter.

A near miss is an event that could have led to a workplace injury, illness or death. While you are not required to report near misses to your insurer, you should be taking note of them as they can help you identify deficiencies in your workplace safety protocols.

You should use near misses as the starting point to conduct inspections that could help you prevent a real workplace injury in the future. But you can’t investigate what you don’t know, and it’s crucial therefore that your staff report such events.

Investigating near misses is part of any successful workplace safety management program and you should make the process for reporting them easy and without ramifications for the reporting employee.


What is and isn’t a near miss

An OSHA factsheet defines a near miss – or close call – as an incident in which no property was damaged and no workers were injured, but where, given a slight shift in time or position, damage or injury easily could have occurred.

The factsheet stresses that although near misses cause no immediate harm, they can precede events in which a loss or injury could occur.

You should resist the urge to chalk the near miss up to just luck or bad luck, because a series of events or lack of precautions would have led up to the close call.

Typically, near misses are the result of a faulty process or management system and it should be your goal to investigate and find out where the breakdown occurred and what you can do to improve it.


A near-miss program

Near-miss reporting is vitally important to preventing serious, fatal and catastrophic incidents that are less frequent but far more harmful than other incidents.

The National Safety Council recommends that the following should be part of your safety program:

  • Clearly define “near miss.”
  • Establish a reporting system that reinforces the notion that every opportunity to identify and control hazards, reduce risk and prevent harmful incidents must be acted on.
  • Investigate near-miss incidents to identify the root cause and the weaknesses in the system or employee action that resulted in the circumstances that led to the near miss.
  • Use investigation results to address the failure that led to the near miss and to improve safety systems, hazard control and risk reduction.
  • Use the lessons learned and your new protocols in employee safety training.


Reporting system

One of the key aspects of a near-miss program is reporting. Most importantly, you want to encourage your workers to report such incidents because often they may occur out of sight from a supervisor or manager.

You should put out clear instructions for all personnel on how to report near misses, including whom to report to. Create forms that detail the events, what happened and why they think it constituted a near miss.

Make sure to not assail any worker reporting a near miss. Encourage your personnel to report near misses without fear of retribution or being blamed.

Avoid thinking in terms of whom to blame when investigating a near miss and instead focus on what precipitated it.


Case studies

LESSONS LEARNED – A manufacturer uses event and near-miss analysis to head off future incidents. It uses an event system that records the near miss, including detailed information on what led to the close call and what lessons can be learned from the event. Those lessons are shared throughout the organization.


IMMEDIATE ACTION – A chemical manufacturer tracks lower-level claims and near misses to identify areas where more significant injuries are likely to occur. The company encourages employees to take action to resolve issues on a temporary basis until permanent controls can be implemented.

Agency Mulls Not Counting Portion of First Aid Claims in X-Mods

first aid stuff

California’s workers’ compensation rating agency is developing new guidelines that would exempt a portion of first aid claims from being included in the calculation of employers’ X-Mods.

Under state regulations, employers are required to report injuries that require first aid and are not severe enough for the employee to seek medical treatment or miss work. But despite the rules, few employers report the claims to their insurance companies.

The Workers’ Compensation Insurance Rating Bureau hopes that creating an exemption in the experience rating plan for first aid claims and injuries would increase reporting.

According to the trade press, the Rating Bureau is working on a plan that would exclude a portion of every claim from the X-Mod formula. The amount for that exemption has not been set and it’s likely that the change, even if approved this year, won’t take effect until at least 2017 or 2018.

But regardless, the move would be a welcome development for California employers, many of which are reluctant to notify their insurers of any injuries that involve only first aid treatment for fear that it will affect their X-Mod or because they are confused by the rules. The reporting of first aid claims is typically not mandatory in most other states.

The industries in which the lack of first aid claim reporting is most prevalent are the construction and restaurant industries, but it occurs in other sectors as well, according to the Rating Bureau.

