I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. Employers carry a big responsibility on matters relating to the resolution of injuries and illness of workers at the workplace. To address such issues, employers have to obtain workers’ compensation insurance coverage for themselves and arrange it for their employees. This is essential in processing claims related to injury or illness for workers.

If you need to speak to an experienced workers’ compensation attorney, please call me at 916.921.6400 for free, friendly and no obligation advice.

Employer Notice Regarding Workers’ Compensation Insurance

It is the absolute responsibility of an employer to provide information on workers’ compensation through pamphlets explaining the rights and responsibilities. As soon as a new employee is hired, the employer must affix a notice at a prominent place explaining the procedures for trying to attain or qualify for workers’ compensation insurance.

A prominent place is not behind the door of a closet that no one would ever see unless they were the janitor for instance.

The “notice to employees” must spell out how workers can access compensation coverage and medical aid for injuries sustained at the workplace. Any failure in doing so will be a misdemeanor on the part of the employer and may invite a civil penalty of $7,000 for each violation.

Workers should know that an employer cannot ask for their employee to bear a part of the burden of workers’ compensation insurance premium or costs that the business needs to pay. This insurance responsibility is considered a part of the cost of doing business. Therefore, an employer cannot ask for a worker’s help in paying any part of the premium or any part of their insurance cost obligations.

That would be worse than your spouse asking you to pay for your own birthday gift. Not good!

Procedure to Access Insurance Benefits

An employer must provide a workers’ compensation claim to an injured worker within a working day of an injury or illness reported. The employer must get the claim copy filled out by the affected worker within a day and forward it to the claims administrator with detailed notes on the occupational injury or illness that has occurred.

Once the worker’s claim is submitted to the administrator the employer must authorize a maximum amount of $10,000 toward treatment of that condition.

In the interim, the injured worker must receive a lenient treatment at the workplace and must be exempted from heavy work. The transitional work must be lighter in nature.

In the event of a worker becoming a victim of a crime at a workplace, the employer must similarly provide the workers’ compensation claim form to the staffer within a day of the crime.

How to Provide Medicare for Injured Workers?

Arrange Medical Aid: Call 911 to summon emergency care from the hospital, ambulance, fire department, or police. For first aid, contact the employer immediately.

Report the Injury. Report the injury to a supervisor or a representative of the employer as soon as possible. The employer must make sure that the injured worker is issued a claim form within a day of the injury. As time is a critical factor in claiming insurance benefits, there should not be any delay in initiating the claim.

Cash for Treatment: As soon as a claim form is filed, the employer or claims administrator must authorize $10,000 towards the appropriate treatment until the claim is disposed of.

Primary Treating Physician (PTP): The injured worker must consult a PTP who is an authorized professional to treat injured workers. Other options for treatment include:

• Visiting a pre-designated personal physician or a medical group after the injury.
• Some employers might be using a medical provider network (MPN) or a health care organization (HCO) for providing treatment to injured or ill workers. MPN comprises a group of physicians who provide treatment to injured workers.
• The worker must be clear from the employer on the treatment coverage applicable to them. They must know whether the medical coverage is HCO or MPN and act accordingly.
• In case an employer is not using an MPN or HCO, the claims administrator must designate a doctor who may first examine the injured worker until a personal physician or medical group steps in.

Role of Medical Provider Networks

Many employers use MPN health care providers for giving medical care to injured workers. In case a worker has a pre-designated physician or a medical group that he had been consulting prior to work injury, he can continue to obtain medical care from the same doctor.

If a non-MPN doctor has been giving care for an existing injury, then the worker must switch over to a doctor within the MPN.

Uninsured Employer vs. Injured Employee

Considering the importance of workers’ compensation benefits as the remedy in addressing workers’ injuries, it is imperative that an employer has legitimate insurance coverage. There is no compromise on this aspect.

It is clear that any employer staying illegally uninsured will face a criminal charge. That misdemeanor is punishable with a fine up to $10,000 or imprisonment or both. Uninsured employers also face the risk of additional penalties from the state. The fine can run up to $100,000.

A worker can file a complaint against an uninsured employer at the nearest office of the Division of Labor Standards Enforcement. The relevant offices can be found on the white pages of local telephone directories listed under labor standards enforcement and industrial relations.

Financial Risk of Uninsured Employer

If an employer is uninsured and a worker suffers a work-related injury or illness, the responsibility squarely falls on the employer to pay the bills of the injured worker. For detailed information, the local DWC district office should be contacted.

A worker can sue an employer with a civil action suit if the employer has not insured himself and a workers’ compensation claim on the worker injury has to be filed.

Aggrieved workers can also seek benefits from the Uninsured Employers’ Benefit Trust Fund (UEBTF). The UEBTF pays the claims emanating from illegally uninsured employers who do not pay the required amount for (or any amount for that matter) workers’ compensation benefits designated under the Workers’ Compensation Appeals Board stipulations.

The unit is a part of the Division of Workers’ Compensation that pays benefits to injured workers who are hurt or ill while working for uninsured employers.

The UEBTF reimburses expenditures from the employer through many channels including filing of liens against their property and follows many formalities on the issuance of benefits.

I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. If you or someone you care about has been injured at work and need an experienced lawyer to help you navigate the complexities of this type of injury claim, please contact me right away at 916.921.6400 for compassionate, free and friendly advice. I can also be reached online at AutoAccident.com.

I have been practicing law since 1982, helping people injured in accidents and their families recover. Some of my valued client reviews can be found on: Yelp, Google, and Avvo.

My work securing settlement awards and verdicts for my clients in excess of one million dollars has earned me the recognition of the Million Dollar Advocates.

See summaries of my past Verdicts and Settlements posted on my website, AutoAccident.com.

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