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Workers’ Comp. and Health Insurance

  • Dave Brown, Esquire
  • 09/21/2020

If you are unlucky enough to injure yourself at work , you will find out that your life will be turned upside down. You will be in pain which will require you to see doctors, take medication, and receive other treatment like physical therapy and injections. You will most likely be unable to perform your job. On top of all that, the workers’ comp. insurance company for your employer may deny your claim for any number of reasons in which case you will not have any income while your claim is being fought.

If all that’s not bad enough, you may lose your health insurance after a period of time. It sounds harsh, but it’s true. Here’s what you need to know about your entitlement to health insurance if you injure yourself at work.

If you’re not a member of a union and therefore don’t have a collective bargaining agreement, you have limited rights with regard to health insurance. That’s if your employer has even provided you with health insurance in the first place. Many employers, especially small employers, do not – they pay you wages, but you’re on your own for health insurance. Other employers offer health insurance to their employees – but at a cost. If you want health insurance
for you and your family, part of your paycheck will be deducted to cover your share of the health insurance premiums. Some employers – usually large companies – pay 100% of their employees’ health insurance premiums. If you’re part of a union, most likely you will have union dues taken out of your paycheck, part of which will go toward paying your health insurance premiums – and you will have greater rights if you suffer a work injury.

So what happens if you have health insurance through your employer and you get injured at work? If your claim is accepted by the workers’ comp. insurance company – which isn’t likely because these companies are quick to deny claims – your bills for your work injury will be covered, but that’s separate and apart from your health insurance which provides coverage for your non-work-related medical treatment. If your workers’ comp. claim is denied, not only will your bills for your work injury be unpaid, your health insurance will be in jeopardy.

The reality is that, as a rule, your employer is not required to maintain your health insurance. Even if they are one of those generous employers that pays 100% of your health insurance premiums, they could choose to stop covering you after you injure yourself on the job. If so, your employer will provide you with a notice advising you that they will be terminating your coverage and the effective date, and that you will have the option of paying your health insurance premiums for 18 months. But it may be difficult for you to afford those monthly payments, especially if your workers’ comp. claim has been denied.

If you’re working for one of those employers that maintains you on the company’s health insurance plan but deducts part of your paycheck to cover the premiums, they may give you the option to continue making payments to cover your share of the health insurance premium. But of course, if your workers’ comp. claim has been denied and you’re not receiving a check, it may be hard for you to afford those payments.

Depending on how long you have worked for your employer and how many people they employ, you may be able to apply for FMLA leave on the basis that you have a serious health condition that prevents you from working. You will need to be employed by your employer for more than 12 months and worked at least 1,250 hours over the 12-month period. Also, your company must employ a minimum of 50 employees. If these criteria are satisfied and you are approved for FMLA leave, while this doesn’t put more money in your pocket, you will have job protection for 12 weeks, and during that time your employer cannot cancel your health insurance. However, at the end of the 12-week period, if you have not returned to work for your employer, your employer is no longer required to maintain you on its health insurance plan unless you have protection under a collective bargaining agreement. If you do, the provisions in your collective bargaining agreement will set forth the protection that you are entitled to with regard to your health insurance.

Sorry for all this doom and gloom – injuring yourself at work disrupts your life on so many levels. It’s critical for you to retain a top workers’ comp. lawyer – one with extensive experience and expertise – if you are unfortunate enough to sustain a work injury. It can happen when you least expect it and if you find yourself in this position, you need a lawyer who will fight the insurance company tooth-and-nail. You need a lawyer at Pearson Koutcher Law.
Workers’ comp. is all we do, and we will zealously represent you in your workers’ comp. claim. Please call us for a free and comprehensive consultation.