Every employer in California deserves compensation for injuries incurred in their workplaces. The possibility of receiving full compensation for your injuries depends on the actions taken by your employer. The California Workers' Compensation Act (WCA) has set rules and regulations to ensure employers find the right financial aid for their injured employees.

Unfortunately, some employers don’t assist their employees in receiving their rightful compensation as required by the law. You have the right to seek legal help if your employer doesn’t offer the required assistance to ensure that you’re rightfully compensated. At The Workers Compensation Lawyer Law Firm, we aim at providing the best legal services to employees who have their claims denied by their employers. We serve the entire Los Angeles area.

Coverage Requirements for Your Employers

Before we go into details about how your employer should handle your work-related injury claim, it's better to understand your employer's coverage requirements. In California, almost every employer must secure a worker's compensation coverage for their employees. According to the California Workers' Compensation Act(WCA), an employee is anyone working for another person or organization and isn't an independent contractor. The coverage works whether the employee is a full-time or part-time employee.

Coverage requirements also apply to temporary employment agencies, referral services, labor contractors, and similar hiring temporary workers.

Employers can secure workers' compensation insurance policy through a private insurance company licensed in California or self-insurance certification with the Office of Self Insurance Plans (OSIP).

Coverage Notice Requirements

WCA requires employers to display a notice in a noticeable place stating that they have a worker's compensation insurance coverage that complies with their regulation. Failing to do so is a misdemeanor and might subject you to penalties.

The coverage notice should be available in English and Spanish and should include specific information about the workers' rights and tools under the Workers' Compensation Act.

If an employer fails to provide this notice, the employee can seek treatment from a physician of their choice for the injuries incurred when the employer didn't display the notice.

Apart from posting these requirements, employers must provide this information to new employees while hiring them or at the end of their pay period. They should give the following instructions to new employees:

  • Ways to obtain appropriate medical care after incurring a job-related injury
  • The responsibilities and functions of a primary treating physician
  • How to obtain and submit the form that an employee should use to notify that they want to use a personal physician

 How You Should Report a Work-related Injury Under California's Workers' Comp

Since now you know your employer's insurance coverage requirement, it's crucial to understand how to submit your compensation claim. Employees are required to give written notice of an injury they've incurred in a workplace within thirty days. However, employers can still receive a notice about the injury once it occurs. For instance, if a foreperson or supervisor witnesses the injury, they can give the notice on behalf of the employee. Once the employer learns about the injury, they must provide the employee with a claim form.

However, practically, employees should not entirely rely on their employer's knowledge about the injury. Instead, the best practice is to give a formal written notice as soon as the injury occurs.

Even so, failing to give timely and accurate notice of the injury doesn't bar the injured employee from receiving compensation benefits if the failure didn't prejudice or mislead the employer. This means the employee doesn't lose the right to the benefits if the delay didn't prevent the employer from investigating the incident that caused the injury.

How to Give a Notice for Cumulative Injuries

Cumulative injuries occur over a specific time. An occupational illness can also develop after repeated exposure to toxic substances.

Identifying and reporting a cumulative injury can be difficult within thirty days. That is why California laws have simplified this task by defining the date of a cumulative injury as:

  • The time that an employee suffered a disability from a specific injury, and
  • Should have known or was sure about the disability from the employment

You can therefore notify your employer about a cumulative injury thirty days after realizing it or when it causes you to miss work and has turned into a permanent condition.

The safest way to notice a cumulative work injury is when you suspect you're missing your work due to a work-related condition. Apart from that, if a doctor tells you about a permanent health condition that results from the job, you should immediately notify your employer about the condition.

Even so, an employee can report a cumulative injury within one year after the date of the injury as described above and the last date of working in an occupation that causes cumulative injury, whichever comes first.

Employers Responsibility to Providing a Claim From

An employer must provide a claim form to the injured employee after learning about the work injury if the injury made the employee lose time beyond their work shift and needed first aid and medical treatment.

The employer should accompany the claim form with written notice of the worker's eligibility for the benefits. They can provide the notice by mail or in person. the notice must contain the following information:

The procedure that the employee will use to begin the process for collecting worker's compensation

  • A detailed description of the benefits that the worker can collect
  • What will happen when the employer files the claim form
  • The organization or person that the worker can obtain medical care for the injury
  • The responsibility and function of the primary physician
  • The rights of the employee to change their treating physician
  • How the employee can seek medical care when the claim is pending
  • How the law will protect the employee from discrimination

Please note, you can disagree with decisions affecting your claim, but you should consult a lawyer if you disagree with the decision. Many attorneys offer a free consultation which you can take advantage of.

How to Complete Your Workers' Compensation Claim Form

An injured employee should complete the "employee" section of the compensation claim form to make a compensation claim.

