Worker’s Compensation and Health Insurance

Many people have questions when it comes to the world of medical expenses in the aftermath of a work-related injury and for obvious reasons.  The cost of healthcare can be a major financial burden and employers will not usually give you a straight answer as to who is paying for what.  Most employers will suddenly start hiding information form you because they simply don’t want to pay for workers comp benefits. This article will help break down some of the FAQs regarding medical treatment and its payment.

Whose responsibility is the payment for medical treatment?

When it comes to a work-related injury, employers are responsible for paying for any and all reasonable and necessary medical treatment for their workers. Do not confuse this with health insurance, which your employer is not mandated to provide you – health insurance, even when provided by your employer, and worker’s comp medical benefits are two entirely different things.  Employers have to follow the Michigan worker’s compensation law on medical benefits.

Under worker’s comp, medical treatment can include physical therapy, medication, surgery or other operations, hospital stays, and doctor visits. Its range of treatments also include dental care, hearing aids, wheelchairs, prosthetics, eyeglasses, and any other appliance that is necessary in the treatment or relief of the work injury.  Nursing care can also be a necessary medical benefit.

What happens when employers deny the work-treatment relationship?

Frequently, certain employers will dispute the reason-ability or necessity of a medical treatment in regards to the job. Generally, the employer (or, more likely, their insurance carrier) will argue the treatment is not work-related, and therefore not their responsibility to pay for (i.e. refusing to pay for back treatment for someone with spinal arthritis).  Depending on the injury’s location and severity, worker’s comp will have more or less extensive range.

Can my employer continue providing healthcare?

Absolutely, and in fact many do exactly that. While it is not required under Michigan state law to provide health insurance to someone currently receiving worker’s compensation benefits, it is in generally in the best interest of the employer to continue doing so.  This is because health insurance, as a fringe benefit of the job, would have its value in cash added to the average weekly wage that a disabled worker receives from the employer, making it generally cheaper to pay for health insurance than to pay out in wage loss benefits.

Is there a way to protect my health insurance?

With many employers choosing to lay off employees who cannot work due to an injury, a federal law known as COBRA can step in and help the worker a bit. Under COBRA, a fired employee can continue using the company’s health insurance plan for a short period of time, though they must pay the premiums themselves, making it quite expensive.

Furthermore, many employment or union contracts can grant disabled workers the right to health insurance. This is part of the reason why it is so imperative that an injured worker contacts an experienced worker’s comp lawyer, as otherwise both your health insurance and worker’s comp case could be at jeopardy.

Should I listen to my employer if they instruct me to use my health insurance for my injury?

The short answer? Absolutely not.  The longer answer is that this can be a last-ditch effort by an employer to avoid paying out worker’s comp for your injury. First of all, worker’s comp is unlimited, with no deductibles or co-pays, as opposed to health insurance; so using it for its designed purpose is logical.

Next, it is worth remembering that you could end up paying for treatment out of pocket under your health insurance, but not under worker’s comp, which will provide reasonable and necessary medical treatment for as long as necessary.  It is possible to utilize your health insurance to help pay for treatment while you appeal a denied worker’s comp claim. This will let you get treatment while you fight for your benefits in court, as many health insurance companies agree to pay for medical treatment in these scenarios, with the understanding that they will be reimbursed in the case of a successful worker’s comp suit.

Taking the First Step To Recovery After a Work Injury

All in all, a good summary is that worker’s comp should cover all reasonable and necessary medical treatment for an at-work injury. Your employer is not required to provide health insurance, but many do anyways to avoid paying out cash benefits to employees. In the case of a denied worker’s comp case, use your health insurance to cover medical bills while you file a suit against your employer. In the case you lose your medical insurance, utilize COBRA or a union/employment contract.  If you have any further questions regarding medical treatment under worker’s compensation, or would like to take the first step in appealing a denied claim, contact us today. Our lawyers are well-versed in these matters, and can evaluate if your claim is legitimate.  Call The Clark Law Office today at +1 (517) 347-6900.

5/5 - (1 vote)