“I don’t need workers’ comp insurance because I own the business.”
I hear this all the time. It’s usually followed by: “I can opt out in Missouri—and my health insurance will cover me anyway.”
Technically, that’s true. In Missouri, business owners can choose to opt out of workers’ compensation coverage. And yes, health insurance may cover certain medical expenses.
But here’s the question most people don’t stop to ask: What isn’t covered?
The Gap Most People Ignore
When I push back, I usually say:
“Health insurance doesn’t cover lost wages.”
And that’s just the beginning.
Workers’ compensation isn’t just about medical bills. It also covers:
- Lost wages while you recover
- Vocational rehabilitation if you can’t return to your previous work
- Permanent disability benefits
- Death benefits for your family
Even as a business owner, those protections matter.
Still, for many people, those points fall on deaf ears. The focus stays on saving money by skipping workers’ comp and relying solely on health insurance.
But that confidence may be built on shaky ground.
A Surprising Discovery
Recently, while researching Missouri’s mandatory payroll numbers for 2026, I came across a pamphlet from the Missouri Department of Labor and Industrial Relations titled Workers’ Compensation Requirements for the Missouri Construction Industry.
Buried on page two was a yellow “sticky note” designed to stand out. It read:
“Important Note: Those considering ‘withdrawing’ or ‘rejecting coverage’ should bear in mind that health insurance plans generally refuse to pay for medical treatment resulting from on-the-job injuries.”
That caught my attention immediately. (MO Dept of Labor Pamphlet)
So I picked up the phone and called my health insurance agent to ask about this.
The Fine Print That Changes Everything
My agent explained that my specific policy does not include this exclusion—but some do.
It’s called a work-related injury exclusion or occupational injury exclusion.
In plain terms, that means a health insurance policy can deny a claim if the injury is work-related—even if you opted out of workers’ compensation.
Even more concerning? Claims may be denied if you could have had workers’ comp coverage but chose not to carry it.
And yes, courts have upheld these denials.
Are You Saving Money—or Taking a Risk?
That small “sticky note” in the state’s pamphlet feels like more than just a warning—it feels like a signal.
Opting out of workers’ comp might save a few thousand dollars this year. But if something goes wrong, the cost could be far greater:
- Medical bills that aren’t covered
- Lost income with no safety net
- No access to disability or rehabilitation benefits
For a business owner, that risk doesn’t just affect you—it affects your family.
Final Thought
Skipping workers’ compensation might look like a smart financial decision on the surface. But when you dig into the details, it can turn into a costly gamble.
Before you opt out, make sure you truly understand what you’re giving up—and what your health insurance may not be willing to cover.