Many people 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. You should pay the same 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.
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. Your TTD payments are two-thirds of your average weekly wage for the 52 weeks prior to your work injury. While you are out on TTD it is important to talk to your employer about how workers’ compensation and health insurance coverage interact.
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.
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 cancelled 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, you can still be fired by your employer 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.
You have the option of temporarily continuing your health insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Your health plan administrator must 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. If you work for an employer that has fewer than 20 full-time employees, North Carolina has a state continuation program similar to COBRA. Either way, you may want to shop around and consider other insurance companies to find your best options for obtaining private insurance.
Get a FREE Case Evaluation from NC 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 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.
There is no charge to call us for an initial case evaluation. It is completely FREE to you.
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