Who Pays Your Health Insurance While on Workers’ Compensation?

If you can’t work due to a job-related injury and are receiving workers’ compensation benefits, your employer should continue to pay their portion of your health insurance premium for as long as you are employed. However, you’ll also need to keep paying your portion of the premium.

Injured workers have certain protections that allow them to keep their employer-sponsored insurance coverage when they’re unable to work due to injury. But even if your employer terminates you or you quit your job while you’re out on workers’ compensation, you may still be able to keep your insurance.

Can My Employer Drop My Health Insurance While I’m on Workers’ Comp?

If you’re taking workers’ compensation while recovering from a work injury, your employer can’t terminate your health insurance out of retaliation. Barring special circumstances, your employer is generally required to maintain your coverage. That said, there are a few scenarios in which it might be legal for your employer to cancel your insurance, including:

You Signed a Contract Allowing the Cancellation

Some employers may require you to sign a contract stating that they’ll terminate your insurance coverage if you’re unable to work for a specified period. However, these contracts aren’t always enforceable. You should consult a qualified lawyer if your employer terminates your coverage and gives this reason.

You Stop Paying Your Premiums

With most employer-sponsored health insurance plans, your employer pays most of your monthly premium, but you’re still responsible for some of it. If you stop paying your portion, your coverage could lapse.

It’s important to note that if your policy lapses after you fail to pay your premium, your employer isn’t the one who terminates the policy — your insurance provider is. If you want to reinstate your coverage after such a lapse, you’ll need to get in touch with your insurance carrier.

Your Employer Encounters Major Financial Problems

If your employer runs into so much financial difficulty that it becomes impossible for them to meet their basic financial obligations, it may be legal to terminate your health coverage.

Can I Use COBRA to Keep My Health Insurance While on Workers’ Compensation?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law that allows workers to keep their employer-sponsored health coverage for a limited time after job loss. This is known as “continuation coverage.” If your employer has 20 or more employees on a group health plan, they’re required to offer it.

You shouldn’t have to use COBRA while receiving workers’ compensation benefits unless you lose your job. However, if you do, you’ll be responsible for the full premium cost.

Can I Use My Personal Health Insurance for Treatments Workers’ Comp Won’t Cover?

In theory, workers’ compensation is a perfect system: You get hurt at work, and your employer pays for all medical treatments while also paying you part of your wages. Unfortunately, it’s not uncommon for employees taking workers’ compensation to run into problems with their claims. For example, if your claim isn’t approved right away, you could be stuck paying expenses out of pocket.

In this situation, your health insurance might cover your medical treatment. If it does, there’s a catch — while workers’ compensation generally covers 100% of all necessary medical care, your health coverage will likely require a copay or coinsurance. You might also have to meet your policy’s deductible before your insurance kicks in.

However, there’s no guarantee that your insurance will cover your injury. If your insurance company learns (or even suspects) that your injury was related to work and should be covered under your employer’s workers’ compensation insurance, they might deny coverage.

Can My Employer Terminate My Health Insurance in Retaliation for Filing a Workers’ Comp Claim?

Some employers are more ethical than others. While your employer can legally terminate your health insurance after you file a workers’ comp claim for a few reasons, retaliation isn’t one of them.

Employers know that retaliation is illegal, so they may try to disguise the actual reason for dropping your insurance. If you believe your employer has canceled your health coverage to get back at you, speak with a workers’ compensation lawyer as soon as possible.

Many workers’ compensation attorneys offer free consultations, during which your prospective lawyer will likely be able to tell you whether your employer’s actions were within the confines of the law. If they weren’t, your legal professional can offer advice on the next steps to take.

If I Return to Work on Light Duty, Will My Health Insurance Be Reinstated?

The short answer is yes – your employer shouldn’t cancel your health insurance while you’re out on workers’ compensation. If they terminate coverage for a legitimate reason — like if your contract specifies that your insurance will end if you can’t work for a certain period — they should reinstate your insurance when you return.

However, depending on the difference between the work you performed before and the work you’re doing now, your employer might be able to deny you coverage. For instance, if your employer only offers health insurance to full-time employees and you return as a part-time worker, you may no longer be entitled to benefits.

These laws can vary depending on your industry, your employer, and the nature of your injury. When in doubt, it’s always wise to meet with a workers’ compensation attorney.

Can You Sue if Your Employer Denies You Health Insurance Benefits?

The workers’ compensation system was put into place to ensure that injured employees could recover critical benefits without having to sue their employers. However, if your employer violates your rights at any point during the process of filing for or receiving benefits, you may have grounds to file a lawsuit. Given the complexity of workers’ compensation laws, it’s wise to consult a trusted workers’ compensation lawyer when you’re considering taking legal action because in some cases, you may be able to resolve the matter without having to file a lawsuit at all.

Many employers who violate the law do so because they assume their employees don’t know any better. When an employee has dedicated legal representation, it might only take a simple conversation between the attorney and the employer to rectify the situation. In other cases, it might be more appropriate for your lawyer to contact Pennsylvania’s Department of Labor and Industry, the government organization that oversees the workers’ compensation system.

At Pond Lehocky Giordano, we understand that no two workers’ compensation cases are alike, and each one deserves a customized legal strategy. Our attorneys have more than 250 years of combined experience, and we’ve won more than 100,000 cases.

Talk to a Lawyer if You’re Being Denied Health Insurance While on Workers’ Comp

Going up against workers’ compensation insurance companies can be daunting, but we routinely fight small employers and large corporations alike to defend our clients’ rights. There are no guarantees in the legal world, but when you have a committed legal advocate by your side, you can greatly improve your chances of success.

At Pond Lehocky Giordano, our attorneys bring over 250 years of combined experience and a proven record of 100,000+ successful cases to help you get the compensation you need. Call 1-800-568-7500 or contact us today for a free consultation.