Top 10 Myths About Workers’ Compensation Claims

When someone at your job shows up with a cold, there is a good chance they might spread those germs to everyone else. That could result in you taking a sick day or two as you ride out the cold, but you wouldn’t file a workers’ compensation claim.

Workers’ compensation is an insurance policy that employers must carry, designed to provide coverage for injured workers on the job.

If you’ve been injured on the job and need to file a workers’ compensation claim, you could benefit from retaining the services of an experienced workers’ compensation attorney to help ensure that you’re filing out the correct forms and have the right supportive documentation.

That attorney can also stand by in case your claim is denied. You are entitled to appeal to get the remedy you’re entitled to. It also helps to get informed about what is myth and what is fact when it comes to workers’ compensation claims.

Consider the following 10 myths and facts:

Myth #1: Only Injuries That Happen at a Job Site Are Covered

Fact: If you’re on the job, doing what you are asked, and getting paid, you’ll be covered by workers’ compensation insurance.

Many jobs require you to clock in at a specific location and remain there for the entire shift. However, some jobs require workers to run errands for their boss, make deliveries or pickups, or meet clients.

If you are injured on any of those official work commutes, you are entitled to file for workers’ compensation. There might be additional complexities in a car accident if the at-fault driver’s insurance company gets involved. That is something your attorney needs to sort out.

Myth #2: My Boss Has the Final Approval for a Claim

Fact: You must report the injury to your boss or immediate supervisor. From that moment on, they are no longer part of the process. It will be the workers’ compensation insurance carrier who decides on approvals or denials.

The company, not your boss, pays workers’ compensation insurance. Their only involvement in the claim is to verify that you’re an employee and that you reported the accident.

On the other hand, if your boss refuses to notify the company’s insurance carrier, then you need to file an official complaint with your state workers’ compensation board.

Myth #3: I Can Use My Personal Health Insurance for My Workplace Injury

Fact: Most private health insurance plans exempt workplace injuries because of workers’ compensation coverage.

The workers’ compensation program supersedes private health insurance for a workplace injury. It would be like double dipping if you made two claims. However, if the workers’ compensation carrier denies your claim and your appeal, you may be able to file a claim with your insurance company.

Myth #4: If the Injury Was My Fault, I Can’t File a Claim

Fact: Workers’ compensation operates as a no-fault system.

With a workers’ compensation claim, it is less about who caused the accident and more about where and when it occurred. Not every workplace injury happens because of a power tool.

You could injure your back by lifting a heavy object. The exception is if your negligence caused the injury. For instance, if you are working under the influence of drugs or alcohol, you would be considered responsible and denied a claim.

Myth #5: My Employer Pays the Workers’ Compensation Benefits

Fact: The majority of approved workers’ compensation benefits are paid by the independent insurance company and not as an out-of-pocket expense by your employer.

When you get into a car accident caused by another driver, the driver’s insurance will pay for the damages. The same goes for workers’ compensation benefits. There might be a rise in premiums, but that is a cost that the company will shoulder.

Bottom line: You should not feel guilty about the money you are due for your injury; it will not impact the company’s bottom line.

Myth #6: I Have to Start the Claim Process

Fact: As part of the workers’ compensation regulations, your employer is legally obligated to notify the company’s insurance carrier the moment they are informed about the injury.

No matter how minor, every job-related injury must be reported. Your employer will start the claim process for serious injuries by contacting the company’s workers’ compensation carrier.

You’ll be given the appropriate forms or website portal to submit the claim to the state or workers’ compensation board. That is to verify the accident and put it on record.

Myth #7: I Can Sue My Company for Pain and Suffering

Fact: You are not entitled to sue for pain and suffering, provided your employer has workers’ compensation insurance and did not intentionally injure you.

Workers’ compensation insurance is designed to protect workers and their employees.

The employees have their medical expenses and lost wages covered, but the trade-off is that they are not entitled to sue their company. The only exception is if a third-party vendor is responsible for causing your injury.

For instance, if a delivery truck from another company runs over your foot, you could sue that company for damages.

Myth #8: My Insurance Adjuster is On My Side

Fact: Your insurance adjuster is accountable to the insurance carrier.  You’ll be assigned a claims adjuster when you file a workers’ compensation claim.

This is the person who will investigate the accident, review your submitted expenses, and make recommendations for the insurance carrier. This is someone employed by that carrier whose mission is to maintain profits.

That doesn’t mean the adjustor will automatically be antagonistic; it just means they will always prioritize the insurance company’s interests.

Myth #9: It Will Take Years to Get Benefits

Fact: If the injury causes you to miss work, you’re entitled to weekly reimbursement based on your salary.

Depending on the policy, you might have to exhaust your accumulated sick days to recover from your injury before the workers’ compensation benefits start to reimburse you for your salary. Typically, these are short waiting periods. The goal is to see if you can get back to work before the wage replacement benefits kick in.

Myth #10: It is Too Expensive to Hire a Lawyer

Fact: Most workers’ compensation attorneys don’t charge upfront fees.

You might be hesitant to hire an attorney to help you file a workers’ compensation claim.

Most lawyers don’t charge upfront fees. Any costs would come from the benefits that you receive, but you’ll know exactly what those costs would be like before their work on your behalf begins.

If you have questions about your claim, check out our resources at Work Injury Advisor.