If you’re claiming workers’ comp in Scranton, you may have questions for a Scranton workers’ compensation lawyer about how your health insurance works concurrently. One of the most common questions is whether an employer will cover your health insurance premiums while you are receiving workers’ compensation benefits.
The short answer to this question is yes and no:
No: Under Pennsylvania law, your employer is not obligated to pay your health insurance premiums while you are on workers’ compensation.
Yes: Under Pennsylvania’s workers’ compensation law, your employer must pay your medical bills for all costs related to your on-the-job injury.
Confused? Don’t worry. Our award-winning workers’ compensation attorneys can tell you whether your employer can cancel your health insurance benefits, and we’ll lay out your options if you lose your coverage.
If you’re hurt at work and worried about your health insurance coverage, contact Munley Law’s Scranton workers’ compensation attorneys today for a free case evaluation. We’ll protect your rights and help you get the benefits you and your family need.
Contact a Workers’ Compensation Attorney at Munley Law
Call Us At 844-686-5397 What Medical Costs Are Covered by Workers’ Compensation in Pennsylvania?
When you get hurt at work in Pennsylvania, your medical bills can add up fast. The good news is that workers’ compensation benefits are designed to pay for the medical treatment you need to recover from your work injury. Under Pennsylvania law, your employer’s workers’ comp insurance must cover all necessary and reasonable medical care related to your workplace injury. This includes:
- Doctor visits
- Emergency room care
- Surgeries
- Medications
- Physical therapy
- Medical supplies and equipment
As long as the treatment is tied to your work-related injury, it should be paid for through your workers’ compensation claim — not through your own health insurance.
Medical Benefits for Injury-Related Care Only
It’s important to know that workers’ compensation only pays for injury-related care. If you or your family members need treatment for something unrelated — like a check-up, a chronic illness, or dental care — you’ll need to use your private insurance.
Can My Employer Cancel My Health Insurance While I’m on Workers’ Comp in Pennsylvania?
The short answer is yes — in Pennsylvania, your employer can cancel your employer-provided health insurance while you’re out on workers’ comp. That’s because there’s no law that forces them to keep paying for your health benefits while you’re not working.
Family and Medical Leave Act (FMLA)
There is one exception: the Family and Medical Leave Act (FMLA). If you qualify for FMLA, your employer must keep your health insurance for up to 12 weeks. During that time, you’ll need to keep paying your share of the premiums, just like you would if you were working. After those 12 weeks are up, they’re no longer required to keep you on the plan.
How Do I Know If I Qualify for FMLA?
To qualify for FMLA, you must check the following requirements:
- You worked for your employer for at least one year.
- You worked at least 1,250 hours in the past year.
- Your employer has at least 50 employees.
Munley Law Workers’ Compensation Attorneys will Protect Your Rights
One of the most important aspects of any workers’ compensation claim is employer retaliation. It is of the utmost importance for you to know that your employer cannot fire you or cancel your benefits just to punish you for filing a workers’ comp claim. That is illegal.
At Munley Law, we don’t like bullies. If you suspect your employer is trying to punish you for filing a claim, reach out to a Munley Law workers’ comp lawyer as soon as possible. We will help you review your options.
If you have indeed been the victim of retaliation and need to take legal action to uphold your rights, we can assist with this as well. All of our attorneys are members of the American Association for Justice, and we have four lawyers board-certified in Civil Trial Law and Advocacy by the National Board of Trial Advocacy. Our partners have also been ranked in the Top 100 Trial Lawyers in the state for their exceptional achievements in local courts.
“Honoring those who came before us, Munley Law proudly continues our family tradition of innovation, caring, and integrity. Three generations of Munleys have built this firm on one belief: that injured people deserve the same fierce advocacy that the powerful receive as a matter of course. That belief still drives everything we do.”
Caroline Munley
Health Insurance Options While on Workers’ Compensation
We know that losing your health insurance while you’re already dealing with a work injury can be a financial disaster. We want you to know there is hope, and you do have options. If your employer cancels your coverage while you’re on workers’ comp, you may be able to get new insurance through one of these routes:
COBRA
COBRA is a federal law that lets you keep your employer’s health plan for a limited time after losing your job or coverage. You’ll likely have to pay the full cost of the plan yourself, and it can be expensive. However, it’s often the fastest way to stay covered without changing doctors or starting a new plan.
Medicaid
If your income is low while you’re out of work, you might qualify for Medicaid, which offers free or low-cost health coverage. Medicaid rules vary by state, but in Pennsylvania, many injured workers can qualify — especially if they have children or other dependents.
The Health Insurance Marketplace
The Affordable Care Act (ACA) Marketplace is another place to find coverage. Losing your job-based insurance counts as a “qualifying event,” which means you can shop for a new plan even if it’s not open enrollment season. Depending on your income, you may also qualify for financial help to lower your monthly premiums.
Spouse or Family Plan
If your spouse or domestic partner has a job with benefits, you might be able to join their health plan. Some plans allow you to join mid-year if you’ve lost coverage.
