In Ohio, you should be able to maintain your employer-sponsored health insurance while collecting workers' compensation disability benefits. These are two separate benefits, and one does not replace the other. As long as you continue to be on your employer's payroll, your health insurance coverage should also continue. However, if you lose your job while you are on temporary total disability, you will also lose your health insurance benefit.
If you are struggling to get medical treatments covered or believe you have been fired in retaliation for filing a workers' comp claim, you should not hesitate to contact my office for help. We help Ohio workers get the compensation to which they are entitled for medical care and lost wages.
How Workers' Comp and Health Insurance Apply to Injured Workers in Ohio
Workers' compensation is designed to provide medical benefits and wage replacement to employees who are injured or become ill due to work-related circumstances. Workers' comp includes coverage for medical treatment and other health care expenses related to the initial work injury. Employer-sponsored health insurance covers medical care not related to the work injury, including wellness exams and treatment for other conditions.
Maybe you used your health insurance for your first visit to a doctor following your workplace injury—or that your primary care doctor diagnosed you with an occupational disease. This is common and perfectly fine. Once a work-related condition is identified, however, you must see a doctor certified by the Bureau for Workers' Compensation (BWC) and file a workers' comp claim to cover your medical treatment going forward. If your claim is allowed, your health insurer will probably seek reimbursement from the BWC, but that is not something you have to worry about.
How Could I Lose Health Insurance While Collecting Workers' Comp?
There are a few scenarios where you could lose your health insurance or encounter complications related to it while on workers' compensation. These include:
- You get fired. Ohio is an "at will" employment state, which means your employer can fire you at any time and for any reason, including no reason. If your position is eliminated while you are out on TTD, you will unfortunately lose access to all of your benefits, including health insurance.
- You quit. If you resign from your job while you are collecting TTD, you could still collect workers' comp benefits if you are medically eligible, but you would lose your employer-sponsored health insurance.
- You reject modified work. If you are offered modified work that meets your medical limitations, you have to accept it or lose your TTD benefits. In this situation, you will likely also lose your position with your employer and lose health insurance as well.
- You fail to pay your premiums. If you are receiving lost wage benefits, you will not be getting a paycheck from your employer. If your health insurance premiums are deducted from your paycheck, you could lose your insurance coverage for nonpayment. You should arrange for a way to pay your premiums while you are on lost wage benefits.
Staying informed and understanding your rights and responsibilities is important to make sure you can continue to access the medical care and benefits while collecting Ohio workers' compensation.
Is There a Way to Continue My Health Insurance After I Lose My Job?
COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows individuals covered by their employer's group health insurance plan to continue their coverage for a limited period, typically up to 18 months, after experiencing a qualifying event that would otherwise cause the loss of their health insurance. These events can include job loss, reduction of work hours, or other circumstances that would terminate their group health insurance coverage.
Under COBRA, individuals can maintain their existing health insurance by paying the full premium, which includes the part previously covered by their employer. While it can be prohibitively expensive, COBRA offers a safety net for individuals during transitional periods, helping to bridge the gap in health coverage while they seek new employment or explore alternative insurance options.