The claim form is written in English and Spanish. Other versions are available for download in Vietnamese, Tagalog, Korean, and Chinese from the Workers' Compensation website.

An employee must provide the following information to complete the claim form:

  • Your details which include your name, address, and social security number
  • The email address that you would want to receive a confirmation email
  • The date and time of your work-related injury
  • The address and description of the place where you incurred the injury
  • A description of the injury and part of your body that was affected
  • Your signature

In some cases, it's easier to provide this information. However, there are times you will be forced to give ambiguous answers, especially when you cannot ultimately determine the exact date of your cumulative injury. That's why it's recommended that you write down every part of the body that seems to be affected by the work accident to receive your compensation on time.

How You Can Know that Your Employer Didn't Report Your Injury Claim

The best and easiest way to determine whether your employer is aware of your injury claim is by asking about your worker's compensation claim status. In California, insurance companies have a quick response time for workers' compensation claims, which means that you should be left wondering if this takes too long.

Typically, it takes three business days to hear from the respective insurance company. Therefore, if you don't hear any word within these three days, it means that something might be wrong.

Reasons Why Your Employer Doesn't Want to Report Your Work-related Injury

Employers or supervisors fail to report an employee's injury out of forgetfulness in many cases. Many managers have packed schedules, and forgetting to file a compensation claim could be possible. However, this can cause many complications, so employers should prioritize these tasks above anything else.

Other less justifiable reasons why an employer might fail to report your injury claim include:

  • You have a minor injury that doesn't validate the need for worker's compensation benefits
  • Your accident is not part of the worker's compensation regulations
  • Your claim can increase the workers' compensation premium
  • You can rely on your healthcare benefits to treat yourself
  • You will probably give up on the claim if they deny it for a longer period

Of course, none of these reasons are valid since they derive your worker's compensation right. Please don't allow your employer to pay for your medical treatment out of their pocket. This means that you will be surrendering your rights to the workers' compensation insurance and all the full rights available under the workers' compensation law.

Regardless, if your employer has issues related to the claim, they have the right to contest it. The system is set to resolve such disputes. Therefore, your employer has no right not to report your claim regardless of the reasons they have.

Your Employers Responsibility Once You Submit the Compensation Claim

Once you have filled in the "employee" section of the compensation claim form, your employer will fill the "employer" section and submit it to the compensation claim administrator. The administrator is usually an employee of your organization's insurance company. Your employer should then give you a dated copy of the completed claim form, in person or by mail, within a day of receiving the claim form from you.

It's essential to keep the copy with you as evidence that you've filed your claim correctly. The form also holds crucial information needed to pursue legal action against your employer.

What Happens When Your Claim is Submitted to the Workers' Compensation Administrator

Once your employer submits your claim form to the workers' compensation administrator, this commences a ninety-day period in which the administrator can deny your claim without proving that your injury is compensable.

This presumption is essential since it avoids a situation where the insurance company claims that your injury is not related to your work unless it discovers evidence that can support this after the ninety days have passed.

Therefore, it's crucial to file your form promptly since you may benefit from the presumption that the injury is compensation if it's not denied within ninety days of filing.

By filing a claim form with the claims administrator, your employer or insurance company should authorize a maximum of $10,000 to seek necessary medical treatment for the injury indicated on the claim form, as the administrator decides whether to accept or reject your claim.

If the administrator accepts your claim, your treatment should continue without the dollar limit. However, if the administrator rejects the claim, your treatment will stop unless you successfully challenge the decision. Your employer is still responsible for paying the allowable treatment cost of up to $10,000 incurred until the denial date.

Filing a claim with the administrator also restricts medical providers from collecting their treatment expenses directly from the injured worker unless they receive a notice from the administrator that they have rejected the claim.

Factors that can lead to a Claim Rejection by the Workers' Comp Administrators

Workers' compensation can deny employees their legitimate compensation claim, forcing them to hire lawyers and force them to pay their compensation. Some of the main reasons why your insurance claim may be rejected are as follows:

You're Filing an Unwitnessed Injury

Workers' compensation insurance companies don't reimburse unwitnessed injuries. Therefore, if you are hurt at work but no one saw your accident, you can't do anything about that. However, you should report the injury to your supervisor or co-worker immediately and tell everyone about the injury.

You Took Too Long Report the Injury

Workers' compensation insurance companies also don't like cases where employees report their injuries immediately. These insurance companies assume that you were not really hurt, hence the need not to report the injury immediately. The best way to beat this assumption is by reporting your work-related injury immediately to the supervisor and filling out the accident report. This will ensure compliance with the law and guarantee your benefits as soon as possible.

