Could I lose my health insurance while I’m on workers' comp?

Key Takeaways: 

These benefits cover different things and usually are able to coexist without conflict. But as a member of the Ohio State Bar Association’s workers’ compensation specialty board, Jim Monast has seen how quickly that changes: losing a job, rejecting modified work, or missing a premium while on temporary total compensation (TT) affect your health insurance status.  Here's how the two systems interact, and Jim can do to protect your coverage.

These programs are meant to work together, not against each other, as they’re separate benefits. Workers' comp covers medical treatment and wage replacement tied specifically to your job-related injury or illness. Your health insurance covers everything else: checkups, unrelated conditions, prescriptions that have nothing to do with the injury, and so on.

As long as you stay on your employer's payroll, that health insurance coverage generally continues even while you're collecting workers' comp benefits. The trouble starts when your employment relationship changes.

At Monast Law Office, we won’t let you be misled by company and managed care representatives or be denied rightful coverage. Let’s review what you need to know to protect your health.

How Workers' Comp and Health Insurance Work Together

If you used health insurance for that first visit to urgent care after getting hurt, or your primary care doctor first diagnosed an occupational condition, these are common practices and not a problem. 

But once a work-related injury or illness is identified, Ohio law requires you to see a provider certified by the Bureau of Workers' Compensation (BWC) and file a claim for ongoing treatment.

If the claim is allowed, your health insurer will typically seek reimbursement from the BWC for what it already paid. This reconciliation happens between the insurers and isn't something you need to manage yourself.

How Could I Lose Health Insurance While Collecting Workers' Comp?

This is a critical question. Allowable coverage might become more complicated if your employment status or premium payments change. Here are some typical scenarios: 

• 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 TT, you’ll unfortunately lose access to all of your benefits, including health insurance.
• You quit. If you resign from your job while collecting TT, you could still collect workers' comp benefits if you’re medically eligible, but you would lose your employer-sponsored health insurance.
• You reject modified work. If you’re offered modified work that meets your medical limitations, you have to accept it or lose your TT benefits. In this situation, you’ll likely also lose your position with your employer—and health insurance as well.
• You fail to pay your premiums. If you’re receiving lost wage benefits, you won’t be getting a paycheck from your employer. If your health insurance premiums are deducted from your paycheck, you could lose coverage for nonpayment. While you’re receiving lost wage benefits, it’s recommended to arrange for a way to pay your premiums.

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.

Can I Continue My Health Insurance After I Lose My Job?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) 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 coverage.

Under COBRA, you could maintain existing health insurance by paying the full premium, which includes the part previously covered by their employer. While it can be prohibitively expensive, it might bridge the coverage gap during transitional periods while you seek new employment or explore alternative insurance options.

Protecting Your Coverage While You're on Workers' Comp

When these two benefits overlap, the rules get confusing fast. Jim helps injured Ohio workers sort through the details, understand what could affect their benefits, and take practical steps to avoid unnecessary coverage problems. Here’s what he advises: 

• Ask about using private health insurance after a work injury if you're unsure whether a provider needs BWC certification.
• Confirm with your employer's HR department how your health insurance premium will be paid while you're on TT.
• Keep a record of every premium payment and every communication about your coverage status.
• Get any offer of modified work in writing, along with the specific physical restrictions it accommodates.
• Watch for signs of employer pressure to file a work injury through health insurance instead of workers' comp.
• If you're let go while on TT, talk with Jim to review your options before assuming you have no recourse.

Health insurance and workers' comp aren't meant to compete with each other, but the moment your job status changes, the two systems stop moving in step—and that's exactly when injured workers need clear answers the most.