Do I have to pay for my own health insurance while I’m off on workers comp?

Do I pay for my own health insurance when I’m on workers comp? Who pays for my health insurance while on workers comp in Florida? Can I lose my health insurance while on workers comp? Can an employer cancel health insurance while on disability? Can employers cancel health insurance while on workers compensation in Oregon? These are all important questions and ones which may need legal assistance to answer.

Whether or not your employer needs to provide you with workers compensation health insurance while you are off on workers comp is a very complicated question to answer, and one you are going to need a lawyer for.

While many states, including Alabama, Alaska, Colorado, Connecticut, Florida, Kansas, Maine, Rhode Island, and Washington DC have laws mandating that employers either pay for health insurance for workers comp employees or compensate for lost health insurance benefits along with lost wages, the Employee Retirement Income Security Act of 1974 (ERISA) preempts these state laws. Thus, you will need to determine if you and your employer are covered by ERISA.

To find workers compensation legal advice near you, enter your ZIP code in our search tool above.

Understanding Workers Comp and Health Insurance

Workers comp benefits apply to any worker who suffers a qualifying work injury. They guarantee that the worker’s health insurance (which includes medical bills, lost wages, and disability benefits) will be paid by his employer’s workers compensation insurance. However, the “medical bills” requirement applies only to medical bills relating to the injury, so you may still need your health insurance if you have a family who is covered under the policy or if you need routine care while on workers comp.

You will have to check both the rules of your state law, and also determine if ERISA applies to you, in order to determine whether your employer has to pay for the continuing health insurance coverage or not. If your employer isn’t obligated to pay, then you may also be able to take advantage of COBRA provisions that allow you to continue to keep your existing health insurance coverage, while on workers comp, if you pay the full premiums (i.e. you get the same coverage at the same discounted group rate as before, but now you’re picking up the whole bill for the premiums instead of your employer paying some).

Does the Family and Medical Leave Act offer health insurance during workers comp?

The Family and Medical Leave Act (FMLA) may be able to help while you are out on extended medical leave under certain circumstances. Factors such as company size, employee tenure, and annual hours worked will determine what, if any, benefits are available.

The FMLA offers coverage up to 12 weeks.

Does COBRA offer continuing health insurance coverage?

If you are out past the 12-week FMLA cut-off, COBRA continuation coverage may be an option to extend your health insurance coverage. If you qualify, COBRA can extend health insurance coverage an additional 18 months.

Are there other health insurance options while on workers comp?

There may be other state or federal programs that can help with health insurance while on extended medical leave. Check with your company’s human resources department to see what may be available.

If necessary, you can also reach out to a legal professional for additional assistance.

Getting Help

To get help with determining which laws will apply to your workers comp case, consult with a lawyer as soon as possible. Find legal assistance near you by entering your ZIP code below.

Case Studies: Exploring Health Insurance Coverage During Workers Comp

Case Study 1: The Impact of ERISA on Health Insurance Coverage During Workers Comp

We examine the application of the Employee Retirement Income Security Act of 1974 (ERISA) on health insurance coverage for employees on workers comp.

We explore a scenario where an employee in a state with ERISA preemption is unsure whether their employer is obligated to provide health insurance or compensate for lost benefits during their medical leave. We discuss the legal implications and potential recourse for the employee.

Case Study 2: Ensuring Continued Health Insurance Coverage Under COBRA

This focuses on the role of the Consolidated Omnibus Budget Reconciliation Act (COBRA) in providing continuing health insurance coverage for employees on extended medical leave due to workers comp.

We present a scenario where an employee has exceeded the 12-week Family and Medical Leave Act (FMLA) coverage and needs to explore alternative options. We discuss how COBRA can extend health insurance coverage for an additional 18 months and the requirements for eligibility.

Case Study 3: State and Federal Programs for Health Insurance During Workers Comp

We explore the availability of state and federal programs that can assist employees with health insurance coverage while on extended medical leave due to workers comp.

We present a scenario where an employee is concerned about losing health insurance during their absence from work. We discuss the potential options and resources available through state programs, federal programs, and employer-provided benefits.