Work injuries can leave you unable to pick up your job duties, potentially running into issues with your employer. While they are paying your Workers’ Comp, they will cover your health issues related to the work injury – but what about the rest of your healthcare needs? Do they still have to pay for your health insurance?
Employers usually cover health insurance for their employees, but they are not required to keep doing so if the employee is not actively working for them. That means that during your recovery period or while you are totally disabled and unable to return to work, your employer does not have to keep giving you health insurance, with the exception of potentially having to offer you COBRA coverage. In any case, they need to keep paying for the healthcare related to your work injury through your Workers’ Compensation coverage.
For help with a work injury case, call the Certified Pennsylvania Workers’ Compensation Specialists at Cardamone Law today at (267) 651-7945.
Do Employers in Pennsylvania Have to Provide Health Care and Workers’ Comp?
Under Pennsylvania law, employers are not actually required to provide health insurance for their workers. Most do choose to – and federal law does require employers with over 50 employees to provide some health coverage. However, Workers’ Compensation is always required.
What this means is that you might not get health insurance from your employer initially, but if you face work injuries and successfully file a Workers’ Compensation claim, they will be required to pay for your healthcare related to that injury. Our Pennsylvania Workers’ Compensation lawyers can help you file your claim against their Workers’ Comp insurance to get your medical care and wage-loss benefits paid – along with other potential benefits – after a work injury.
If I Get Injured and Cannot Work, Can My Employer Cut Off My Health Insurance?
Because Pennsylvania employers are not required to pay for health insurance in the first place, they can technically decide to stop offering health insurance under many circumstances. If you are injured and cannot work, your employer can also stop your health insurance. In fact, they can legally let you go from your position and fill the position with a worker who is able to continue the job while you are gone, and there is no requirement that they hold open your position.
At the end of the day, if they cancel your health insurance, this could make it much harder for you to support yourself and your family while you are drawing on Workers’ Compensation benefits. Even though Workers’ Comp will cover your health needs related to your injury and the treatment for that injury, it does not cover other care needs you or your family members face, such as other ongoing disabilities or health conditions you had well before the accident.
Fortunately, many employers are not this cruel. Especially if your injury is likely to only keep you out of work for a few months, your employer can certainly keep you on, continue to pay your health insurance and other benefits, and give you your job back when you recover from your injuries. However, there is unfortunately nothing requiring them to do so.
Can I Keep My Health Insurance if I Go Down to Light Duty/Part-Time Work While on Workers’ Comp?
If your employer provides you with health insurance, they may be willing to keep you insured if your injury allows you to continue working part-time or on light duty work. However, this might jeopardize your Workers’ Comp benefits since you cannot get “total disability” benefits if you are actively working. While you cannot return to work at full capacity, you may still be able to get Workers’ Comp benefits for 2/3 of the difference between your pre- and post-injury wages, which might be “worth it” if you are able to keep your insurance and you can actually handle part-time work.
Can I Get Health Insurance While I’m Disabled and Drawing on Workers’ Comp in Pennsylvania?
If you file for Workers’ Comp and lose your health benefits from your employer while you are unable to work, you may be able to get insurance coverage in the meantime through three major options in Pennsylvania:
COBRA
Federal law – specifically the Consolidated Omnibus Budget Reconciliation Act (COBRA) – requires any employer with health care coverage and at least 20 employers in the previous year to cover any employees who lose their coverage for a limited time after their coverage ends. Specifically, they have to give you 60 days to decide if you want to use COBRA, at which point your insurance coverage can continue for a maximum cost to you of 102% of what they paid before.
To qualify for COBRA, you have to meet certain requirements, like losing your job or having your hours reduced. This means that a disabling injury should qualify you, especially if you were actually fired while you are unable to work.
Even though COBRA is capped at 102% of the previous cost, that can still be quite expensive for you if you were used to your benefits being included as part of your employment.
Health Insurance Marketplace/Pennie
The Affordable Care Act’s Health Insurance Marketplace allows individuals and families to shop for healthcare. There are limited enrollment periods every year, but you usually enter a special enrollment period for 60 days if you lose your health insurance from work.
You can shop for a plan at HealthCare.gov or through the Pennsylvania-specific Marketplace website, Pennie.com. Insurance plans are often priced based on your income, helping to make plans affordable while you are on reduced income.
Medicaid and CHIP
When you are on Workers’ Compensation, your wage-loss benefits are only 2/3 of your typical wages in most cases. This reduced income might put you into eligibility for Medicaid, helping you to get coverage that way.
If your children lost their health insurance from your work, then they also need coverage. The Children’s Health Insurance Program – CHIP – can often help your children get insurance at low/no cost to you.
Call Our Workers’ Compensation Attorneys in Pennsylvania Today
For a free review of your Workers’ Comp case, call the Pennsylvania Workers’ Comp lawyers at Cardamone Law at (267) 651-7945.