When employers fail to report first aid claims it causes problems for claims adjusters, hinders workers’ ability to access workers’ comp benefits and has a negative impact on the employers that play by the rules and report all of their claims.

Also, what starts as an injury that only requires first aid treatment can later develop into a full-blown claim if the initial injury worsens.

According to the trade publication Workers’ Comp Executive, the Rating Bureau is looking at imposing a first aid claim exemption of $250, $500 or $1,000. It has been testing the different amounts and the effects on ensuring reliability of employers’ X-Mods.


Depending on the amount, it would have a substantial impact on reportable claims:

  • The $250 threshold would eliminate 15% of the claims in the system.
  • The $500 threshold would eliminate 36%.
  • The $1,000 threshold would eliminate 54%.


The biggest concern is that eliminating so many claims could reduce the rating system’s ability to accurately predict system costs and set accurate rates.

The Rating Bureau expects that at the $250 threshold, the change would mostly affect employers who have no other claims and that it would push up their X-Mod by just one percentage point on average.

The committee studying the issue “thought this was a reasonable trade off to get more claims into the system,” David Bellusci, the Rating Bureau’s chief actuary, said during a classification and rating committee meeting in early April, according to the trade publication.

The perception there is that the honest employers reporting all of their claims, including these smaller first aid only claims, are at a disadvantage to employers that are not currently reporting these claims.

Also, the Rating Bureau plans to work Cal/OSHA in regard to changing the definition of first aid. Cal/OSHA regulations do not require that employers report injuries that require first aid to the agency.


EEOC’s Data Collection Proposal Could Spike Litigation against Employers

equal pay

A new proposal by the U.S. Equal Employment Opportunity Commission to collect pay data from all organizations with more than 100 employees would likely open up employers to further litigation and regulatory actions.

The EEOC says it wants to use this data to identify areas of possible pay discrimination. But this fresh trove of data would likely lead to litigation by employees who feel they are underpaid compared to their colleagues, and to administrative actions, according to employment law attorneys.

The commission already uses so-called EEO-1 reports to collect demographic data about employers’ workers, such as race, ethnicity, sex, and job category of employees. Under the proposal, starting in September 2017 it would also gather data on pay ranges and hours worked.

The EEOC and the Department of Labor would use this data to identify pay disparities across industries and occupations, and strengthen federal efforts to combat pay discrimination.

The agencies would also use the information to assess complaints of discrimination, focus agency investigations, and identify pay disparities that it could probe more deeply.

Under the proposed regulations, employers with more than 100 workers and who file the EEO-1 forms would be require to include on the revised form:

  • Total W-2 earnings.
  • Aggregate W-2 data in 12 pay bands (pay ranges) for the 10 EEO-1 job categories. Employers will count and report the number of employees in each pay band.
  • The total number of hours worked by the employees in each pay band. The EEOC intends to use this data to analyze pay differences while also taking into account the differences in hours worked, as well as accounting for part-time work. (Note: The EEOC made a point of saying it doesn’t want data about specific employees, and that the data will be kept confidential.)


EEOC investigators would analyze W-2 pay distribution within single organizations and compare that data to aggregate industry or metropolitan area data.


Employers react

Already there has been pushback from employer groups about the administrative burden this would put on businesses. And some have voiced concern that data could be misconstrued as it fails to take into account the subjective factors influencing pay, such as experience and skill.

According to a new report in Bloomberg BNA, the EEOC’s assurance that it will keep employers’ pay data confidential doesn’t necessarily mean it will. It interviewed one labor law attorney who said that the data could be subject to Freedom of Information Act requests.

There are also “serious questions” about relying on the W-2 data, as pay could be influenced by shift differentials, an employee’s willingness to work overtime and other factors, Greg Keating of Boston-based Choate, Hall & Stewart L.L.P. said.

An employee’s W-2 form “doesn’t tell the whole story by any means,” he said, adding that pay differences within pay bands also can occur for many reasons that have nothing to do with gender or race bias.

