Workers compensation rules can get complicated but are really simple. You get hurt. You get treatment. You get paid.
So what happens if your boss doesn’t follow the rules?
Specifically, what if your employer refuses to file a workers compensation claim?
Employers are required to post rules around the workplace that spell out the protocol to follow in case of an injury. If you’re involved in an accident, you might want to rip that poster off the bulletin board and slam it down on your boss’s desk and say, “Look at this!”
Such dramatics might be effective and make you a hero to your coworkers. But before you march into your boss’s office, you should arm yourself with as much information about filing a workers comp claim as possible. Here’s what you need to know.
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Can an Employer Refuse to File a Workers Comp Claim?
Your employer has a legal obligation to provide employees with all the paperwork needed to make a formal report of an injury suffered in the workplace. It also has the responsibility to provide workers with a list of approved medical facilities under its workers comp plan.
That said, you have the initial obligation to file a report of a workplace injury or work-related illness. Don’t assume an incident is obvious to everyone concerned – especially to the foreman who saw you carried out on a stretcher after a broken bone or worse.
Not filing a report, or not knowing the deadline to file a timely report, would provide a reason for a company to contest a workers comp claim.
You must comply with the reporting period parameters posted in the workplace (or at least they should be posted) and allowed by the state. If you don’t, you risk a corporate refusal of the claim. Some states allow as long as two years, while others allow only a few days.
There may be other reasons a company refuses a workers comp claim. Your employer might contest the seriousness of the injury. He or she could argue the injury did not happen in the workplace or did not result in the employee missing workdays.
The safe course of action is to inform your employer immediately of a work-related injury. Make sure your employer provides you with a DWC-1 form to document the accident. Then make sure you inform the state worker’s comp board about your injury.
That DWC-1 form is pretty straightforward. It requires you document the following:
- Date and time of injury.
- Location of incident.
- How it happened.
- Your resulting symptoms.
What Happens If an Employer Does Not Report an Injury to Workers Comp?
Refusing (or simply failing) to submit legitimate workers comp forms can cost a company steep fines by the state board. Depending on the extent of the injury being ignored or unfairly contested, a state board could fine the employer thousands of dollars.
The consequences of an unreported claim for a business owner or corporate entity could go beyond fines to misdemeanor or even criminal charges. The employee being denied workers comp benefits could also file a lawsuit for damages.
But what do you do if your company simply disputes your claim for the reasons we mentioned? Say it doesn’t believe your injury was serious, or that it happened at work. What if your claim is past the deadline for reporting?
“If an employer disputes a workers’ compensation claim or fails to report it, an injured employee has several options,” said Allen Clardy, personal injury attorney and founder of the Clardy Law Firm. “They can choose to write to the insurance company that provides the employer’s workers’ compensation insurance or perfect a claim with the Workers’ Compensation Commission or state agency that handles workers comp claims in their state.
“This must be done within the statute of limitations. Each state has unique laws governing workers’ compensation claims, so it’s always advisable to seek advice from a lawyer and ensure all proper forms are correctly filed with the state agency.”
You could also get your own group health insurance or that of a spouse to pay for your medical treatment so you can receive care and hopefully begin your recovery while your claim is settled in court. You may need to provide a Notice of Dispute letter to your insurance company. In some cases, you may even have to sign a reimbursement letter to pay back the costs when your workers comp claim is settled.
“If an employee is injured on the job and their workers’ compensation claim is denied by their employer, they are responsible for paying the bills for the related medical treatment,” said Clardy. “Once the claim is hopefully found compensable by the Workers’ Compensation Commission after an evidentiary hearing, the workers’ compensation carrier would be responsible for going back and paying all causally-related medical treatment.”
What to Do If an Employer Does Not Report an Injury?
So you’ve been injured on the job. You’ve taken the appropriate action: notified your employer, filled out the appropriate form documenting the time and place of the accident. And you did it all in the time allowed by your state’s regulations.
But your employer has not reported your injury. What now? Where do you turn for help?
Know that once notified, your employer must file what’s commonly referred to as a “First Report of Injury.” If the employer doesn’t, he/she is breaking the law.
Stay on top of the situation. If your employer does not report your injury within a specified time, you can file a separate claim with your state’s workers compensation board.
If your employer does not provide you with a claim form, you can download one from the state board’s website. You also could have an attorney handle the paperwork and hound your employer to file your claim.
Given the complexity of workers compensation laws, hiring an attorney is a wise move, especially if your employer is dragging his/her feet.
“If the employer drags their feet with the handling of the claim, the injured worker must keep in mind the statute of limitations for filing a claim with the Workers’ Compensation Commission,” reminds Clardy.
Can I Sue My Employer for Not Reporting My Injury?
While workers typically cannot sue employers for work-related injuries, one scenario where a worker can sue an employer is the employer’s refusal to report an injury claim.
It’s important you understand that you (most often) must report your injury and complete the necessary paperwork before suing an employer for refusal or failure to file your claim. Following protocol and paying attention to what’s required of you to file a successful claim becomes even more critical if suing an employer becomes necessary.
Another scenario where it might be possible to sue an employer is when your employer does not carry workers comp insurance of any kind and you are injured on the job.
The legal onus is on the employer to provide that insurance. Not doing so could be a felony and punishable by six-figure fines and even jail time in certain situations.
How Long Does an Employer Have to Report an Accident?
As is the case with an employee notifying the employer of an accident, the employer should act as soon as possible in notifying the state’s workers comp board.
Even though employers are required to fill out and submit a DWC-1 form, that doesn’t mean they will. That’s why there are deadlines for workers comp.
They vary from state to state but are typically about 30 days. Florida, Texas and a few other states allow only a week.
Penalties for failing to comply also vary. The minimum charge is typically $100, but missed or late reporting can result in a $2,500 fine in California. In some states, it’s up to $7,000 depending on the severity of the injury.
And in case you’re wondering, such penalties are not typically deductible as a business expense.
Why Might an Employer Refuse to File a Workers Comp Claim?
Your employer is in business to make money, and workers compensation claims can take a bite out of a company’s profit margin.
Responsible employers know that’s just the cost of doing business. If they provide a safe working environment, the no-fault workers comp system will protect them from frivolously expensive claims.
There are legitimate reasons an employer would refuse to file a workers comp claim. At least they’re legitimate in the employer’s eyes.
For instance, your employer might believe he has a valid defense against your claim. Among the potential points of contention:
- Your injury did not require medical attention.
- Your injury did not require time off from work.
- You were not actually hurt while on the job.
- You filed a false claim.
- You did not notify your employer within the required time frame.
All those are legitimate reasons you could be denied workers comp. They also are all potentially contestable, which is why you should consult a lawyer if your employer starts to play hardball.
You must look out for yourself. Remember, workers comp is like auto insurance. Employers need to carry it by law, but the more it’s used the higher the cost to the company.
For that reason, an employer might pressure you to use your private health insurance or offer to pay you while you’re not working. Refuse those offers.
There’s no guarantee an employer’s offer to pay you while you’re not working would extend past your deadline to file a claim.
The system provides employers a clear path to contest a workers comp claim. It does not allow them to pressure an employee to use their own medical insurance or to accept an offer to get paid while they’re out of work injured.
If you’re injured on the job, workers comp is your protection. Make use of it.
Remember the foundation blocks of workers comp. You get hurt. You get treatment. You get paid.
About The Author
Bill Fay has touched a lot of bases in his 45-year career. He started as a sports writer, gaining national attention for work on college and professional sports. He had regular roles as an analyst on radio and television and later became a speech writer for a government agency. His most recent work is as an internet content marketing specialist. Bill can be reached at email@example.com.
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