Employer Refuses to File Workers Comp Claim

Workers compensation is called “no-fault” insurance because the worker does not need to prove that the employer was responsible for the injury, but that doesn’t stop employers from trying to find “faults” that will allow them to refuse to file a claim.

Among the many reasons employers might not file your claim:

• Because insurance premium costs go up – This is probably the #1 reason employers don’t want to file workers comp claims. Workers comp insurance, like every other form of insurance, goes up when you make claims. Some employers tell an employee they will reimburse the worker for medical treatments, rather than file a workers comp claim and see their rates go up.
• Worker didn’t notify the employer in time – The deadline for reporting an injury ranges from 3 days in Wyoming to 90 days in Iowa and obviously varies dramatically from state-to-state. In fact, 13 states have a reporting deadline of “as soon as possible” which could mean whatever you want it to mean. Check the laws in your state.
• Your injury didn’t happen at the workplace – This is the most disputed part of workers comp claims. Your injury/illness must be directly related to work activities. You can’t hurt your knee playing basketball, then go into work the next day and claim an injury.
• Was there a witness? – If there were no other workers present when you got hurt – and no video footage available to substantiate your claim – your boss might question whether this happened at work.
• Pre-existing condition – If you complain often about a sore back, and later claim a back injury from lifting a box over your head at work, your employer can argue that this was a pre-existing condition that caused the injury.
• Do you actually work for that employer? – Independent contractors usually are not covered by workers comp.
• Use of illegal drugs – When an accident occurs, you may be asked to take a drug test and if you’re caught with illegal drugs in your system, the employer might not file a claim.
• Injuries as a result of fighting – Being involved in reckless conduct at the workplace, and sustaining an injury because of it, could be grounds not to file a claim.
• You filed a false claim – Nobody saw the accident; doctors can’t find anything wrong with you; and there is no evidence to verify this happened in the workplace. Those are all good reasons an employer won’t file a claim.

One thing you might want to pass along to an employer who won’t file a workers compensation claim for you: A California study found that 67% of denied claims, were paid within one year.

And it cost 50% more to pay those claims than it would if they had been accepted in the first place!

Can an Employer Deny Workers Compensation?

If the employee files a claim, the employer must report it to the insurance carrier and, in many states, to the state workers compensation program.

It’s not out of the question that an employer can deny workers compensation coverage if the employer believes the accident didn’t happen at the work site, is the result of a pre-existing condition or resulted from reckless behavior because of drug use or alcohol.

But if an employee makes a workers compensation claim, the employer must notify their insurer and the state with a First Report of Injury. The employer should make notes about the time, date, and location of the accident and question witnesses about the circumstances of the injury. Most employers turn that information over to the insurance claims adjusters and let them handle the rest of the claim and coverage.

What Happens If an Employer Does Not Report an Accident to Workers Comp

In most states, employers have 30 days to file a workers compensation claim for their employees. Employers who fail or refuse to file a workers compensation claim face fines that could go as high as thousands of dollars and possibly face penalties that include jail time.

In California, for example, state laws level a $10,000 fine or one year in the county jail – or both – against employers who don’t have workers compensation insurance when an employee gets hurt. In Pennsylvania, not having workers compensation insurance is a misdemeanor that carries a fine of up to $2,500 and one year in jail. If the failure to comply is intentional, it is considered a felony and the fine is $15,000 and up to seven years in prison.

If your employer won’t file a workers compensation claim for you, go to your state workers compensation website and file a claim of your own. Better yet, if the process has reached this aggravated stage, it would be time to visit a workers compensation lawyer and get legal advice.

What to Do If Employer Refuses Workers Comp

If your employer doesn’t have workers compensation insurance, you should report them to the state agency in charge of workers compensation. Workers compensation is mandatory in every state but Texas, where it is optional and most businesses carry it anyway. The penalties in most states are severe enough to convince businesses to have workers comp, but some companies still try to go without it as a cost-cutting measure.

If you are injured and discover your employer doesn’t have workers compensation insurance, you should immediately contact an attorney. You could have an opportunity to sue the employer with a personal injury lawsuit and recover damages, including pain and suffering compensation that is not available in workers comp.

If your state has an uninsured employer’s fund, you can make a claim there to receive the benefits – medical expenses and wage compensation – that you would have if your employer had workers compensation insurance.

However, you can’t take both options. If you accept workers compensation benefits from the state, you can’t file a personal injury lawsuit. That’s why you should consult with an attorney before making a decision on which route to take.