So, the data on which the EEOC intends to rely is “quite suspect” as an indicator of any unlawful practice, Keating said.

Another attorney, Stanley Pitts, a partner with Honigman Miller Schwartz & Cohn L.L.P. in Detroit, told Business Insurance magazine that the EEOC is most interested in probing higher-paid categories and “trying to look at the ‘glass ceilings’ for gender or pay discrimination.”


The takeaway

At this point, it’s unclear how the EEOC might use this data, but employers can nonetheless take some preemptive action.

The law firm of Thompson Coburn LLC in a recent blog recommends that employers with more than 100 workers examine their payrolls to identify any inadvertent pay differences and to compare the pay rates of similarly situated employees when changing workers’ salaries.

The law firm also recommends that employers that currently must submit EEO-1 reports conduct self-audits of their payrolls to identify any areas where they could be vulnerable to litigation for unequal pay practices.

The public has until April 1 to submit comments on the proposed rules.



Post Cal/OSHA Form 300A by Feb. 1

Hand reaches out from big heap of crumpled papers

Employers with 10 or more employees are required to post their 2015 Cal/OSHA 300A form starting on Feb. 1 until April 1.

Form 300A reports an employer’s total number of deaths, missed workdays, job transfers or restrictions, and injuries and illnesses as recorded on Form 300. It also includes the number of workers and the hours they worked for the year.

Nonexempt employers with more than 10 employees must post the form..

There are actually three related forms you need to keep up to date:

  • OSHA Form 300 – Log of Work-Related Injuries and Illnesses
  • OSHA Form 301 – Injury and Illness Incident Report
  • OSHA Form 300A – Summary of Work-Related Injuries and Illnesses


The OSHA 300 series forms are written in plain language and are intended to simplify work-related injury and illness record keeping and enhance company safety and health programs.

The resulting data collected by these forms will be used to track and compile statistics on work-related injuries, illnesses, and deaths so that employers and Cal/OSHA can develop a picture of the extent and severity of work-related incidents. They will also help Cal/OSHA identify the scope of employer-assistance needs.


Form 300

OSHA’s Form 300, the “Log of Work-Related Injuries and Illnesses”, must be used to classify work-related injuries and illnesses and to note the extent and severity of each case.

When an incident occurs, you must use the log to record specific details about what happened. You are required to use this form to record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid.


Form 301

You have seven days to fill out Form 301, the “Injury and illness Incident Report,” after a work-related injury or illness occurs. The form must be kept on file for 5 years following the year to which it pertains.

Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety.


Form 300A

If you have more than 10 employees you must complete Form 300A even if no work-related injuries or illnesses occurred during the year.

The total number of incidents in each category listed on Form 300 must be transferred to the Form 300A.

Form must be displayed in a conspicuous location where notices to employees are customarily posted. A copy of the “Summary” must also be made available to employees who move from worksite to worksite and employees who do not report to any fixed establishment on a regular basis.

At the end of the three-month period, Form 300A should be taken down and kept on file for a period of five years following the year to which it pertains.


IRS extends ACA reporting deadline for employers


The IRS has extended the deadline for reporting health plan information for 2015 under the Affordable Care Act.

Starting this year, applicable large employers (those with 50 or more full-time or full-time equivalent employees) must report whether an individual is covered by minimum essential coverage and that an offer of minimum essential coverage that provides minimum value was made to each full-time employee. This is done in form 1095-B and 1095-C.

Under a notice issued on Dec. 28, the deadlines for furnishing employees with the 2015 Form 1095-B (Health Coverage) and Form 1095-C (Employer Provided Health Insurance Offer and Coverage) have been extended from Feb. 1, 2016, to March 31, 2016. These forms explain to the employees their health benefits that you provide, if any.

The same notice also extended the deadline for filing with the IRS Form 1094-B (Transmittal of Health Coverage Information Returns), Form 1095-B, Form 1094-C (Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns) and Form 1095-C.

