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Employer-Funded Health Insurance and Workers’ Compensation

Many employees who get injured and need workers’ compensation also have employer-funded health insurance. The employer may pay for part of the premiums, or the employee may pay all the premiums but get a group rate for using the company chosen by the employer. When employees learn that the employer’s workers’ compensation insurance company should pay their medical expenses for the workplace injury, they wonder what happens to the health insurance. Sometimes, it is even the same insurance company, so figuring out who pays what is even more complicated.

Workers’ Compensation Benefits Granted

Hopefully the insurance company granted you medical and wage-loss benefits after you were injured. If so, you should not need to use your health insurance to pay for medical expenses. All bills should go through the workers’ compensation insurance company, not your health insurance. If you have insurance through the same company as the workers’ compensation insurance, check your bills and statements very carefully to make sure you are not charged any of the costs of care for your injury.

The workers’ compensation insurance company should pay for all medical expenses that are reasonable related to your workplace injury. It will not pay for your routine medical expenses such as physicals. Those costs should be billed through your health insurance.

Workers’ Compensation Benefits Denied

If the workers’ compensation insurance company initially denies you workers’ compensation benefits, you probably have some medical expenses to pay. The insurer will not pay for the medical expenses unless you challenge the denial. You probably will need to retain an attorney and file a Claim Petition with the Department of Labor and Industry.

In the meantime, you still need to pay your medical bills. Talk to your health insurance company about how much of these bills it will cover for now. Also, keep careful track of which bills are for treatment related to your workplace injury. If you are successful in challenging the denial of workers’ compensation benefits, the workers’ compensation insurer will reimburse you and the health insurance company. The health insurance company has a “subrogation” interest, or a right to seek reimbursement for the medical expenses. In the end, make sure that your health insurance company is not unnecessarily paying expenses related to your injury.

Need help getting workers’ compensation for your injury? Joe Osterbauer, Esq. and the Osterbauer Law Firm stand up for injured Minnesota workers’ rights. Joe’s 27 years of workers’ compensation experience and his team’s speedy service combine to get clients the results they need. To schedule a free consultation, visit Osterbauer Law Firm online or call Joe’s office at (612) 334-3434.