Filing a workers’ compensation claim can be stressful, especially when you’re unsure how it affects other aspects of your life—like your health insurance. At Mehta & McConnell, we’ve seen how confusing this process can be for injured workers. That’s why we’re here to discuss the details and answer your most pressing questions, including: Who pays your health insurance while on workers’ compensation?
Let’s look closer at how workers’ compensation interacts with your health insurance and what you can expect if you’re dealing with a workplace injury in North Carolina.
Balancing Workers’ Compensation and Health Insurance
If you’re injured at work, you may wonder how your health insurance will be affected. Common concerns include:
- Will I lose my health insurance while receiving workers’ comp benefits?
- Does my employer have to pay my health insurance while on workers’ comp?
- Can I use my own insurance instead of workers’ comp for treatment?
These are valid questions, especially when medical expenses pile up and you cannot work. Unfortunately, workers’ compensation and health insurance systems operate separately, which makes navigating their rules tricky.
Why It Matters
Health insurance provides a vital resource for medical expenses unrelated to your work injury, such as routine checkups, family healthcare, and prescriptions. Losing coverage during your recovery could mean paying significant out-of-pocket costs for non-work-related medical needs. On the other hand, if you rely solely on workers’ comp coverage, you may be limited to treatment strictly related to your workplace injury, leaving gaps in your overall healthcare.
For example, a workers’ compensation claim might cover physical therapy for a back injury sustained at work but won’t cover the cost of treating an unrelated chronic condition like diabetes. Therefore, it’s essential to understand how your health insurance and workers’ comp benefits can coexist.
How Workers’ Compensation Works in NC
In North Carolina, workers’ compensation is governed by the North Carolina Workers’ Compensation Act. Under this act, workers’ comp benefits cover medical expenses, wage replacement, and other costs directly tied to workplace injuries. However, these benefits do not extend to unrelated medical needs, where your health insurance plays a critical role.
Let’s break down some key aspects.
Who Pays Your Health Insurance While on Workers’ Compensation?
Whether your employer continues to pay for your health insurance during your recovery depends on several factors:
- Your employment status. If you remain an active employee (even if you cannot work temporarily), your employer may continue paying their share of your health insurance premiums.
- Company policies. Some employers provide health insurance as part of a benefits package and may maintain coverage while you’re out on workers’ comp.
- COBRA eligibility. If you lose your job or employer-sponsored insurance, you may qualify for COBRA, which allows you to continue your coverage by paying the premiums yourself.
While workers’ compensation benefits help cover work-related injury expenses, they don’t include paying for your regular health insurance premiums. The North Carolina Workers’ Compensation Act doesn’t require employers to maintain health insurance during your time off unless explicitly stated in your employment agreement.
Can I Use My Own Insurance Instead of Workers’ Comp?
Generally, you cannot use personal health insurance for medical expenses related to your workers’ compensation claim. North Carolina law ensures that all costs directly tied to your work injury are handled by workers’ comp, not your health insurance.
For example, if you require surgery for a workplace injury, your employer’s workers’ compensation coverage is responsible for the cost. If you attempt to use personal insurance, the claim may be denied, or your insurer may seek reimbursement.
This division protects you from unfair financial responsibility, but it also means that workers’ comp claims must be carefully documented to avoid delays in receiving care.
Does My Employer Have to Pay My Health Insurance While on Workers’ Comp?
This is a common concern. Unfortunately, workers’ compensation and health insurance are governed by separate rules. While employers are legally required to provide workers’ compensation coverage for workplace injuries, no North Carolina law mandates that they pay your health insurance premiums while you’re out on workers’ comp.
However, some employers voluntarily continue health insurance coverage during your leave. Reviewing your employment contract or employee handbook to understand what benefits you’re entitled to and for how long is critical.
To ensure you maintain coverage and avoid any surprises, follow these steps:
- Talk to your employer. Ask about your health insurance benefits while on workers’ comp and whether coverage will continue.
- Review your rights. Check your employment contract and benefits package for specific policies.
- Explore COBRA. If coverage is at risk, COBRA offers a way to continue your health insurance. Though it can be expensive, it provides peace of mind during uncertain times.
- Seek legal advice. At Mehta & McConnell, we’re experienced in navigating workers’ comp health insurance issues and can help you protect your rights.
These steps can help you avoid lapses in health insurance coverage and unexpected expenses during your recovery. For more information on how workers’ compensation works in North Carolina, refer to the North Carolina Workers’ Compensation Act, which outlines your rights and protections under the law.
A Path Forward with Mehta & McConnell
At Mehta & McConnell, we understand how overwhelming workplace injuries and benefits questions can be. With over 30 years of combined experience, we’ve helped countless clients secure the benefits they need while protecting their rights.
If you’re wondering who pays your health insurance while on workers’ compensation or have other concerns, we’re here to help. Schedule a free consultation with our North Carolina State Bar board-certified attorneys today. Let us guide you toward the resolution you deserve.
Viral Mehta
Viral Mehta is the managing attorney of Mehta & McConnell Injury Lawyers, a Charlotte, North Carolina Workers’ Compensation law firm. He enjoys spending time with friends and family, traveling, sports, and reading.
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