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Health insurance usually won’t pay if you get hurt at work

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Posted on February 5, 2021

Your employer carries insurance to protect you in addition to offering insurance as a benefit. Whether you have an employee-sponsored health insurance policy or purchased your plan off of the Marketplace, you probably think that your health insurance will cover the cost of any injuries or illnesses you might have.

While insurance companies can no longer refuse to cover conditions you’ve had for a while, there are circumstances in which they won’t pay for your medical care. If an insurance company knows that a different kind of coverage should apply to your situation, they likely won’t cover the bills when you go to see your doctor or wind up in the hospital.

Will health insurance pay when you get hurt at work?

If you end up hurt on the job and have to leave and go get treated, your health insurance may pay for your initial visit. However, once the company learns that your injury or illness was the result of your job, they will likely decline future payments related to the condition and subrogate any claims they already paid to the workers’ compensation policy your employer carries.

Why is workers’ compensation a better option than your health insurance?

There are two good reasons why it’s better to get benefits through your workers’ compensation policy than it is to receive them from your health insurance provider. First of all, there are patient contributions to consider.

With standard health insurance, you often have an obligation to pay hundreds, if not thousands, of dollars out of pocket. Deductibles, coinsurance and co-pays all apply to the care that you receive, leaving you with a lot of expenses. Workers’ compensation does not have any recipient responsibility. You don’t have to pay a co-pay or meet a deductible. Workers’ compensation should cover 100% of your approved care needs.

The second reason why workers’ compensation is a better option is that you may also be able to get disability benefits through workers’ compensation. Your health insurance plan certainly is not going to cover your lost wages, but workers’ compensation will cover a percentage of your missed income.

Advising your employer of the injury and filing necessary paperwork as soon as possible will help you connect with the workers’ compensation benefits you need after an injury on the job.