Will my employer cover my health insurance premiums while I’m 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. We will discuss how workers’ compensation and health insurance coverage work together in Pennsylvania. We’ll tell you whether or not 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 personal injury attorneys today for a free case evaluation. We’ll protect your rights and help you get the benefits you and your family need.
Workers’ Compensation in Pennsylvania: What Medical Costs Are Covered?
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 workers’ comp lawyer as soon as possible. We will help you review your options.
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.
Is it Worth Speaking with a Workers’ Comp Lawyer About My Health Insurance Rights?
When you’re hurt at work, 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.
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 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. We know how to hold your employer and their insurance provider accountable. Call us today for a free consultation.
Health Insurance & Workers’ Compensation Frequently Asked Questions (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.
Can I be fired and lose insurance while on workers’ comp?
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.
Call the Munley Law workers’ comp attorneys to Protect Your Health and Your Rights After a Work Injury
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. 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 the Munley workers’ compensation lawyers or fill out our online form to get started.
