By Ed Risch, Tentinger Law Firm, P.A.
For the first five years of my legal career, I represented workers’ compensation insurance carriers for claims related to work injuries. After being on the defense side of the fence, I switched sides and represented injured workers, also for 5 years. I now represent both.
To say the least, I learned a great deal by working both sides of the fence. I am frequently asked “What is the one most important thing you learned as the result of working for both insurance companies and employees?” My response is always, “Employers need to report the injury to their workers’ compensation insurance carrier as soon as possible and the insurance carrier needs to begin its investigation as soon as they receive notice from their insured.” Following this advice gets the claim off on the right foot and concludes with a quick resolution.
Employer’s Duty to Report an Injury
After an employee reports a work injury to his/her employer for which the claimed disability exceeds three calendar days, employment related deaths the exception, the employer must submit a First Report of Injury to its workers’ compensation insurance carrier within 10 calendar days of the first day of disability or the date the employer was aware of the disability.
Based on my experience, I cannot stress enough how following this simple rule can make the claim move forward in a more manageable way.
When representing workers’ compensation insurance carriers, it is often claims come across my desk due to the fact the employer failed to report the injury in a timely manner or at all. Due to the employer’s failure to report the injury, the employee has sought legal representation. If only the employer had reported the injury in a timely manner, the insurance carrier could have begun its investigation, determined liability, and pay benefits if required. Quick reporting by an employer usually leads to a happy employee. A happy employee generally means lower litigation fees for the insurance carrier.
From the employee’s side of the claim, most of my clients sought legal representation due to the fact they had not heard from their employer or its workers’ compensation insurance carrier after reporting an injury. They admit, had the employer or its insurance carrier contacted them about a reported injury, they may not have sought legal representation. I have cases where the client came to me solely because there was a lack of acknowledgement of the injury. Once we make contact with the insurance carrier, the claim is acknowledged and either accepted or denied. If accepted, the employee is happy. Certainly, if the employer had reported the claim as required, I would not be needed due to a satisfied employee. If denied, we are able to start the litigation process and hopefully resolve the claim in a timely fashion with little costs to each side.
It is important that an employer report the injury as required.
Filing the Notice of Insurer’s Primary Liability Determination
Once the employer reports an injury to its workers’ compensation insurance carrier, and the claimed disability extends more than three calendar days, the carrier must make a liability determination within 14 days of the first day of disability or the date the employer was aware of the disability, whichever is later. Failure to make the determination in 14 days can result in penalties.
As soon as the insurance carrier receives notice of an injury from its insured, it is important that the claim be assigned to a claims handler and the investigation period begins immediately.
When defending a claim, another reason a file comes across my desk is due to the fact the claim handler received notice of the claim long after the injury was reported to the employer by the employee and the employer failed to notify its insurance carrier. The claim handler is forced to deny the claim due to the fact there has been a lapse of time between the date of injury, medical treatment, and lost time from work. The claim handler is better off denying the claim and transferring the file to an attorney to handle due to the events that occurred since the date of injury.
It goes without saying, if the workers’ compensation insurance carrier fails to act upon notice of an injury by its insured, you can be assured the employee is getting more frustrated as the days pass. As time passes, the probability the employee retains an attorney increases.
Although reporting an injury and conducting an investigation once notified of an injury in a timely manner may seem simple, it is often neglected and a main reason an employee seeks representation. Being timely is sure to reduce litigation costs and foster quicker resolution of a claim.
*Ed has experience representing both insurance companies and employees for claims related to work injuries.