If you’ve been injured at work in North Carolina, you might wonder, Who pays for health insurance while I’m on workers’ compensation? or, Does my employer have to pay my health insurance while I’m on workers’ comp?
These are valid concerns, as medical bills can pile up quickly. Let’s dive into these important questions and shed some light on how health insurance works during workers’ comp.
For assistance from an experienced Charlotte and Winston-Salem workers’ compensation lawyer, please call (336) 724-2828 or reach us online today.
Who Pays Health Insurance Premiums While You’re on Workers’ Compensation?
When you’re injured at work and need time off, figuring out who covers your health insurance can be confusing. This primarily depends on whether you continue to remain employed while on workers’ comp.
Employer Paid and Employee Paid Insurance Premiums
As long as you remain employed, you can expect your employer to continue paying their portion of your health insurance premium. However, you will have to continue paying your share of the premium, if any.
If you cannot work at all, you won’t receive a regular paycheck, but you may receive temporary total disability (TTD) benefits. TTD are benefits offered through workers’ compensation that apply when a work-related injury or illness prevents you from performing any duties of your job. In simpler terms, if you’re injured to the point you cannot work while you recover, TTD helps replace part of your income. Keep in mind that if your employer was previously deducting your portion of your health insurance premium from your paycheck, those deductions will stop if you aren’t getting paid. That means you may need to make these payments directly to your insurance provider. If you fail to do so, your insurance may be canceled.
If you can work at a reduced capacity, you may receive temporary partial disability (TPD) benefits to make up a portion of your lost income. Since you will likely still be receiving a paycheck while on TPD, payroll deductions can continue to cover your health insurance premium.
Regardless, it’s important to check with your employer directly to ensure your premiums continue to be paid. Your employer might not automatically inform you about steps you need to take to continue your health insurance contributions, so be proactive and ask how to handle it. It’s also a good idea to keep a record of these conversations, perhaps by communicating through email, just in case you need the reference later on.
COBRA Option
If your employment terminates while you are on workers’ comp, your employer-sponsored health insurance will terminate. In that case, you may be eligible for COBRA coverage. COBRA lets you continue your health insurance coverage. However, you’ll have to pay the entire premium plus a 2% administrative fee.
You typically qualify for COBRA if you were enrolled in your employer’s health plan on the day before your employment ended. This includes situations where your employment ends due to work-related injury. However, it’s essential to confirm whether there are any changes in benefits or network restrictions with COBRA. Make sure to compare the costs and coverage options before deciding whether to opt for COBRA.
Can Your Employer Cancel Health Insurance While You’re on Workers’ Compensation?
Whether your employer can cancel your health insurance depends on whether you remain employed with them. If your injury prevents you from working long-term, you likely won’t be able to continue your employment.
However, if you are able to continue working or are disabled for only a short time, certain legal protections may prevent your employer from terminating your employment:
- Leave laws. If you qualify under the Family and Medical Leave Act (FMLA), you may take leave of up to 12 weeks to recover from an injury or illness. During this time, your employer cannot cancel your group health insurance, and once your leave ends, your employer has to restore you to the same job or an equivalent job.
- Retaliation. North Carolina’s Retaliatory Employment Discrimination Act (REDA) prohibits employers from taking adverse actions, including terminating employment or canceling benefits, to punish an employee for filing a workers’ compensation claim. Nevertheless, employers can still terminate employment for legitimate reasons, such as layoffs, misconduct, or inability to perform job duties (if not covered by FMLA).
- Accommodations. If your injury allows you to perform your job with reasonable accommodations, your employer might be obligated to offer them under the Americans with Disabilities Act (ADA).
If you’re unsure about your employer’s specific policies or your rights, consulting with a North Carolina workers’ comp attorney can be extremely helpful. They can guide you through the legalities and ensure you maintain health insurance coverage while recovering from your work-related injury.
How Workers’ Comp and Health Insurance Work Together
Your workers’ comp coverage has primary responsibility to pay for your work-related medical expenses. If the workers’ compensation provider accepts your claim, they typically pay for these expenses directly. If there is uncertainty about whether your claim falls under workers’ compensation—for example, if the workers’ comp insurer denies your claim—your health insurance may pay the initial costs of your medical treatment. If you later win a workers’ comp claim or receive a settlement, you will need to reimburse the health insurance provider for costs they paid on your behalf.
Get the Support You Need from EMP Law
As you can see, the question of who pays for health insurance while you’re on workers’ compensation is more complex than you may initially think. While your employer’s workers’ comp insurance primarily covers injury-related treatment, your regular health insurance is still needed to cover unrelated medical expenses. This may be especially true if your health insurance coverage extends to other family members, such as your spouse or children.
For these reasons, it is crucial to make sure you can continue your health insurance while on workers’ comp. If you’re uncertain about your coverage or encounter obstacles, reach out to us. Our seasoned North Carolina workers’ comp attorneys at EMP Law are dedicated to ensuring you receive all the benefits you are entitled to. We know it can be challenging when you’re up against organizations with more resources than you. But we’re here to stand up and fight for you.
Contact us online or call (336) 724-2828 today for a consultation, and let us support you through this process.
Michael provides compassionate, diligent, and creative legal services that are tailored to meet each client’s specific needs. His experience relating to clients from diverse backgrounds makes him well suited for representing his clients across a broad range of legal areas. He practices in the areas of employment law and family law, and is experienced in criminal law.
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