Finding out that your employer may not have workers’ compensation insurance can be alarming after a work injury, especially when you are already dealing with medical treatment or time away from duty. But the absence of a traditional insurance policy does not always mean your employer is illegally uninsured.
Public agencies in California may be authorized to self-insure their workers’ compensation obligations. That distinction can be particularly important for police officers, firefighters, and other public employees. Private ambulance, emergency-response, or security employers, however, must also have valid coverage or authorized self-insurance. Our workers’ comp lawyers in Oakland can review coverage issues affecting an injured first responder and determine what options may be available when benefits are not being provided.
What if my employer doesn’t have workers’ comp insurance?
You may still have a right to workers’ compensation benefits. The first step is determining whether your employer is actually uninsured. An employer may not have a conventional workers’ compensation insurance carrier because it is legally self-insured or participates in another authorized coverage arrangement.
If the employer has neither workers’ comp insurance nor lawful self-insured status, it may be illegally uninsured. The employer can still be responsible for benefits resulting from a compensable workplace injury.
What if I work for a public agency that is self-insured?
A public employer does not necessarily need to purchase a workers’ compensation policy from an insurance company. California allows qualifying cities and other public entities to self-insure their work comp liabilities. Some public agencies also participate in joint powers authority arrangements that pool workers’ compensation liabilities among participating agencies.
For an Oakland first responder, this means that not recognizing the name of an insurance company—or being told that the department is self-insured—does not by itself indicate a coverage problem. If medical treatment or benefits are being delayed, the important question is who administers the claim and whether the employer has a valid workers’ compensation arrangement.
What happens if a private first-responder employer is illegally uninsured?
The situation can be different for a first responder employed by a private organization, such as a private ambulance, emergency medical transport, security, or other response service. If that employer was legally required to secure workers’ compensation coverage but failed to do so, it remains responsible for benefits connected to a compensable work injury.
Depending on the claim, those benefits may include:
- Medical treatment
- Temporary disability benefits for qualifying wage loss
- Permanent disability benefits when applicable
- Other workers’ compensation benefits available under California law
Keep in mind that the absence of an insurance carrier can make the process more difficult because there may be no traditional insurer or claims administrator handling treatment authorizations and benefit payments.
Can the UEBTF pay benefits if my employer is uninsured?
California has an Uninsured Employers Benefits Trust Fund, or UEBTF, for workers injured while working for illegally uninsured employers.
UEBTF benefits are not automatic. An injured worker generally must pursue the workers’ compensation case, establish the employer’s liability, and follow the procedures required for an uninsured-employer claim. If the Workers’ Compensation Appeals Board awards benefits and the employer fails to pay them, the UEBTF may pay qualifying benefits and pursue reimbursement from the employer.
What should I do if I think my employer has no coverage?
Do not assume that a lack of visible insurance information means you cannot pursue a claim. Start by determining exactly who employs you and how that employer provides workers’ compensation coverage.
Useful steps may include:
- Report the work injury if you have not already done so
- Complete and return the DWC-1 claim form
- Confirm the employer’s full legal name
- Determine whether the employer is insured or authorized to self-insure
- Keep medical records, work-status reports, wage records, and correspondence
- Document any unpaid treatment or disability benefits
- Find out whether UEBTF procedures may apply if the employer is illegally uninsured
For Oakland first responders, identifying the employer’s coverage arrangement is especially important because public self-insurance and illegal lack of insurance are very different situations.
Which workers’ comp lawyers in Oakland can review my employer’s insurance coverage?
Unclear workers’ compensation coverage can create immediate problems with treatment, wage replacement, and claim administration. First responders in Chinatown and elsewhere in Oakland can have our attorneys verify whether an employer is insured, lawfully self-insured, or potentially uninsured and explain what that means for the claim.
We can also address how you can choose your work comp doctor and what protections apply if you are fired for filing a claim. Arrange a free consultation with our team, and we’ll take a look at your injury, coverage concerns, and available options. Contact us today!
