The Myths and Realities of Workers Compensation Insurance

February 3rd, 2021 abriinsurance
Workers Compensation Insurance

A new year is spread out ahead of us, and anything is possible. We all know this to be very true after 2020. To be safe and to be prepared we wanted to provide our readers with a little insight into worker’s compensation insurance!

Having a stable job has been a life raft for so many through 2020 and into this new year. We watched unemployment rise higher than it’s been since the depression, the number of individuals applying for unemployment skyrocketed, and the realities of not having the insurance needed for your everyday life as a consequence of these occurrences was felt by many. If 2020 and early 2021 have taught us anything, it’s to be prepared for anything and everything. You just don’t know what could happen anywhere or anytime. Many individuals were forced to get a temporary job to replace a furloughed position, many in fields they were new or unaccustomed to. This came with an onslaught of all kinds of issues that many didn’t expect. In a year where anything could happen, it’s always best to be prepared and to and stay ahead of the game! Today, we are going to be discussing worker’s compensation insurance, everything you need to know about it, its realities, and a few myths surrounding the topic that need to be debunked and left behind for good.

What You Need To Know & The Realities of Workers Compensation Insurance

There is so much information out there and available to you about worker’s compensation. Some of it is buried in legal documentation, some are common knowledge, some your company shares with you, and some of it is talked about around the water cooler. What are the realities you need to know and understand about workers comp before you need it after an accident or mishap? The reality is that any company wants to keep you safe, but even after doing everything by the book and thinking above and beyond, even the safest work environment can’t stop a human accident or err. For those who might be new to the working world, worker’s compensation covers the cost of medical needs and rehabilitation for workers injured on the job. It is important to remember that worker’s compensation varies from state to state. For all of our readers that are local, your worker’s compensation is much different from our readers who might be on the west coast. Let’s jump into what you need to know!

  • When you’ve been injured due to an accident at work, workers compensation offers the injured party five basic benefits:
    • Health care.
    • Temporary disability benefits that help cover your wages while you’re recovering and unable to work.
    • Lifelong permanent disability benefits if the injured party is unable to return to work due to the injury.
    • Supplemental job displacement benefits that pay for the injured party to relearn their skill or to learn another if they are unable to return to the job they had before their injury.
    • Death benefits are paid to the spouse, children, or dependents of the worker if their injury leads to death.
  • Every state but Texas is required to have worker’s compensation insurance, and more than half of all states require it if your company has at least one employee. This means that workers comp is required for big and small businesses.
  • Depending on the state, if your company does not have workers comp, the punishment could be very severe. Punishment can include criminal noncompliance, high fines, civil charges, criminal charges, and time in prison.
  • The cost of workers comp depends on what state you’re in and it also depends on what type of work your employees do. The more dangerous and physically challenging the job is and the higher the risk, the higher the insurance will cost.
  • Which employees are eligible for workers comp varies from state to state, many requiring workers comp for all employees working under a W2, but in other instances, some states will require it for freelancers and independent contractors.
  • It is very important to understand that worker’s compensation only covers accidents that happen on the job or as a result of your job. It does not cover injury or illness outside the job.
  • Some states are “no-fault” states while others are “fault states”. “No-fault” states mean injured employees do not need to prove that their injury was the fault of someone else to receive their worker’s compensation benefits. In “fault” states, workers have to prove who was to blame for the accident that caused their injury. This can make the claim process longer and drawn out. South Carolina is a “no-fault” state,
  • In South Carolina, your employer is not allowed, by law, to fire you in the response to you filing your worker’s compensation claim.
  • It is not your boss who is responsible for compensating you for your work injury, it is your employer’s insurance carrier or fund. Do not allow your boss to threaten you into believing otherwise, and do not accept payment from them in exchange for you to not file a claim. Do not be afraid to file a claim in fear that it will cost your employer thousands of dollars. That is what the insurance is for. Their insurance payments might go up, but they won’t be out of pocket for everything that they owe you!
  • Please note that under the current law for workers compensation in South Carolina, your employer has the right to choose what doctor treats your injuries. If you choose another doctor to treat you without your employer’s permission, they might not be responsible for your medical expenses.
  • If you are hurt on the job and you are denied immediate and appropriate medical treatment, you can either hire an attorney or handle the case yourself.
  • Please note that worker’s compensation is state-regulated for coverage for workers who are injured on the job while group health insurance provides coverage to all employees for preventative care and medical care needed for anything that did not happen on the job.
  • It is important to report your injury as quickly as you can because each state requires workers to give notice of their employee’s injuries within a certain deadline period. If you miss this deadline, you might miss out on your worker’s comp benefits.
  • Fast treatment of your injuries provides important evidence in your claim, provides you with important documents that describe your injuries, and helps to prove in writing how bad your injury was.
  • You will be required to go through an IME examination, an independent medical examination. This is not an appointment to treat your injuries but to provide an examination, review the reports from your doctors that did treat your injuries, and help the individual conducting the IME write a full report on the situation. You must attend these examinations or your worker’s comp benefits will be terminated. The report that will be written from your IME summarizes your accident, your doctor’s report, how you will be restricted in the future because of your injuries, and if you’ll be able to return or not. Insurance companies will go to an IME if they want to cancel or lower your compensation rate.
  • Please keep a detailed record of everything that happened to you, and keep every piece of documentation possible to uphold your case and claim. This will help support you if any legal issues arrive or an insurance company tries to deny or downplay your injury and benefits.
  • While it might happen at work, worker’s compensation does not cover injury caused by a fight that an employee started.
  • Injuries that are received by an employee because they were under the influence are also not covered under workers comp.
  • Worker’s compensation covers full-time, part-time, and contracted employees.
  • Worker’s compensation is designed to avoid lawsuits for the company that has an injured employee. They cover the care of the employee to avoid huge lawsuits that could destroy a company. However, if a company is negligent in providing proper care, coverage, and helping their employee to return to work, they can still be liable and taken to court.
  • Even if you are partially at fault for your injury, you can still file a worker’s compensation claim.

