Who pays your health insurance while on workers’ compensation? Your employer continues to contribute to the traditional health insurance premium, even when you have made a Workers’ compensation insurance claim.
If you are fired or advised to take disability, you are responsible for paying for your portion or your own health insurance premium while using workers’ compensation. Ask a South Carolina workers’ compensation lawyer about what and who workers’ compensation does and does not cover.
What Workers’ Compensation Covers Instead of Health Insurance
In many cases, workers’ compensation in South Carolina covers medical treatment related to your work injury. This means that your payout is for doctor visits, hospital stays, medical tests, medications, rehabilitation, and ongoing medical care as they pertain to your work-related injury. While these benefits cover medical costs, they do not pay your health insurance premiums.
Workers’ compensation also provides what are known as indemnity benefits, which are compensation for things like lost wages while you cannot work during your recovery. These are separate from health insurance plans, whether your own or your employer’s. This means that indemnity benefits do not pay for your health insurance while on workers’ compensation.
Workers’ compensation does not cover employer-paid or personal health insurance premiums unless a separate agreement exists. There are no laws in South Carolina that force employers to pay for those insurance costs while you are out of work to recover and are receiving workers’ compensation. Shelly Leeke fights for you to get paid anyway.
Who Is and Is Not Covered by Workers’ Compensation
Employees are covered under the South Carolina Workers’ Compensation Law when they are injured while performing work duties on the clock. This extends from full-time employees to part-time, apprentices, and other people working under some form of contract for hire.
An important distinction is that independent contractors are not covered by workers’ compensation in South Carolina unless it is a part of the agreed-upon contract for their work or they purchase their own workers’ compensation insurance. Just because you are doing work for another company does not entitle you to these benefits.
If you are covered and injured on the job, workers’ compensation will pay for the related medical treatments for your injury, but that is not the same as paying for your health insurance while on workers’ compensation. It is not a payment out of those insurance plans either, so it should not affect or relate to the premiums you normally pay. Shelly Leeke gets results that keep your life stable.
What Role Do Workers’ Compensation Insurance and Health Insurance Play for Mental Conditions?
Mental injuries are not recognized quite the same as physical injuries under South Carolina law, so having conditions like PTSD covered by workers’ compensation is often not the case. Many times, they will not be covered without an accompanying physical injury or extraordinary working conditions that produce mental strain well beyond most workplaces.
If you acquire post-traumatic stress disorder (PTSD) from the same accident that caused your physical injury at work, your mental health treatments may be covered by your workers’ compensation payouts. This does not mean that your employer or the payouts pay for your insurance while you are on workers’ compensation. It also does not mean that insurance is the entity paying for your treatment.
If you believe that mental health treatment is necessary as a part of your recovery, you have to get a medical diagnosis and report your injury as part of your workers’ compensation claim. This will not get your employer or the workers’ compensation payout to pay for your insurance, even if there is a separate policy related to mental health treatment.
What Indemnity Benefits Mean for Your Costs
Since your injury will keep you away from work for the recovery period, you will be unable to earn wages as you normally would. This is where indemnity benefits come in. They refer to the compensation you receive to address those lost wages. They are usually ⅔ of your normal wage and are intended to help you with costs for daily life:
- Groceries
- Rent or mortgage payments
- Utility bills
- Transportation
- Personal care items
- Other essential expenses
Indemnity benefits do not explicitly pay for your health insurance, while claiming workers’ compensation, and the terms of these payouts may even specifically stipulate what you can and cannot use these funds for. If your employer stops paying traditional health insurance premiums due to firing you, then you are responsible for funding your own traditional health insurance.
Steps to Take if Health Insurance Premium Payments Stop
Check on all documents, agreements, policies, and terms of your employment to see if there is any language that says your employer agrees to continue paying for your group health insurance during your leave, even when workers’ compensation is involved. An agreement like this can obligate them to continue paying for your health insurance like normal.
You should see if your health plan provides options like continuation of health coverage (COBRA) or other individual plan options. If an employer stops paying, you can likely keep your coverage by paying for the health insurance while on workers’ compensation out-of-pocket. These can be incredibly high premiums, but it is an option if you have to have insurance for your specific needs.
Document all communications you have with your employer and insurance company about what you want to do regarding your health insurance. Note the dates, times, and topics of conversations, especially if or when coverage lapses. Trust Shelly Leeke by talking to a knowledgeable lawyer as a good course of action to see about what legal options you have to get your insurance paid for.
Get Your Workers’ Compensation Cases Assessed to Figure Out How Your Insurance Gets Paid on Workers’ Comp
Figuring out who pays your health insurance while on workers’ compensation may not be all that straightforward in your case.
Team Shelly Leeke could find clauses in the terms of your employment or extenuating circumstances that specifically designate your employer or yourself to pay for your health insurance during your period of workers’ compensation. Do not hesitate. Call Shelley Now!