According to the Pennsylvania Plan Year 2026 Affordable Care Act and Qualified Health Plans Summary Report, in terms of costs, most local individual healthcare insurers’ plans will see statewide average rate increases of around 21.5% in 2026. The Commonwealth has also seen a 12.7% average rate increase in 2026 across the small group market, driven mainly by rising medication and healthcare service costs.
Is it Worth Speaking with a Workers’ Comp Lawyer About My Health Insurance Rights?
When you’re hurt at work in Scranton, you shouldn’t have to worry about losing your health insurance — but for many injured workers in Pennsylvania, that’s exactly what happens. And once your coverage is denied or dropped, things can get complicated fast.
There are a lot of legal gray areas when it comes to workers’ comp and health benefits. Maybe your employer says your injury isn’t work-related. Maybe they stop paying your premiums without telling you. Or maybe your coverage is dropped while you’re still receiving treatment. These situations aren’t just stressful — they can seriously impact your recovery and your finances.
Moreover, if you are forced to take out a private health insurance plan after losing your insurance through your employer, the costs to you can be high. The Pennsylvania Health Access Network has noted that the state’s official online health insurance marketplace, Pennie, has seen an average rate increase of 102% across its listed insurance plans in 2026.
That’s why it’s so important to talk to a Munley workers’ comp lawyer in Pennsylvania as soon as possible. Our team of experienced attorneys will answer your questions, help you understand your rights, negotiate with your employer and their insurance company to keep your coverage in place, fight back if your benefits are unfairly denied, and explore other coverage options if your insurance is dropped.
Since 1959, the Munley workers’ compensation attorneys have helped thousands of Pennsylvania workers who have lost health insurance after a work injury, and have also won significant settlements in legal actions and penalty petitions for illegal healthcare insurance terminations. Our Super Lawyers-recognized attorneys know how to hold your employer and their insurance provider accountable.
Health Insurance & Workers’ Compensation FAQs
Does Workers’ Comp Replace My Health Insurance?
No. Workers’ compensation only covers medical treatment related to your work injury. It does not replace your regular health insurance. You will still need health insurance for any medical expenses that are not tied to your injury.
What Is Covered Under My Workers’ Compensation Benefits in Scranton?
Your employer’s workers’ compensation insurance is legally required to cover all of your necessary medical care expenses after you suffer an injury at work. Your benefits will cover the costs of doctor’s visits, emergency care, surgeries, physical and rehabilitative therapy, medication, and other medical supplies needed for your recovery. As long as you are eligible for workers’ comp in Pennsylvania, none of the aforementioned costs will need to be paid through your health insurance.
Can I Be Fired and Lose Insurance While on Workers’ Compensation?
Yes, in some cases, you can lose your job while receiving workers’ comp. However, your employer cannot fire you for filing a claim — that’s considered retaliation and may be illegal. If you’re fired, your employer-sponsored health insurance could be canceled, but you might qualify for COBRA or another coverage option.
Who Pays for My Spouse’s or Child’s Care If I Lose Coverage?
If your employer ends your health insurance, your family will also lose their coverage under that plan. In that case, you may be able to switch them to another policy — like a Marketplace plan, Medicaid, or your spouse’s insurance, if available.
How Much Will I Pay for Healthcare If I Lose My Insurance-Sponsored Plan?
Your out-of-pocket health insurance costs for private plans depend on many factors, including your age, the number of dependents, and the plan and provider you choose. The average costs for Affordable Care Act (ACA) Marketplace “benchmark” plans with Silver tier coverage vary from around $571 per month for a 20-year-old enrollee to $1,598 per month for plan holders who are 60 years of age. Bear in mind that this is just an example, and that you will need to research specific plans within your budget to gain a true idea of the associated expenses.
Call the Munley Law Scranton Workers’ Comp Attorneys to Protect Your Health and Your Rights
At Munley Law, our team understands how confusing and stressful the workers’ comp process can be, especially when your health insurance is at risk. Our experienced personal injury lawyers, frequently listed in the Best Lawyers in America, have a profound understanding of the law and your rights, and J. Christopher Munley is named one of Best Lawyers’ Lawyer of the Year for Workers’ Compensation to offer specialized support for your case. Caroline Munley is also a Pennsylvania Bar Association-certified workers’ compensation specialist with the skill to secure the compensation you need for your recovery.
Whether your employer canceled your benefits, denied your claim, or left you with unanswered questions, we’re here to help.
Your initial consultation is always free, and you won’t pay us a dime unless we win your case. Call Munley Law’s workers’ compensation lawyers or fill out our online form to get started and get results.
Caroline Munley
Caroline Munley is an experienced and award-winning personal injury lawyer and is a board-certified workers’ compensation specialist. Since 2018, she’s been listed in Best Lawyers in America (Personal Injury Plaintiffs; Workers’ Compensation Claimants, Northeastern PA), Lawdragon, and has been a Pennsylvania Super Lawyer since 2022. A member of the International Society of Barristers, Caroline has won millions of dollars for car accident, commercial truck crash, and workplace injury victims.
