When you’re injured on the job, there’s a lot to think about. However, one thing you don’t want to worry about is your health insurance. While worker’s compensation will cover your medical bills and the ongoing care relating to your on-the-job injury, it doesn’t cover the cost of medicine or treatment for illnesses and injuries you sustain off the clock.
This means that it’s imperative that you maintain your health insurance.
Then the question is: Can you? And if so, who will pay for it? It’s important that you understand the answers to these questions so that you stay protected even as you heal from your work-related injury.
What is Workers Comp?
Workers compensation is a state-mandated coverage that companies must obtain to protect their workers from work-related injuries. Workers comp insurance provides for medical treatment, ongoing medical care, lost wages, funeral costs, and disability benefits when you’re hurt at work.
For instance, examples of work-related injuries include developing carpal tunnel syndrome, suffering a fall from a ladder, or injuries from a car accident while driving for work.
Workers comp is different from health insurance. Typically, health insurance pays for medical care and other expenses that occur as a result of illnesses and injuries that occur outside of work, such as when you slip and fall in your driveway or develop cancer.
When you work for a company, you’re definitely covered by workers comp. However, you may or may not receive health insurance as a benefit.
Will My Job Pay for Health Insurance While I’m on Worker Comp?
In short, the answer is maybe, but probably not.
Some employers may continue to pay for your health insurance costs out of kindness. This may be more likely to happen when you’ve been sick a long-time and well-liked employee or you work for a small company where you have personal ties with the employer.
However, in most cases, your employer will not continue to pay for your health insurance benefits. Why? This is because many insurance plans have eligibility requirements that you must meet to stay as an active participant.
For example, a common requirement is that you work at least a certain number of hours per week. If you are not working due to an injury, you will not meet this eligibility requirement. It also implies that your employer is not required to keep you on the health insurance plan.
How to Get Health Insurance While on Workers Comp?
Just because you’re injured on the job doesn’t mean you have to lose your health insurance coverage. However, the question then becomes, who will pay for it?
Using PTO or Sick Leave
If you have accrued vacation time or sick leave, you can use this benefit to circumvent a health insurance program’s minimum hours eligibility requirement — at least for a little while.
Most insurance programs consider employees who are taking accrued time off as actively working. This means that if you have six weeks of accumulated leave, for instance, you can use them and still be considered an active worker.
Your employer will continue to pay your health insurance benefits during this time. It’s only after you have exhausted your paid time off that you need to figure out what to do next.
Family and Medical Leave Act (FMLA)
If you have worked at your job for at least a year, have worked at least 1,250 hours over that last year, and work for a company that has over 50 employees within a 75-mile radius, you qualify for FMLA coverage.
FMLA offers workers up to 12 weeks of unpaid leave when they have a baby, need to care for a family member or suffer from a medical condition themselves. Sustaining an on-the-work injury qualifies you for FMLA.
One of the employer’s responsibilities under FMLA is to provide the same level of health insurance coverage during leave as the employee had prior to it. This means that for up to 12 weeks, your employer must pay for your health insurance benefits.
However, once you’ve reached 12 weeks of leave, your employer is no longer bound to FMLA guidelines and can discontinue coverage.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
If you don’t qualify for FMLA or have exceeded your 12 weeks of leave, your next option for maintaining health insurance is COBRA.
COBRA is a program that lets you effortlessly continue your health insurance coverage when you experience a change in your work situation. Under COBRA, you’re allowed to remain a participant in your company’s health insurance plan for up to at least 18 months.
However, you’ll be responsible for paying for it.
This means you’ll have to cover both your employer’s portion of the bill, as well as your own if you were paying for any of it.
For example, if your health insurance costs $600 per month and your employer was paying $540 (90%) and you were paying $60 (10%) through paycheck deductions, you’ll now be responsible for 100% of the $600 per month cost.
Other Options for Health Insurance
While COBRA is an option for maintaining health insurance, it may not be an affordable one depending on your employer’s insurance program.
Thankfully, California workers have other options for obtaining health insurance at potentially lower rates: these other solutions include Medi-Cal, Medicare, and the Affordable Care Act (ACA).
You may qualify for Medi-Cal if you have a household income up to 138% of the federal poverty line.
Also known as Obamacare, the ACA typically only allows for enrollment during special enrollment periods. However, you qualify for your own special enrollment period when you experience certain life events, such as loss of health insurance. To qualify, you must have a household income that’s between 138 and 400% of the federal poverty line.
In a nutshell, when you get hurt on the job, your primary focus should be on getting better. However, it’s also important that you know what you have to do to maintain health insurance benefits. Depending on the circumstances, your employer may continue to pay on your behalf for a while, but ultimately, you’ll be on the hook for the cost.
If you have been injured at work it can be overwhelming figuring out the workers’ compensation system and maintaining your work benefits. You don’t have to do this alone. The lawyers at The Morris Law Group are here to help you. Feel free to call our office for a free consultation.