The deadline for filing electronically has been moved to May 31 from Feb. 29. If filing by paper, the deadline has been moved to June 30 from March 31.

Report All Workplace Injuries Promptly, Including First Aid

IF ONE OF your staff suffers an injury at work, it’s your duty to report that injury to your workers’ comp carrier.

Many employers think they can skip making a report if someone is hurt at work yet doesn’t need to go see a doctor immediately. But the problem is that even what seems like a minor injury can turn into a major problem down the road.

Take the case of a man who was working for Louis Truth Dairy, when a crate with milk containers down a shoot and hit him in the shin.

The force of the impact knocked him to the ground and left a welt. Despite the bruise, he did not see think the injury was serious, so he didn’t report it to his employer.

But the welt became a boil that eventually opened up and became infected. The man then sought care from his doctor, but did not mention the wound to his employer until three months after the workplace injury was incurred.

Although, in this instance, the employer had no control over the delay, it’s common for workers not to report a minor injury, such as a small cut on the hand.

But you never know when an injury can become infected or otherwise develop into something more complicated.


Consequences of Late Reporting

  • A delay in seeking treatment may cause a deterioration in the employee’s condition.
  • Hindering your ability to investigate the claim, as witnesses may no longer be available or key evidence may not be preserved.
  • The ability to deny uncompensable claims can be affected. Many states have regulations that prohibit denial of claims after a specified time period.
  • The ability to deny a claim due to a worker being under the influence of drugs or alcohol.
  • The opportunity to direct the initial treatment to an occupational health clinic that specializes in treating workers’ comp injuries and coordinates with the employer’s return-to-work program may be lost.


First-aid claims

In California, employers are permitted (under specific guidelines) to directly pay for their first-aid claims. This practice may have a positive effect in minimizing the impact on future experience modifications, and reduce the future cost of premiums. But you need to carefully make a decision on first aid.



First aid, as defined by the California Labor Code and Regulations, is any one-time treatment, and any follow-up visit, for the purpose of observation of minor scratches, cuts, burns, splinters or other minor occupational injuries, which do not ordinarily require medical care.

Such one-time treatment, and follow-up visit for the purpose of observation, is considered first aid, even though provided by a physician or by other registered professional personnel.



All first-aid claims should be reported to your workers’ compensation carrier as a precautionary measure.

We can assist you if you have any claims questions. We can work with your carrier to help you be certain that such claims are classified as first-aid only.


Examples of first-aid treatment

  • Application of antiseptics
  • Treatment for first-degree burns
  • Application of bandage(s) during any visit to medical personnel
  • Use of elastic bandage(s) during first visit to medical personnel
  • Removal of foreign bodies not embedded in an eye if only irrigation is required
  • Removal of foreign bodies from wound if removed using tweezers or another simple technique
  • Use of non-prescription medications and administration of a single dose of prescription medication on first visit for minor injury or discomfort
  • Soaking therapy on initial visit to medical personnel or removal of bandages by soaking
  • Application of hot or cold compress(es) during first visit to medical personnel
  • Application of ointment to abrasions to prevent drying or cracking
  • Application of heat therapy during first visit to medical personnel
  • Use of whirlpool-bath therapy during first visit to medical personnel
  • Negative x-ray diagnosis
  • Observation of injury during visit to medical personnel

injured at work gold-silverman

More Than Half of Employers Feel Unprepared to Manage ACA Compliance

A new study has found that more than half of large employers are not prepared to properly comply with all of the requirements of the Affordable Care Act.

The study by ADP, a payroll vendor, looked at how companies are gearing up to comply with the ACA’s regulatory requirements.

Because the research looked at the preparedness of large employers, which have sophisticated human resources departments, it is likely that small and mid-sized employers are even less prepared.

