Workers’ compensation protects people who get hurt on the job. Workers’ compensation can pay for injury-related medical care and can also provide disability benefits. However, workers’ compensation health coverage does not apply to unrelated medical issues and does not apply to anyone else in the family other than the injured worker. Those hurt on the job and unable to return to work may worry about losing their employer-sponsored insurance coverage.
Do employers need to continue providing health insurance benefits while a worker is on an extended leave of absence due to a job-acquired medical condition?
Every company has different policies
There is no single rule that governs health insurance policy continuation while a professional is on an extended leave of absence due to job-acquired medical issues. Details about the situation, including internal policies within the company, the terms of the employee’s contract and any agreement between a union and the business, can influence what happens next.
Technically, the law does not require that employers continue to provide health insurance coverage to workers during an extended leave of absence. However, company policy, labor agreements and employment contracts may require that the company pay for continued health insurance coverage for an injured or sickened worker. Without pre-existing policies or agreements, the worker could be at risk of losing their policies.
What options do employees have?
Workers who receive employer-paid health insurance as a job benefit have a few options available if they lose their policy because their employer stops paying for coverage during their leave of absence. In some cases, workers can pay out of pocket to continue their coverage with the same policy.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies after workers lose their jobs and may allow them to retain their policies for as long as they can cover the premiums themselves. The reduced income of an employee on workers’ compensation may prevent them from covering higher COBRA premiums.
They may need to use the federal health insurance Marketplace to purchase their own policy or switch to a spouse’s employer-sponsored insurance. In scenarios where the injured employee can barely make ends meet, they may qualify for Medicaid coverage until they return to work.
Professionals worried about ensuring the continuation of their health insurance and the protection of their families may need assistance during a workers’ compensation claim. Talking with a lawyer about specific concerns, such as employer-sponsored health insurance, can help workers understand their rights and minimize the negative impact of job-related health challenges.