Can I apply for group health insurance and workers’ compensation at the same time?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 16, 2021

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Workers compensation insurance and group health insurance can both have similar filing requirements. In fact it might even seem like a good idea to apply for group health insurance benefits at the same time as workers’ compensation benefits, but this is not true—even if an employer has suggested doing so.

Group Health Insurance vs Workers Comp

Group health insurance policies generally exclude payment for any benefits for work-related injuries; they might even require the injured worker to state in writing that the benefits being provided are not a result of a work-related injury. This is because group health insurance plans exist alongside workers comp insurance plans; filing under both group insurance and workers comp would otherwise lead to double payment.

Additionally, most group health insurance policies usually require that the injured worker pay a portion of the medical expenses, whereas workers’ compensation pays 100% of an injured worker’s reasonable and necessary medical expenses. From the perspective of the insurance companies themselves, group health plans are also usually entitled to reimbursement from the workers’ comp insurer for work-related injuries. They can put a lien on any settlement funds until they are paid. If you were able to use group health insurance instead of workers’ comp insurance for medical bills, you would lose the value of wage loss and permanency benefits, as most group health insurance policies do not provide for lost wages or disability benefits.

Getting Help

If you have any further questions about which insurance plan your hospital bills fall under, consult with your employer’s HR department or contact your workers’ comp attorney.

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