Why employees shouldn’t use health insurance for work injuries

On Behalf of | Dec 21, 2023 | Workers' Compensation

Many employees find the idea of filing a workers’ compensation claim distasteful. They would rather continue working. If they have insurance coverage or other benefits that could offset their expenses, they may try to use those benefits instead of filing a workers’ compensation claim as a result.

Some workers use paid leave benefits and health insurance coverage instead of workers’ compensation because they view that as easier, faster or less likely to cause negativity with their employers. However, using personal health insurance for a job-related medical issue could be a major mistake.

Insurance rules prohibit such practices

The first reason why using health insurance for a job injury is a mistake is that technically health insurance should not apply in that scenario. Liability laws pass responsibility to other parties in certain scenarios, including incidents at someone’s place of employment. Generally speaking, if there is another form of coverage that should apply, workers should not try to use health insurance for that claim. They may end up needing to repay the benefits if the health insurance company discovers that the issue relates to their job.

There are no patient responsibility costs

Standard health insurance coverage makes the person seeking treatment pay for a significant portion of their care costs. Most insurance policies have a deductible that applies. Workers will have to pay thousands of dollars out of pocket before the policy starts covering their costs. They may also have co-pays due at every appointment or each time they pick up a prescription. Finally, co-insurance might require that they pay a flat percentage of their total treatment costs. Workers’ compensation benefits include full medical coverage.

Workers do not have to pay out of pocket for the care received during a workers’ compensation claim. A workers’ compensation claim can also help an injured employee get their employer to accommodate their condition based on medical recommendations.

Businesses are not legally allowed to retaliate against workers who report injuries on the job or file workers’ compensation claims. As a result, ultimately, thoughtfully approaching the subject of benefits for a work injury can make a major financial difference for an injured employee.