Kick the Myths

Now that you know a little more information about worker’s compensation, it’s time to kick some common myths to the curb.

  • Myth #1: Once a claim has been paid to an employee, the employer has no more responsibilities. False! It’s very important that an employer stays in contact with their employee to be aware of their employee’s healing process and how they are working towards getting back to work.
  • Myth #2: Only large businesses and corporations have to have worker’s compensation. False! As we discussed above, companies with as little as one employee are required to have workers comp insurance depending on the state and the type of business.
  • Myth #3: Worker’s compensation fraud happens all the time. False! According to, only about 1% to 2% of claims are false, but individuals must keep their eyes open to this. Fraudulent claims have been known to steal up to $80 billion every year.
  • Myth #4: You have to be doing your job when you get inured to file your claim and receive compensation. False! You do have to be at work when you’re injured, but it can be an injury caused by both job related and non-job-related accidents to receive your benefits.
  • Myth #5: You have to be on the job site to be eligible for your worker’s comp benefits. False! According to WorkInjurySource.Com, car accidents make up a huge part of worker’s compensation claims. They are also a leading cause of work-related deaths. This applies when driving is part of your job, not necessarily your commute to the office.
  • Myth #6: Your employer will always help you maximize your benefits. False! You will be compensated by your employer’s insurance company. Your employer will play a very small role in the process outside the claim process.
  • Myth #7: If you have to hire a lawyer, the legal fees will eat up all of your benefits. False! Work injury lawyers work on a contingency fee basis, only taking a portion of your compensation if your claim turns out to be successful.
  • Myth #8: Having employees fill out a 1099 is a way they can avoid paying workers compensation. False! Independent contractors are still eligible for workers comp, and if a company is found to have denied their employee compensation, they could be held criminally liable.
  • Myth #9: You can get fired for filing a claim for workers comp. False! The action of doing so is called retaliation, and both state and federal laws impose very stiff penalties for employers who engage in this behavior.
  • Myth #10: You can wait to see if you’ll fully recover before you file a claim. False! You will need to file a claim as quickly as possible and get the medical help you need within a specific range of time or you may not receive the number of benefits you deserve or any at all!

We hope all of this information clears up all of your questions, fears, and concerns about worker’s compensation insurance. You should not be afraid while on the job that you won’t be covered and you shouldn’t be afraid to ask for the help you need. Please research every one you wish to work with. If you’re a business owner, research the insurance company you’re looking to work with. If you’re an injured employee, please research any lawyer you want to work with. Please don’t hesitate to reach out if you have any questions or concerns. We want you to stay as healthy and as safe as possible and to receive the care and benefits you need if you are ever sick or injured. We’re Abri Insurance and we are here to make sure you have the best coverage for life in the Lowcountry!

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