November 29, 2022
Does Health Insurance Cover Work Related Injuries After Settlement

Does Health Insurance Cover Work Related Injuries After Settlement

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Does health insurance cover work related injuries after settlement? In most states, a full and final indemnity agreement means you waive the right to make future claims related to your injury. (Workers’ compensation may cover injuries and illnesses that aggravate or “lighten” a pre-existing condition, as long as the new injury is work-related.)

If you are injured on the job, your employer and the employee insurance company should provide you with a list of doctors from which to choose. You have the right to choose your occupational physician from this list. And this doctor becomes your authorized attending physician. Regarding the employee compensation, your employer and the insurer are responsible for the reimbursement of medical treatments by or under the direction of your authorized attending physician.

Sometimes injured workers and their employers try to find ways to pay for medical treatment other than workers’ compensation. There are many reasons for this. For example:

  • The injured worker may think that the injury is minor and that he can return to work without much or no loss of time. They would rather deal with health insurance than deal with the paperwork and hassle of the workers’ compensation claim process. As such, the injured employee will not file a claim for workers’ compensation with the Workers’ Compensation Commission.
  • The employer is concerned about rising worker compensation premiums, so he promises the injured worker that he will pay for medical treatment in cash or out of pocket. The employer does not inform his insurance company about the accident at work, but his promise does not last long, because the medical treatment is more expensive than the employer expected.
  • The injured employee thinks he will be fired because of the work accident, so instead of reporting the accident or making a claim, the employee decides to pay the medical expenses out of pocket. They often tell the health care provider that the injury occurred at home.

This article looks at the risks of using health insurance to pay for work-related injuries. Read on to learn about the benefits of receiving medical treatment through workers’ compensation instead of private health insurance. Then call an occupational accident lawyer for a free strategy session.

Table of Contents

Employee Compensation vs. Private health insurance

Workers’ Compensation provides for the payment of medical bills for reasonable and necessary medical treatment related to your accident at work or occupational disease.

Due to the existence of workers’ compensation, many private health insurance companies will refuse payment for any treatment they believe is related to an accident at work. Private health insurers often only use language in their policies.

Many health insurance contracts contain language such as We will not pay for necessary care and treatment for illness or injury for which benefits are provided under state or federal workers’ compensation, employer’s liability, or occupational disease law. Some health insurance plans even exclude coverage when the injury or illness can be covered by workers’ compensation, regardless of whether the injured worker receives workers’ compensation.

What if I am treated for accidents at work through private health insurance?

When an injured employee decides to be treated for accidents at work through regular health insurance, there is a risk that the private health insurance company will investigate if they receive notice, either from the injured worker, the employer, the occupational accident insurance company, or medical provider or your medical records, that the injury occurred on the job.

The examination can be done right away, as soon as your medical providers (doctors, surgeons, hospital, physical therapist, chiropractor, etc.) know, or it can be done many months later. It depends on the health insurer. However long it takes, you can count on the health insurer to investigate whether it is responsible for treating your accidents at work. You should consider the private health insurance company’s lien when negotiating a workers’ compensation plan.

What if the doctor finds out I was injured at work?

Some doctors will refuse to treat you through your regular health insurance plan if they know your injury occurred on the job. They know that the health insurer will probably reject all the doctor’s bills and that they will not receive payment.

Remember, you should always be honest with your doctor. It is the only way to win compensation from your employees. And when you tell your doctor the truth about an accident at work, you should assume that the private health insurance company will eventually find out that this is a possible case of workers’ compensation.

When the private health insurance company learns that your injury occurred on the job, it can withdraw all existing payments, refuse to approve additional payments, and withdraw all payments already made. If the private health insurer does not withdraw the benefit, they can request reimbursement directly from you. That is why it is important to discuss all medical matters with your occupational accident lawyer.

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Additional things to consider when deciding whether to use health insurance for employee injuries

We recommend seeking medical attention through workers’ compensation in any situation. Using private health insurance involves many risks. Here are additional reasons why you should use workers’ compensation and not private health insurance:

  1. Most of us have private health insurance through our employers, which we can lose at any time. You could lose your private health insurance if you are fired from your job, which often happens to injured workers who are unable to return to work or who have a permanent partial disability that prevents them from returning to their pre-workplace jobs. damage. At that point, you have three options: (a) remain uninsured; (b) purchase private health insurance through the Affordable Care Act (ACA) exchange, or (c) pay for private health insurance through COBRA.
    1. Neither option is good. You will have to pay a lot of money to stay insured, money that you will not have if you are unemployed and unable to return to your job before the injury. Or if you are treated without insurance, you could file for bankruptcy due to high medical costs related to your work accidents.
    1. With the workers’ compensation, you receive lifelong medical benefits. These benefits are not dependent on your continued employment. The work accident insurance company is responsible for paying medical bills for your work accidents, regardless of whether your employer has fired you or you are unemployed.
  2. You do not pay a personal contribution for the employee’s remuneration. Most private health insurers require you to pay a personal contribution for each medical appointment. These copays can range from $10 to $100 per appointment. You do not pay a personal contribution for employee benefits.
  3. There is no deductible or maximum deductible for employee compensation. Most private health insurance plans have a deductible. If your claim is covered by the Virginia Workers’ Compensation Law, you don’t have to pay a deductible to get treatment.
  4. industrial accident insurance has no benefit limits. No matter how much your medical treatment costs, workers’ compensation should pay for it.
  5. Disability benefit reimburses you round trip miles to medical appointments and the pharmacy. Private health insurance does not. This is an important factor, especially for those of you who live in rural areas and may need to travel long distances to see specialists or go to the pharmacy.
  6. Your private health insurer may not provide transport to and from medical appointments. Work compensation requires the employer and his work accident insurer to pay the transportation costs associated with your medical treatment.
  7. Private health insurance does not provide benefits for loss of wages or permanent partial disability. Workers’ compensation does not only provide reimbursement for medical expenses, but also wage-replacement benefits, such as temporary full incapacity for work and temporary partial incapacity for work.
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Can I take out private health insurance if the occupational accident insurance company refuses to cover me and my case is pending?

So he took our advice and filed a claim for benefits with the Workers’ Compensation Commission after his accident at work. But your employer and your employees’ insurance company refuse to provide or pay for a medical panel of doctors. Should you use health insurance to cover your accidents at work until the Commission has decided on your employees’ benefits at its hearing?

Yes, you should use your health insurance if workers’ compensation refuses to cover or pay for the treatment you need. But tell the health insurer that the occupational accident insurance policy refuses your medical treatment. And don’t settle your case without considering how much your private health insurance company paid on your behalf. They can impose a pledge on the proceeds of the liquidation. Or they can withdraw the payment if their interests are not taken into account. When the payment is withdrawn, the medical provider may sue you for the payment of your medical care. This is not a good situation to be in.

Conclusion – Does Health Insurance Cover Work Related Injuries After Settlement

An experienced personal injury attorney can amend the settlement agreement to protect you from an aggressive private health insurance company that paid for your work injury treatment. Your lawyer can also negotiate with the private health insurer before reaching an agreement.