Today at work I fell, hard. My neck and shoulders are stiff and they ache. I wanted to go to the Dr. My boss however thinks that I do not need to go. He kept telling me that it costs our store $1600 if I go to the Dr so I have to be sure that I really need to go. My concern is not about my current condition but a few months time. I do not want to have problems later that I can trace to my injury but have no proof that it occurred at work. My question ir really what is the employers cost of a claim. I do not understand why they would bother to have this insurance if a claim costs more than if they just sent me to the dr out of pocket. Is my boss wrong (or lying)?
The cost is not direct, unless your employer has a DEDUCTIBLE on their policy. Most agents won't recommend a deductible, as it rarely saves more money than it costs - unless the employer has six figure premiums.
What happens is, all his claims for the year get lumped together, and if he has MORE claims than expected, his policy is surcharged, for THREE YEARS. How much of a surcharge, depends on how much more than average he has in claims. At the same time, if his claims are UNDER expected claims, that counts towards a credit.
This is called "experience rating".
I'd say your boss is, at best, inaccurate. And it doesn't matter. He's on the hook for the bills. Tell him, if he doesn't want to file the claim, all he has to do is pay the bills himself. To protect yourself, you NEED to go to the doctor, as soon as possible after the work injury.
Your boss is trying to intimidate you. You have the right to file a WC claim with your employer. Every day you delay in doing so jeopardizes you right to treatment.
As a former employer I can tell you, if this is a minor injury, and you'll know it (your letting this decision to go to the doctor be clouded by dollar signs), then you need to tell your employer that you want this a "report only", which means that he'll report it to the insurance company and that's it. If this is a broken bone or a ligament tear, etc., then by all means you need to go to the doctor, and his insurance should pick up all the cost, unless he goes ahead and pays the claim out of pocket. I often did this on smaller claims because when the insurance kicks in and pays, they often (and will) raise premium rates in the future...so the employer ends up paying 15X more in the long run than if he would of just paid out of pocket. *Don't you love insurance, HAHA*.
If your fall was the fault of the employer, i.e. slippery floor, etc., then if your employer is smart at all then he'll fix the problem and next time you have a safety meeting you or your employer should bring that up.
This shouldn't be a factor, but for a lot of cash strapped small businesses now (small businesses weren't given any government stimulus money, but are feeling the full effect of the recession) the thought of paying higher premium and/or a HIGH doctor bill, is something that he/she might view you negatively for. If it was the company's fault for your fall and it did do something worse than a bruise, then your in the right. If it was your fault, and it did nothing other than give you a light bruise, then shake it off and make your employer report it as a "report only" claim.