What if Your Employer Forgets or Refuses to File a Workers’ Compensation Claim?
After suffering a serious workplace injury, the absolute last thing you want to hear is that your employer refuses to file a workers’ compensation claim on your behalf.
Whether your employer refuses to file a workers’ compensation claim for lack of coverage, non-compliance or fears regarding increased insurance premiums, disputes over the nature of your injury, or simple negligence, they have still violated the law by refusing to do so.
Not only does an employer’s refusal to report workplace injuries constitute a violation of Pennsylvania workers’ compensation law and workers’ comp reporting procedure, it also directly prevents injured employees from accessing the medical treatment, workers’ compensation benefits and additional financial assistance they need following a workplace injury.
This is the case because, as dictated by the Pennsylvania Workers’ Compensation Act, the preliminary step in determining workers’ compensation claim eligibility is an employer’s filing of their First Report of Injury (FROI) with the Pennsylvania Department of Labor and Industry (PDLI).
Absent a First Report of Injury to the PDLI, injured employees are ineligible to file a workers’ compensation claim. Problematically, simply telling the PDLI that “my employer did not report my injury” is insufficient to gain workers’ compensation eligibility or extend the three-year filing deadline (that if missed, will independently disqualify you from workers’ comp benefits).
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My Employer Refuses to File a Workers Compensation Claim for My Injury, What Do I Do?
If you were recently injured on the job and are worried that your employer may be refusing to acknowledge your injury or report it to the state, you should:
1. Provide a Verbal and Written Report of Injury to Your Employer
The Pennsylvania Workers’ Compensation Act requires claimants to report any work-related injuries to their employers within 21 days of injury, to ensure retroactive workers’ compensation benefits from the date of injury.
Potential claimants are still eligible to report workplace injuries to their employers within 120 days following injury; however, benefits will only be awarded from the date of notice, rather than from the date of injury. Failure to report an injury to your employer within the 120-day period will disqualify you from workers’ compensation benefits.
Employees who suffer work-related injuries or illnesses are encouraged to inform their employer of their injury as soon as possible, as doing so increases the strength of their case and potential benefit awards, limits potential claim disputes, and ensures their employer is given a reasonable period of time to file their FROI with the state before injury-related absences begin.
It is recommended to make reports of injury both verbally and in written form to create a physical record of the injury report, should eligibility questions arise during the claims process. Certain employers will have accident reports available to complete for these kinds of scenarios.
When making a written report to your employer, be sure to make a note of the time and date of injury, the location of the accident or workplace activity resulting in injury, and any symptoms stemming from the injury.
2. Seek Immediate Medical Attention and Treatment
Following a report of injury, your employer is legally obligated to file a report with their workers’ compensation insurance provider and give you a list of approved medical providers to seek treatment from.
Pennsylvania law only requires claimants to treat with employer-approved providers for the first 90 days of treatment. After 90 days, you can seek treatment from any medical provider you wish.
If your employer refuses to provide you with treatment options, you should still seek treatment (with any qualified provider) immediately following your injury and bill any expenses under your own health insurance (if applicable). If you are awarded workers’ compensation benefits, you will be reimbursed for any out-of-pocket medical expenses and outstanding bills.
While treating for work related injuries, it is imperative to notify your provider that your injuries are work-related, as this further adds to the written record of your workplace injury and will be an essential component of the claim evaluation process.
You should also provide your medical provider with the name and contact information of your employer to add to your medical records.
Medical providers will be able to diagnose and attribute specific workplace activity to injuries and illnesses, further increasing the likelihood of a successful workers’ compensation claim.
Medical records can also serve as evidence against employers who refuse to file accident reports and workers’ compensation claims for injured employees.
3. Determine Whether Your Employer Has Filed a First Report of Injury with the PDLI
Under Pennsylvania Law, employers are required to file a First Report of Injury (FROI) with the PDLI Workers’ Compensation Bureau within seven days of your first workplace injury-related absence. In certain extreme cases, such as work-related deaths, employers are required to file their FROI within 48 hours.
These reports are especially important, as they function as the first step in establishing workers’ compensation claim eligibility for injured employees.
In almost all instances, the Workers’ Compensation Bureau will reject a workers’ compensation claim filed without an FROI from the claimant’s employer; meaning injured employees will be forced to bear the financial costs of their injuries and inability to work. However, an employer’s refusal to file an FROI or workers’ compensation claim does not necessarily guarantee you won’t be able to get benefits.
In the event your employer neglects or refuses to file an FROI with the state, they are considered, by the state, to have willfully interfered with the workers’ compensation claims process. In the legal sector, this practice is referred to as an act of “bad faith” resulting in financial damages and interfering with your ability to get workers’ compensation.
4. Appeal Claim Denials
If your employer either refuses or neglects to file a First Report of Injury with the Workers’ Compensation Board, you still have ways to appeal. The Pennsylvania Workers’ Compensation Act affords claimants opportunities for appeal and financial remedy in these situations.
Unfortunately, initial workers’ compensation claims often result in a Notice of Workers’ Compensation Denial. Despite this, you are still entitled to file a claim petition with the Bureau of Workers’ Compensation to get an appeal hearing in front of a judge.
This hearing allows claimants to present all of the documentation discussed in the previous three steps, such as the written report of injury filed with their employer, the medical records attributing their injuries to workplace activity, and any evidence of their employer’s refusal to comply with Pennsylvania workers’ compensation reporting procedure.
In these hearings, the judge has the discretion to overturn the denial of your workers’ compensation claim and award you benefits.
In the event of an overturned claim denial, claimants may also wish to pursue financial recourse for the financial damages caused by their employer’s actions. To recover financial penalties, claimants can file a Petition for Penalties with the Pennsylvania Bureau of Workers’ Compensation, which can result in financial awards up to 50% of past due medical bill balances, wage loss benefits, plus interest and attorney’s fees.
Because of the complexity of workers’ compensation appeals, the team at Krasno, Krasno & Onwudinjo strongly recommends retaining an attorney to assist with these matters.