Safety Employees: Personal Insurance versus Work Comp?

Updated: March 08, 2019


Over the years, I have spoken to clients who have discussed prior injuries (or existing injuries) where they used personal insurance instead of workers’ compensation.  Those people fall into two different groups: Group 1: They didn’t know they had a workers’ compensation claim; or Group 2: They knew they had a workers’ compensation claim and didn’t want to deal with workers’ compensation, so they used their personal insurance.

Group 1

The first group who used personal insurance to handle the work related injury are injured workers who didn’t understand they had a workers’ compensation claim.  Without getting into the complexities of the law, I will say that this happens a lot and it is an innocent mistake that is commonly made.

Group 2

The second group is a group of injured workers who are either advised by their employers to “just use your personal insurance” or they have made their own decision to use personal insurance.
On the surface, this may sound like a faster road to “geting fixed and back to work,” but if you are safety personnel (correctional officer or other employee with custodial duties, CHP, police, sheriff, fire fighter, or other safety personnel), then this decision could be prove to be a HUGE mistake.  Why?  The example below will give you a potential scenario.


Let’s say that you have a knee problem and you need a knee replacement and you suspect it’s work related.  You decide to use personal insurance.  You get treatment and you go back to work.  

Sounds great, right?  Hold that thought….

If you return to work and are able to work through your planned retirement date without any physical issues, then maybe you made the right decision. But, what we do see most of the time?  That worker’s injury gets worse and/or they injure another body part that causes difficulty with performing their essential job duties.

So, let’s take that situation where the worker used personal insurance to get that knee replacement and then the knee gets worse.   Then they injure their back and need back surgery.  
After the back surgery, the back alone is disabling, but it isn’t enough disability to not perform your job duties.  The problem is that the knee is hurting now and between the knee and back pain, you have doubts you’ll be able to return to work.

If you cannot return to work and you are a safety employee, you may be eligible for Industrial Disability Retirement (you can click here to read about it).  

If CalPERS or the city or county agency that handles your retirement decides you can perform job despite your back pain, then they’ll expect you to return to your job. Your response is “my back and knee are bothering me, and together, it’s making it hard to perform my job.” 

If you need the knee and the back in order to be eligible for Industrial Disability Retirement, keep in mind that the only body parts applicable for Industrial Disability Retirement are work-related injuries.  As it stands, this worker only has reported the back injury.  He/she didn’t report the knee, so it isn’t considered industrially related (work-related).  Can you see the problem now?  The knee and back together are preventing this worker from performing your essential job functions, but the back is the only body part considered industrially related, because the worker never reported the knee as work related. 


Hopefully, the situation discussed in the example above shows how using private insurance for what should have been a work-related injury is a problem.  It could affect retirement benefits should you need them down the road.

We’ll emphasize that the worker in the hypothetical example could have other ways to get workers’ compensation benefits on the knee and maybe eventually Industrial Disability Retirement, but this worker’s decision to use personal insurance for the knee has caused a lot of problems and obstacles.