Will My Health Insurance Continue if I File for Workers’ Comp in North or South Carolina?

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Many people in North and South Carolina wonder how filing a workers’ compensation claim might affect their employment status and their benefits – especially their health insurance.

It’s important to understand that your employment relationship with your employer should remain the same even though you have filed a workers’ compensation claim for an on-the-job injury. Although you are pursuing a claim, you are still an employee of this employer, and you should continue to receive benefits just as you always have.

In other words, in North Carolina and South Carolina, your work injury should not change your work benefits status as long as you remain employed. You should pay the health insurance premiums, if any, that you are normally required to. Your employer should continue to pay their portion of your health insurance as they have been doing.

While you are out on disability, talk to your employer about how to maintain your health insurance.

What Happens to My Health Insurance if I Go Out of Work While on Workers’ Compensation?

If your authorized treating provider writes you entirely out of work or your employer is unable to accommodate your work restrictions, you will be placed out of work. You will stop receiving your regular paycheck and you should begin receiving weekly workers’ compensation checks from the workers’ compensation insurance company that services your employer.

This is called temporary total disability or TTD in both North and South Carolina. While you are out on TTD it is important to talk to your employer about how workers’ compensation and health insurance coverage interact.

Who Pays My Health Insurance While I Am Out on Workers’ Comp?

Great question, and one you need to be clear on. Talk to your employer as soon as the decision has been made for you to go on temporary total disability (TTD).

If you usually contribute to your health insurance premium through payroll deduction, your employer may not automatically notify you that you need to continue making these contributions to maintain your health insurance. Ask your employer if and how you should make these contributions, and verify the answer with the insurance company. Always keep a record of these communications!

Do not assume your regular health insurance contributions are coming out of your TTD check!

If your employer continues to make health insurance payments for you, but you are not paying your usual health insurance premiums while on workers’ comp, your health insurance may end up being canceled before you ever realize you owe anything. Talk to your employer, and find out if you need to send in a check each pay period to keep your health insurance coverage current.

What Happens to My Health Insurance if I’m Fired After Filing for Workers’ Comp?

Unfortunately, it is still possible for you to be fired by your employer in North or South Carolina even if you have an open workers’ compensation case. If you are terminated, you can expect your health insurance benefits to end the same way that they would for any terminated employee. There are a couple of options to consider.

You generally have the option of temporarily continuing your health insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Your health plan administrator should give you a notice stating your right to choose to continue benefits provided by the plan. You then have 60 days to accept coverage or lose all rights to those benefits.

If you elect to continue coverage through COBRA, you will have to pay the full cost of the coverage plus a 2% administrative charge. If your employer was paying the bulk of your health insurance expense before your termination, you can expect that health insurance through COBRA will likely be much more expensive than you are used to.

COBRA generally applies to all group health plans maintained by private-sector employers (with at least 20 full-time employees) or by state and local governments.

NC & SC have distinct health care continuation laws if you're fired after filing for worker's compensation.

Check with your state to see what kind of state continuation program is in place. Either way, you may want to shop around and consider other insurance companies to find your best options for obtaining private insurance.

It you were fired while you have an open workers’ compensation case, call us today at 1-866-900-7078 for a free case evaluation.

Get a FREE Case Evaluation from Skilled Workers’ Comp Attorneys

If you are concerned that your employment status or your right to health insurance benefits may have been unduly affected by your North Carolina or South Carolina workers’ compensation case, contact one of our workers’ compensation lawyers right away. There is a lot at stake, and if you are trying to negotiate on your own against a big powerful insurance company, you are likely at a huge disadvantage.

We know how to help you. Our team includes former insurance company defense lawyers and paralegals with inside knowledge of how the “other guys” work and think. And our firm was named to the 2024 Best Lawyers ‘Best Law Firms’ list, earning a Tier 1 ranking (the highest) for Workers’ Compensation law.4

Since 1997, our firm has recovered more than $1.8 billion total for more than 65,000 people. And counting.1

And to help you protect your interests, we provide a risk-free guarantee.

If we don't recover for you, you pay no attorney's fee.2

Contact us or call 1-866-900-7078 for a free case evaluation with no obligation.

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About the Author

Susan “Ali” Overby practices workers’ compensation law in North Carolina for the Law Offices of James Scott Farrin. Ali is a North Carolina State Bar Board Certified Specialist in Workers’ Compensation law and a member of the 10th Judicial District, North Carolina Bar Association, Wake County Bar Association, and the North Carolina Advocates for Justice. In 2021 and 2022, she was named to the “Best Lawyers: Ones to Watch”a list for Workers’ Compensation Law by Best Lawyers in America.

aFor more information regarding the standards for inclusion, please visit www.bestlawyers.com.