Objectives. To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC). Data Sources/Study Setting. Leadership of CHCs in Massachusetts. Study Design. We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts. Data Collection/Extraction Methods. Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated. Principal Findings. Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services. Conclusion. Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.