Applying for workers’ compensation can be a complex process. Workers’ comp rules vary from state to state, and navigating the process while seeking medical treatment adds to the challenge. Moreover, several myths about workers’ compensation can discourage people from applying for the benefits they deserve.
Here are the 13 most common myths people ask about and what you need to know if you experience a work-related injury.
1. Myth: If the injury was my own fault, it’s not covered.
Fact: Workers’ compensation is a no-fault system. Even if you caused an accident, you have a claim.
Workers’ comp has one primary criterion: your injury or illness must directly tie to the workplace to qualify for benefits. For example, if you get a back injury after accidentally driving a forklift into a shelf in a warehouse, you are entitled to workers’ comp benefits.
That said, if you get injured because of your own negligence — like driving a forklift into a wall while under the influence of drugs — the insurance company will challenge your claim.
Learn more about qualifying accidents and injuries.
2. Myth: Only injuries at my job site are covered.
Fact: If you’re doing your job and being paid, you’re covered — no matter where you are.
Injuries that occur when employees complete job tasks during working hours are eligible for workers’ compensation benefits. For example, you are entitled to workers' compensation benefits if you run business-related errands and get into a car accident. Injuries that happen while on a business trip out-of-state can also qualify.
In most states, injuries that happen while commuting to or from work, known as the “coming and going” rule, do not qualify. Qualifications for remote workers also differ from state to state.
Read our guide on what to do if you’re injured at work.
3. Myth: I didn’t report my injury within my state’s required time period, and now I’m out of luck.
Fact: You can file a claim even if you’ve missed the reporting period, but it may be harder to get approved.
The sooner you report your injury to your employer, the more likely the insurance company will approve your workers’ comp claim. Some states even encourage workers to file a claim the same day the accident happens.
There are a few exceptions to this rule. If you cannot file a claim before the deadline because of your condition, or if you report the injury and your employer fails to notify the insurance company, you should be able to submit a late claim.
Here’s a guide with the deadlines for every state.
4. Myth: I can use my regular health insurance for a workplace injury.
Fact: Many health insurers exempt workplace injuries and can refuse to cover your treatment — so workers’ compensation is the only coverage most people have.
Because the workers’ compensation program exists, private insurance companies are not required to cover workplace injuries. If the workers’ comp insurance company denies your claim, you can seek coverage from a private insurer, but this is uncommon.
It’s also essential that your claim is truthful — lying about where your injury occurred is considered insurance fraud.
Here’s what else you can do if your workers’ comp claim is denied.
5. Myth: I can sue my employer for the pain and suffering caused by my injury.
Fact: As long as your employer has insurance and did not intentionally injure you, you cannot sue.
In most cases, workers’ compensation insurance protects employers from lawsuits, and filing a workers’ comp claim is the best way to seek compensation for your injury or illness.
You can file a third-party lawsuit if a third party causes your injury. This third party is neither your employer nor a coworker. For example, if you are a construction worker and injure yourself on the job site, you can sue the general contractor.
In rare cases, you may be able to sue if your employer intentionally caused the accident or if the company does not have required workers’ comp insurance. A lawyer can help you determine if you have grounds for a lawsuit against your employer.
6. Myth: My employer pays for workers’ compensation benefits.
Fact: Almost all cases, your workers’ compensation benefits come from an independent insurance company — not your employer.
Employers in every state except Texas must purchase a workers’ compensation insurance policy to provide benefits to employees with work-related injuries or illnesses. If you sustain a work injury, the insurance company will pay for your workers’ compensation, not your employer.
7. Myth: I have to start the claim myself.
Fact: Your employer is legally required to notify their insurance company as soon as you tell them about the injury.
You must notify your employer about the accident if you get injured at work. Then, your employer will start the claim by contacting their insurance company. The sooner you give notice, the easier it will be to win your benefits.
Typically, your employer will provide you with a claim form to submit to your state or the workers’ compensation board. In some states, like Massachusetts, employers file the paperwork for employees.
Check out our complete guide to reporting a workplace injury, which offers an in-depth review of the claims process.
8. Myth: My boss decides whether my claim will be accepted.
Fact: Once you’ve reported the injury, the outcome is out of your boss’s hands and up to the insurance company.
Workers’ comp is paid for by an insurance company, not your boss. That means an insurance adjuster — also called a claims adjuster — will be the one to investigate your claim and make a decision.
If your employer refuses to notify their insurance carrier, you should contact your state workers' compensation board or Industrial Commission and ask if you can file directly.
9. Myth: My adjuster has my best interests in mind.
Fact: Your adjuster is accountable to the insurance company first and foremost.
The claims adjuster, a representative of the insurance company, will investigate your claim and decide whether to pay out and how much. In most cases, claims adjusters are responsible to the insurance company to decrease the cost of your claim, even if that means denying you medical treatment. Unfortunately, regardless of their feelings about your claim, adjusters are rarely on your side.
Read this article to learn more about how a workers’ comp lawyer can help you navigate the claims process and appeal a decision by a claims adjuster.
10. Myth: Insurers are heavily regulated and will be punished for unfair treatment.
Fact: Unfortunately, insurers have a lot of leeway in handling claims.
Insurers deny workers’ comp claims for various reasons, many of which are at their discretion. The unfortunate reality is insurance companies often engage in unfair practices.
The best way to protect yourself is to know your rights and advocate for what you deserve or work with a lawyer to advocate for you.
If your claim gets denied, here are some common (and legitimate) reasons why.
11. Myth: I won’t see any money from my claim for years.
Fact: If you miss work due to your injury, you’re entitled to weekly cash benefits at the same rate you would earn your regular paychecks.
Once you take time off from work due to your injury, you’ll have to wait until you miss a certain number of days — not years — to start collecting benefits. That waiting period is different in every state. Some states have a short, three-day waiting period, while others require workers to wait a week or more.
Read our workers’ comp waiting period guide to see how long you’ll wait in your state.
12. Myth: My lawyer will file a lawsuit and take my case to court.
Fact: Most lawyers focus on negotiating a fair settlement and arranging medical treatment.
While taking your employer or insurance company to court can be tempting, workers’ comp cases don’t work like other types of lawsuits. For example, a lawyer will help you make your case in court in a public injury case. In a workers’ comp case, a workers’ comp lawyer ensures your paperwork is complete, and you receive a fair settlement and the medical care you need.
Learn more about when to hire a workers’ comp lawyer and how they’ll help.
13. Myth: Good lawyers are expensive — only rich people can afford them.
Fact: Many experienced workers’ comp lawyers don’t charge upfront costs or fees. So, there’s no downside to working with one.
For many people, working with a lawyer seems unobtainable. Many lawyers can be expensive, but there are qualified, caring workers’ comp lawyers who don’t charge for services upfront.
You’ll only pay your lawyer if you win your case — there’s no fee if you lose. Working with a lawyer can only benefit your workers’ comp case and maximize the benefits you’ll hopefully receive.
Learn more about what workers’ comp lawyers really cost.
How to get help with your workers’ comp claim
Separating myth from fact is the first step in successfully filing a workers’ comp claim. Whether you are considering filing a claim or need help challenging a denial, a lawyer can help you get the benefits you deserve.
Take our free workers’ comp quiz to help us find the right lawyer for your case. You’ll get a free consultation and won’t pay your lawyer unless you win benefits.
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