You are scrubbing a shower when you slip on soap scum and shatter your wrist. You go to the ER. When the triage nurse asks “Did this happen at work?”, you honestly say “Yes.” Two weeks later, your Health Insurance provider denies the $12,000 surgery claim, stating “Work-related injuries must be covered by Workers Compensation.” You don’t have Workers Comp because you work for yourself.
Key Takeaways
- The Health Insurance Exclusion: Almost all personal health insurance policies exclude injuries sustained while performing paid work. They expect Workers Comp to pay.
- The “Ghost Policy”: Many commercial clients (property managers) require you to have WC even if you are solo. A “Ghost Policy” excludes the owner (you) but satisfies the certificate requirement—but it pays $0 if you get hurt.
- Owner Opt-In: You can choose to “Opt-In” for coverage on yourself. It costs more, but it pays your medical bills and lost wages ($600/week) while you heal.
- Disability Insurance Alternative: If WC is too expensive, a separate “Accident & Disability” policy is a must to cover your income gap.
The “Why” (The Trap): The Coverage Gap
You assume: “I have Blue Cross, I’m covered.”
The Reality: Insurance companies talk to each other. When you report an injury, AI algorithms check the setting. If it sounds work-related, Blue Cross denies it to force the “primary” insurer (Workers Comp) to pay. If that insurer doesn’t exist, you are stuck with the bill.
The Investigation: Protecting the Solo Cleaner
I priced out options for a solo cleaner in Florida (a high-cost state).
1. The “Ghost Policy”
- Cost: ~$700/year.
- Coverage: $0 for you. It just gives you a certificate to show clients.
- Verdict: Useless for injury protection, good for getting contracts.
2. Workers Comp (Owner Opt-In)
- Cost: ~$2,500/year (based on a set payroll minimum).
- Coverage: 100% Medical + 66% of wages.
- Verdict: Expensive, but saves you from bankruptcy if you need surgery.
3. Occupational Accident Policy
- Cost: ~$500/year.
- Coverage: Specific to independent contractors. Covers medical bills for work injuries.
- Verdict: The “Goldilocks” solution for solos.
Comparison Table: Injury Protection
| Policy | Covers Medical? | Replaces Income? | Cost |
| Health Insurance | No (If work-related) | No | High |
| Ghost Policy | No | No | Low |
| WC (Opt-In) | Yes | Yes | High |
| Occupational Accident | Yes | Limited | Medium |
[IMAGE: Graphic of a denial letter from a health insurer highlighting the ‘Occupational Injury’ exclusion]
Step-by-Step Action Plan
- Check Your Health Policy: Read the exclusions. Does it exclude “occupational” or “compensable” injuries?
- Price “Occ-Acc”: Ask a broker for “Occupational Accident Insurance” for a self-employed cleaner. It is cheaper than full WC.
- Don’t Lie to the ER: Lying about where an injury happened is insurance fraud. Don’t say “I fell at home” if you fell at a client’s.
- Build an Emergency Fund: If you have no coverage, you need 6 months of expenses in cash. A broken wrist means 8 weeks of no scrubbing.
FAQ Section
Does General Liability cover me if I get hurt?
No. GL covers other people (clients). It never covers the insured (you).
Can I sue the homeowner?
Only if they were negligent (e.g., a rotten floorboard broke). If you just slipped on your own soap, you can’t sue them.
Is Disability Insurance the same thing?
Disability pays your income (wages). It does not pay the hospital bill. You ideally need both.