Replies

1. 
   BobKovacs | May 31, 2006 04:43am | #1

   Yes, they could deny the claim, and/or sue you for fraud.  They may not be able to get money from you, but the authorities will be happy to take you at the local jail no matter how broke you are.

   They ask the OTJ question because most insurance policies do not cover work-related injuries- they assume that work-related injuries should be covered by worker's comp insurance.   Since you've been answering "no" to the question, it seems obvious that you knew the answer to your question all ready.

   Bob

1. 
   davidmeiland | May 31, 2006 05:12am | #2

   I pay WC on myself for just this reason. It's optional for corporate officers even if we work in the field, but I'd rather pay for it than have to try to perpetrate fraud on my private medical insurance policy if I have an OTJ injury.

   My rate is about $2.75/hour for most of my work, which works out to $5500 per year (based on 2000 hours), or $458 per month. Very expensive, but since my private insurance is paid thru the business they know damn well I'm a contractor.

   The thing a lot of guys overlook is that WC usually has a disability component if you are out of work from an injury. Try getting that from a medical insurance policy.

1. 
   DanT | May 31, 2006 12:48pm | #4

   Good post.  I do exactly the same thing for exactly the same reason.  If we have a few stitch deal I reach in my pocket and pay for it.  But for bigger injuries you want that protection for yourself and your people.  But the disability component is the real value in my mind also.  Fall off a ladder and break your back, insurance pays the hospital, comp pays you and the hospital.  DanT

1. 
   jocobe | May 31, 2006 02:48pm | #5

   In Maryland, if you are self-employed, as in the single only person of the company......you DO NOT need Workers Compensation Insurance. You are covered under whatever Major Medical Insurance you have.However, if you hire someone you'll need worker's comp. If you hire temporary employees, you'll need to keep track of their hours and report those to your insurance company for worker's comp....usually an audit at the end of the year.View Image

1. 
   hmj | May 31, 2006 03:06pm | #7

   I live in MD, and I am the sole owner/employee. Knew I didn't need it on just me, but the health insurance question came up when I looked into hiring summer help. Nice to know that we pay thousands of dollars a year for health insurance and I am only covered 2/3 of the day. Actually, maybe 1/2 the day since I am pulling a lot of 12 hour days.

2. 
   davidmeiland | May 31, 2006 05:48pm | #9

   I've got my work schedule down to half-days too.

2. 
   hmj | May 31, 2006 02:58pm | #6

   The first year I started the business, my insurance agent could/would not sell me a workers comp policy because I had no baseline salary to establish a rate. I shelved it in the back of my mind until recently when I was thinking about hiring a helper for the summer and knew I would have to get WC and unemployment on him. One of the reason my business does not have a lot of money is because I am trying to keep everything legit. I don't hire illegal day help, pay my taxes and report all my income. Therefore my rates are higher than a lot of my competion and more and more, customers are only interested in how "cheaply" it can be done. The reason I reason I answered no the the OTJ question was becasue I thought it would generate a flood of paperwork and endless hours on hold with customer service. The thought of fraud never crossed my mind. So, I will be asking my agent for a workers comp policy today.

2. 
   robert | May 31, 2006 05:55am | #3

    They ask for two reasons.

    One, as a W/C case, some care that your insurance company might not cover, is covered no questions.

    Two, MOST insurance policies have some kind of clause that excludes on the job injuries for the self employed.

    I last covered myself for 2002 and it was about $11 per hundred for general carpentry. Also, as the owner you might be able to get them to split it. Half Clerical/ Half Carpentry.

3. 
   GHR | May 31, 2006 04:33pm | #8

   I would suggest you read your insurance policy. My insurer pays for ALL health care regardless of cause.

   The ER may ask if your injury is job related because of state reporting requirements.

4. 
   padan | May 31, 2006 05:58pm | #10

   The ER asks the question to know who to send a bill to. The ER is concerned with getting paid, not who's paying. The health ins co, will pay no matter what, as long as you're covered. It shouldn't matter if you're injured on the job or not. On the other hand, worker's comp will only pay if you're injured at work. The OJI ins really does care where the injury occured. Therefore, in your case, the Health ins Co should not "go after" your Company. Normally, health insurance through a spouses' work for Family members covers all members regardless of if the injury is at school, work, play, etc..

   FYI, if you get tired of over-paying ER co-payments (usually $250), you can generally go to a walk-in clinics that take your ins and only have a 10 to 20 dollar co-pay. They can stitch you up just as fast as the ER, and generally have a shorter wait in the waiting room.

   Padan

1. 
   davidmeiland | May 31, 2006 06:24pm | #11

   Your statements are way too broad. The insurance company "should" do this and "shouldn't" do that, "normally" this and that. Suppose you injure yourself badly at work and have a very expensive claim? How can you be sure that they will not investigate the incident and find a reason to deny coverage? How many out there have even read all the fine print that comes with a policy....?

1. 
   padan | May 31, 2006 06:41pm | #12

   David,

   Yes, my reply was general, For the following reasons:

   1. Every insurance Co has different policies

   2. All insurance Co have different packages with different policies

   3. We all have the personal responsibility to read our polices to make sure we're covered.

   The person who asked the question wanted a general response b/c they asked a general question. If they had wanted a specific answer, they would have listed the state they live in, the insurance Co they're dealing with and the policy type they have.

   I've delt with medical insurance for the past 8 years and the absolute truthful answer to the posted question is "It depends". This is obviously way too broad, so I took a little liberty and tried to narrow it down a bit. Based on experience with treating OJIs and personal policies in Texas, my answer holds water.

   Padan