U.S. Healthworks and Alternative Solutions Pays $900,000 for Reported Failure in Reporting First Aid Cases to Carriers

Following an investigation into alleged unfair business practices due to the failure to send Doctor’s First Report of Injury to workers’ compensation insurance carriers, U.S. Healthworks and Alternative Solutions, Inc., the largest industrial medical provider in California, without admitting liability, has agreed to pay $900,000 in restitution for civil penalties, investigative costs and fraud assessment, according to the California Department of Insurance (CDI).

California law requires a physician who treats an injured employee file a Doctor’s First Report of Injury with the claims administrator for every work illness or injury. The insurance carrier or self-insured employer must forward these reports to the Department of Industrial Relations.

The investigation uncovered the apparent widespread practice of having medical providers circumvent the law and withhold required information from the state by allowing the employer to decide which injuries or illnesses are reported in order to reduce or avoid appropriate insurance rates.