The study, “Affordable Care Act and Employer Confidence: Navigating a Complex Compliance Challenge,” found that while 70% of large employers are handling ACA compliance internally, these employers do not feel fully prepared to manage several critical compliance requirements, including:

  • Exchange notices (62% said they don’t feel prepared to deal with the notices)
  • ACA penalties (60%), and
  • Annual health care reporting (IRS Forms 1094/1095-C) (49%).

“As we meet with large employers, it has become clear that many don’t have the systems or processes in place to meet ACA compliance requirements,” said Vic Saliterman, senior vice president at ADP.

To clear the air, we provide the following guidance on these three areas of confusion:


Exchange notices  – The ACA requires employers to provide all new hires and current employees with a written notice about the option to purchase coverage through public health insurance exchanges. This requirement is found in Section 18B of the Fair Labor Standards Act.

In general, the exchange notice must:

  • Inform employees about the existence of the exchange and describe the services provided by the exchange and the manner in which the employee may contact the marketplace to request assistance;
  • Explain how employees may be eligible for a premium tax credit or a cost-sharing reduction if the employer’s plan does not meet certain requirements;
  • Inform employees that if they purchase coverage through the exchange, they may lose any employer contribution toward the cost of employer-provided coverage, and that all or a portion of this employer contribution may be excludable for federal income tax purposes; and
  • Include contact information for the exchange and an explanation of appeal rights.


The Department of Labor has provided the following model exchange notices:

  • You can find the model exchange notice for employers that do not offer a health plan here:; and
  • You can find the model exchange notice for employers that offer a health plan here:

Employers may use one of these models, as applicable, or a modified version, provided the notice meets the content requirements described above.


 ACA penalties

Applicable large employers can incur penalties, which are known as “employer shared responsibility taxes,” if they either:

  1. Do not offer minimum essential coverage to at least 95% of all full-time employees. The penalty for not offering coverage is $2,000 for each full-time employee.
  2. Do not offer a plan that provides minimum value and is affordable (9.5% of wages). The penalty for failing to do so is $3,000 times the number of employees for which the employer fails to offer minimum value and affordable coverage and if those employees receive a subsidy to purchase coverage through a state-run exchange.


The final regulations include transition relief for 2015 that allows employers with 100 or more full-time employees (including full-time equivalent employees) to reduce their full-time employee count by 80 when calculating the penalty.

This relief applies for 2015 plus any calendar months of 2016 that fall within the employer’s 2015 plan year.

But, under the final regulations, employers that change their plan years after Feb. 9, 2014, to begin on a later calendar date are not eligible for the delay.

In subsequent years, the penalty amount is expected to be indexed by the premium adjustment percentage for the calendar year.


Annual health care reporting

Applicable large employers must report to the IRS information about the health care coverage, if any, they offered to full-time employees. The IRS will use this information to administer the employer shared responsibility provisions and the premium tax credit.

Large employers also must furnish to employees a statement that includes the same information provided to the IRS. Employees may use this information to determine whether, for each month of the calendar year, they may claim the premium tax credit on their individual income tax returns.

Annually, large employers must file with the IRS no later than Feb. 28 (March 31 if filed electronically) of the year immediately following the calendar year to which the return relates:

  • IRS Form 1095-C (called “Employer-Provided Health Insurance Offer and Coverage”), and
  • IRS Form 1094-C (called “Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns”)


Transition relief provides that employers do not have to file information returns with the IRS and furnish statements to their full-time employees until 2016 for the 2015 year.

Thus, under this relief, the first statements to employees must be furnished by Jan. 31, 2016, and the first information returns to the IRS must be filed by Feb. 28, 2016 (March 31, 2016, if filed electronically).

Although the first information returns and employee statements are not due until 2016 for the 2015 year, employers may choose to file for the 2014 year.

The IRS has encouraged employers to voluntarily comply with these information reporting provisions for 2014 in preparation for the full application of the provisions for 2015. No penalties will be applied for failure to comply with these information reporting provisions for 2014.

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