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Health Insurance While On Workers’ Comp In Ohio


If you’ve been injured on the job, getting the medical treatment you need should be one of your top priorities. But if you go to the hospital or your doctor’s office, who is going to pay? With the cost of medical care today, this is a very important question, and it is a question you should discuss with your Columbus workers’ compensation attorney during your free initial consultation.

Generally, if you are eligible for workers’ compensation, your workers’ comp claim should cover your treatment costs (in addition to a portion of your lost wages if you are unable to work for an extended period of time). This means that you should not have to seek coverage under your health insurance plan, and you also should not have to pay anything out of pocket. But, securing full workers’ comp coverage for your medical expenses can be challenging—and, even if you don’t obtain workers’ comp coverage, your health insurer could still try to avoid liability on the basis that your injury is work-related.

With this in mind, here’s what you need to know about your health insurance coverage while on workers’ comp in Ohio:

Health Insurance and Work-Related Injuries: What Employees in Ohio Need to Know

The most important thing you need to know is that, in Ohio, health insurance generally doesn’t cover work-related injuries for employees. This is due to Ohio’s state-run workers’ compensation system, which is administered by the Ohio Bureau of Workers’ Compensation (BWC). If you are an employee and you have a work-related injury, you may be entitled to coverage through workers’ comp—and, if you are, the law effectively says that you must seek coverage from the Ohio BWC (or, in some cases, from your employer) because the health insurance companies generally aren’t required to pay.

But, let’s say you use your health insurance. For example, let’s say you see your normal doctor for your first visit and have your doctor’s office bill your health insurance company. In this scenario, your health insurance company is likely to seek reimbursement (or subrogation) based on your right to workers’ compensation benefits. However, if you seek additional health insurance coverage for your injury after your first visit, your insurer may deny coverage based on your workers’ compensation eligibility.

This gets complicated quickly, and to avoid unnecessary issues, the best thing you can do is work with an experienced Columbus workers’ compensation attorney to make sure you seek the full benefits to which you are legally entitled. If you run into any issues with your insurance company, your attorney will be able to deal with these issues on your behalf as well.

Can You Lose Your Health Insurance While On Workers’ Comp?

Along with questions about health insurance coverage, many employees who get injured on the job also have questions about whether they can lose their insurance while on workers’ comp. While health insurance generally doesn’t cover work-related injuries for employees, you shouldn’t lose your coverage as a result of filing a claim for workers’ compensation benefits.

But, while filing a claim for workers’ compensation benefits won’t cause you to lose your insurance coverage, you can still lose your insurance coverage while on workers’ comp. All of the ordinary rules and restrictions still apply—and filing for workers’ comp doesn’t provide additional protections for your health insurance coverage. As a result, you can lose your health insurance while on workers’ comp if:

  • You Lie About the Cause of Your Injury – If you lie about the cause of your injury in order to obtain health insurance coverage and avoid filing a workers’ comp claim, this could result in a loss of coverage.
  • You Lose Your Job – If you have health insurance through your employer, losing your job could mean losing your coverage (though you may be eligible for COBRA insurance). This is true whether you quit or get fired under Ohio’s “at will” employment law.
  • You Don’t Pay Your Premiums – Just like any other insurance policy, you need to pay your premiums in order to maintain your health insurance coverage. If you don’t pay, your insurance company (or former insurance company) isn’t required to provide coverage.

Losing your health insurance can be costly, and it can make it more difficult to obtain new coverage in the future. With this in mind, you want to avoid losing your coverage if at all possible. Once again, an experienced Columbus workers’ compensation attorney can help you avoid unnecessary issues—as long as you contact an attorney in time.

What If I’m Not an Employee?

So far, our discussion has focused on employees. But, what if you are an independent contractor? Under Ohio law, independent contractors generally are not eligible for workers’ compensation.

If you have a work-related injury and you are an independent contractor, you should be able to use your health insurance—because workers’ compensation benefits aren’t available to you. This, of course, assumes that you have paid your premiums and you had coverage at the time of your injury. You may have a personal injury claim as well. Both employees and independent contractors can file personal injury claims for work-related injuries in many cases (though there are special limitations for employees), and if you have a personal injury claim, your attorney will be able to help you seek full compensation for all of the financial and non-financial costs of your injury.

Making Sure Your Medical Bills Are Covered After a Work-Related Injury

Taking all of this into consideration, how can you make sure your medical bills are covered after a work-related injury?

The most important thing you can do to protect yourself is to seek help promptly. This means seeking treatment for your injury right away, and it means talking to a Columbus workers’ compensation attorney about your legal rights as soon as possible. If you are eligible for workers’ compensation, seeing a doctor who is BWC-certified will help ensure that you don’t have any issues with your health insurance company. But, if you see your normal doctor, this should be fine too—just be sure to be upfront about your injury being work-related.

Once the BWC accepts financial responsibility for your claim (or your employer accepts financial responsibility if your employer is self-insured), your medical treatment costs should be covered—and you shouldn’t have to worry about relying on your health insurance. But, various issues can arise, and these issues can be difficult to deal with on your own. As a result, it is best to have an experienced Columbus workers’ compensation attorney on your side. You may also be entitled to disability benefits through workers’ comp, and your attorney will be able to seek all available forms of financial compensation on your behalf.

While dealing with workers’ compensation and health insurance after a work-related injury can be stressful, you ultimately need to focus on doing what is best for yourself and your family. An experienced attorney can help, and you can hire an attorney to protect you at no out-of-pocket cost.

Contact Us to Speak with a Columbus Workers’ Compensation Attorney

If you need to know more about how to protect yourself when it comes to health insurance and workers’ compensation after an on-the-job accident, we encourage you to get in touch. To speak with an experienced Columbus workers’ compensation attorney at Malek & Malek Law Firm in confidence as soon as possible, call 888-444-7440 or request a free consultation online today.