Introduction
When an employee gets injured or becomes ill due to work-related activities, they may be eligible for workers’ compensation benefits. These benefits typically cover medical expenses and a portion of lost wages. However, a common question that arises in such situations is, “Who pays for health insurance while on workers’ compensation?” In this article, we will explore the intricacies of health insurance coverage during a workers’ compensation claim and provide a comprehensive understanding of the subject.
Health Insurance Coverage During Workers’ Compensation
Primary Health Insurance: In most cases, an employee’s primary health insurance coverage remains intact while they are on workers’ compensation. This means that the health insurance plan, whether provided by the employer or obtained individually, continues to cover medical expenses unrelated to the work-related injury or illness. The injured employee can still seek medical treatment for non-work-related conditions, and the health insurance provider will pay for the eligible expenses as per the terms of the policy.
Workers’ Compensation Insurance: Workers’ compensation insurance is a separate coverage that employers are required to provide for their employees. This insurance is specifically designed to cover medical expenses and lost wages resulting from work-related injuries or illnesses. When an employee files a workers’ compensation claim, the medical expenses related to the work-related condition are typically paid by the workers’ compensation insurance carrier.
Coordination of Benefits
Subrogation: In some cases, when an employee receives workers’ compensation benefits, the workers’ compensation insurance carrier may have the right to recover the expenses from the responsible party. This process is known as subrogation. If the employee’s work-related injury or illness was caused by a third party, such as in a car accident during work hours, the workers’ compensation insurance carrier may seek reimbursement from the responsible party’s insurance. This helps ensure that the burden of medical expenses is appropriately allocated.
Coordination of Benefits: In situations where an employee’s primary health insurance and workers’ compensation insurance both cover the same medical expenses, coordination of benefits may come into play. Coordination of benefits is a process that determines how the two insurance coverages work together to pay for the eligible expenses. The specifics of coordination of benefits can vary depending on the insurance policies and applicable laws. In some cases, the primary health insurance may be responsible for paying first, and the workers’ compensation insurance may cover the remaining expenses. Alternatively, the workers’ compensation insurance may be the primary payer, and the health insurance may act as a secondary payer.
Conclusion
In summary, while an employee is on workers’ compensation, their primary health insurance coverage generally remains in effect for non-work-related medical expenses. The workers’ compensation insurance, which is specifically designed to cover work-related injuries or illnesses, pays for the related medical expenses. Coordination of benefits and subrogation may come into play to ensure appropriate allocation of expenses and reimbursement from responsible parties. It is essential for employees to understand the details of their health insurance and workers’ compensation coverage to make informed decisions regarding medical treatment and claims.
References
– Department of Labor. (n.d.). Workers’ Compensation. Retrieved from dol.gov
– HealthCare.gov. (n.d.). Workers’ Compensation. Retrieved from healthcare.gov
