YOU ASK:

Will my health insurance policy cover a work related injury?

WE ANSWER:

Work related injuries are generally excluded from your health insurance coverage, even when that health insurance is employer-sponsored.

The one who will be paying for these injuries would be workers' compensation insurance, which is required by law to be offered by every employee. The principle of "no double-dipping" applies in these cases. Since the injury is to be paid for by workers' compensation, then health insurance will not cover these.

Here is what you can expect from workers' compensation insurance:

  • Workers' Compensation insurance is required to make sure that the employee is protected in case he is injured, gets sick or dies in the course of his doing his job.
  • With the workers' compensation, the employer can readily pay their employees when they get injured or sick during the job, instead of being sued by the employees.
  • Workers' compensation will pay for medical expenses, a portion of the wages or salary of the worker, as well as the continuation of some benefits that were enjoyed by the employees prior to their illness or injury.

The employer may also opt to have workman's or keyman insurance. This will help pay for the gap that may not be covered by workers' compensation. It will also give the insurance additional benefits.

Now, if you were able to get treatment for your work-related injury using your health insurance, you must be careful to state that such injury happened while you were working. This is because you may be found guilty of insurance fraud. The health insurance provider who pays for your treatment has the right to demand reimbursement of all that they paid in the event that you receive workers' compensation for the same injury.

The best thing for you to do when you get injured due to work is to insist that your employer should be the one shouldering the expenses, which will be later filed and reimbursed through workers' compensation. Using your health insurance should be the last resort.

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