There's an Inconsistency Between Your Injury Report and Initial Medical Details

Insurance companies often deny workers' compensation claims if an employee's statement about the circumstances of your compensation claim. For instance, if you report your accident to the doctor differently from how you explain it to your doctor, this could hurt your case. Therefore, you should be consistent with how you report the accident to your health care provider.

You Filed a Workers' Compensation After You Were Laid Off or Fired

Sometimes, workers who are legitimately injured at work could delay filing a workers' compensation claim, and by the time they are filing the claim, they are laid off or fired. Insurance companies don't like this claim since they presume it is nothing more than a revenge claim. Therefore, it's always recommendable to make a compensation claim immediately after you're injured if you want to be compensated on time. Otherwise, you'll have a hard time convincing the insurer that your injury is work-related.

Your Initial Medical Records Shows the Presence of Illegal Drugs in Your System

Insurers will most likely not pay workers' compensation benefits to employees who show illegal drugs in their system after a work-related injury. Therefore, if you're found to have illegal drugs on your system, you'll most likely fail to secure the compensation you deserve.

Next Step if Your Employer Doesn't Handle Your Work-related Injury Claim

Regardless of the reason behind your employer's denial of your work-related injury claim or failure to file your claim, you should know what to do to safeguard your rights. The best way to handle this is by consulting with a lawyer about the case. A workers' compensation lawyer represents injured workers and would tell you if they are eligible to sue for the injury. Your lawyer can file the claim on your behalf if you're eligible.

There are additional steps between filing for benefits and suing your employer in court. For instance, you can file an appeal with California's Workers' Compensation Board. Again, a local lawyer can represent your injuries and explain the steps you should take to collect your deserved benefits.

You can also sue your employer if the employer doesn't provide workers' comp coverage. At this point, you can sue your employer immediately after an injury or illness. This could be the case if:

  • You're an independent contractor and aren't covered under the workers' compensation policy
  • Your employer is exempted from California's workers' compensation law
  • Your employer doesn't provide worker's compensation coverage, which is a violation of California's state law

How Much You Can Recover by Suing Your Employer

The amount that you can recover from suing your employer depends on the extent of your injuries. You can recover compensation for your financial and non-financial loss, but it's up to you to prove how much you deserve to recover.

However, if your injuries are significant, you can recover substantially. Your attorney will help you seek compensation for your current and future medical bills. On the non-financial side, you can recover compensation for pain and suffering, emotional trauma, loss of enjoyment of life, and loss of consortium.

A Quick Step-By-Step Guide to Sue Your Employer for Failing to Submit Your Work-Related Compensation Claim

Filing a claim against your employer is a challenging task. Here is a step-by-step guide on how you can go about this:

Ensure that You've Reported the Injury to Your Employer

You should report your work-related injury as soon as possible. This will help you collect the worker's benefits you deserve and provide crucial documents needed to sue your employer if they don't report the work injury.

Seek Medical Treatment

You should also seek medical treatment as soon as you can. You should seek treatment from an insurance-approved doctor. However, if you want to seek treatment from a doctor outside the workers' comp Medical Provider Network, ensure that you follow the proper steps needed for this kind of service.

Take Notes All the Time

You can only take legal action if you have crucial documents that can support your claim. The best way to do this is by taking notes from the time you incurred your injury, during treatment, and while filing a claim with your employer.

Determine Whether to Hire an Attorney to Sue Your Employer

As mentioned above, many attorneys are willing to provide a free initial consultation to anyone who intends to sue their employer after a work-related injury. A professional attorney should assess your situation to determine whether you're eligible for a claim. If you have a legitimate reason to file the claim, you must work closely with the attorney to maximize your chances of a total compensation recovery.

File Your Claim

You need an attorney to file a workers' comp claim. It's not advisable to do this by yourself. Having an experienced attorney by your side increases the chances of recovering your compensation more than you can achieve by yourself.

Take the right Follow-up Actions

Filing your claim is just the beginning of a process. You need to follow through with your medical treatment to work with your attorney to evaluate your settlement offers. Therefore, you should remain actively involved in the entire process. The more you're involved in the process, the higher the chances of achieving your expectation. You owe yourself to do what you can to recover the compensation you deserve.

Find a Workers Compensation Lawyer Near Me

Many things are at stake if your employer doesn't submit your work injury compensation claim. That is why it's recommendable to seek the help of a professional workers' compensation attorney to increase the possibility of receiving the compensation you deserve.

The first step to receiving maximum compensation for your work-related injury is scheduling a consultation with an experienced attorney. At The Workers Compensation Lawyer Law Firm, we offer a free initial consultation to workers seeking to sue their employers in Los Angeles, CA, for failing to submit their compensation claim with their insurers. We also help workers denied their rightful compensation for their work-related compensation claims. Contact us today at 424-501-9228, and let's help you safeguard your rights.