Hey Guys,
I just started a company and could not provide WC coverage for my employees. I could not find desireable rates I could afford at the time. I do have WC at the moment. I have an ex-employee who I guess is trying to sue for Workers Compensation benefits.
Here is the thing. The gentleman did not suffer his illness , which is a stomach pain/ hernia from the job as he is a light duty worker. I would not classify his illness as a work related illness and the gentleman also has no "incident" date as his stomach problems are on an off. I do know if his doctor visits etc for the pain and he has never brought to upper management's attention that he wanted to file a worker's compensation claim. Even if he did, I would not endorse it as I know it is not work related or work aggravated.
Although we did not have WC at the time, does this gentleman have a case against us? Keep in mind he also never asked to file for WC while working at our company or report an "incident" as it is an illness, not an injury.
Patrick
anyone can bring a claim. whether he "has a case" depends on the evidence. he'll have to have medical report that he has a hernia and a reasonable explanation of it's connection to employment with you.
what will you have?
since you do not have insurance there is no carrier or carrier atty to represent your interests.
are you planning on putting on a defense? what evidence will you present?
P.S. not reporting it to you is not evidence that there was no work injury-- especially if a doctor says he has a hernia and his testimony of what happened is convincing.
if a judge has to decide which of you is most credible why would he chose the employer operating illegally without insurance?
you'd be expected to deny it was reported as you needed to cover your crime.
you are not in a good position.
Patrick,
It is not automatically illegal to operate without Workers' Comp. insurance. Requirements vary by state. What state are you located in? If it was legal to operate without WC insurance and you, therefore, hadn't obtained it, the guy would have to go after you on a civil claim, which is not a no-fault system, as WC is. Thanks
Mike
PLease know that essentially ALL femoral and most abdominal wall hernias are considered congenital in nature; ie. the defect is always pre-exisitng. or in abdominal due to non-work anatomic issues.
That does not mean they don't get allowed but the medical science is really not very supportive.
Mike is correct. It would depend on what state you are in and how many employees you had whether or not you were required to have WC coverage. If you did require it, then (again depending on the state) you could face heavy fines and even jail time. You also lose WC immunity and the injured employee could sue you civilly.
The company is located in California. Its a small start up company with less than 10 employees. As I've said, I do have WC coverage at the moment. I believe I would lose indefinitely if this gentleman had a workplace injury or industry-related illness. But since it is very highly not a work-related or not significantly work aggravated illness (all this person does is light sanding and waxing of parts and allowed to sit on a chair doing his job) will I be able to get away with this one?
It is true that I did not have WC at the time and I am at fault for that. Its a start up company and not everything is set in stone the very first day business opens. However, I do find it fraudulent to try to file a workers compensation claim for something very unlikely to be work related.
Since an insurer will not be representing evidence, would it be possible that my lawyer provide the defense? Would providing medical literature describing a hernia to be pre-existing and describing his duties to be light work suffice?
yes if you have an atty they would be allowed to represent your interests.
no. general information about hernias won't be helpful. best to have a doctor of you or your attys chosing do an evaluation and then have the report submitted to the comp board. I would also suggest that your atty have a deposition done of the worker to get his side of the story.
your atty should be one experienced in work comp defense work.
In califonia most claims end up being accepted and your only hope is in trying to hold the costs down.
again: failure on the employees part to properly report an injury is not considered adequate grounds for a denial of the claim by the employer/carrier.
Patrick, I am someone with the same type of abdominal hernia situation.However, I was doing heavy labor and there was no question that it was work related. I was taken out of my truck and brought to the hospital. It may be hard for the employee in this case to PROVE that the hernia happened at work.Good Luck.