Can I use my health insurance to obtain medical treatment after a work injury?

Private Insurance and Workers' Compensation ClaimsOhio runs the largest state-funded workers’ compensation program in the country, covering 244,000 state employees. Last year, the system provided medical care and wage replacement benefits to injured workers with more than 88,000 claims. For some injured workers and their families, these can be daunting figures. Worry about successfully navigating a large system or confusion about the workers’ compensation process can make employees want to find other ways to address their on-the-job illnesses and injuries. Sometimes, employers may even discourage an injured worker from filing a workers’ compensation claim. Often, workers wonder if it is possible to use their health insurance benefits to treat their injuries. While this seems like a simple option, there are specific rules concerning work injuries, and failing to follow those rules can make it difficult for injured employees to obtain the benefits they need to heal and move forward.

The Benefits of Using the Ohio Workers’ Compensation System

For those workers who fear workers’ compensation or have concerns about the effectiveness of the system, it has some key advantages over private health insurance after a work injury. While both workers’ compensation and private health insurance provide medical care to those under their programs, workers’ compensation offers additional benefits, including:

  • Wage replacement – Often, workers are forced to miss work as they are treated and recover from their injuries. This means lost wages and potentially significant financial strain. Wage replacement benefits compensate workers to minimize this stress and help them remain financially afloat.
  • Compensation for permanent disability – Sometimes, employees suffer injuries which result in a permanent impairment that will affect their ability to work and earn income. Depending on the severity of the disability, different benefits are available to address this future loss of earning power and income.

Private Insurance Is Not Required to Cover Work-Related Injuries

The workers’ compensation system exists specifically to address the unique needs and challenges associated with work-related injuries. The existence of these benefits effectively relieves private health insurance companies from their responsibility to those they insure when the injury or illness occurs on the job. Insurance companies do not have to cover costs that fall under the umbrella of workers’ compensation. If they pay for care related to a work injury, they may seek reimbursement from the appropriate party, known as subrogation.

Both providers and insurance company representatives will inquire on how an injury occurred, and workers should know that lying about the cause—either to avoid the workers’ compensation system or protect an employer—could be considered fraud, which is a criminal offense.

How an Ohio Workers’ Compensation Attorney Can Help

It is natural for workers and their families to have concerns about paying bills after a work injury. These concerns, however, should not keep you from seeking care. Emergency care is covered by workers’ compensation. The Ohio BWC requires injured workers to choose from a list of approved providers for treatment, though some flexibility depends on the situation. Workers’ compensation can provide the medical care and financial support injured workers need to recover and move forward, and workers have a right to these benefits. If you have been injured at work, especially if you feel unsure of your rights or your employers has discouraged you from filing a claim, an experienced attorney can help you:

  • Understand your rights
  • Prepare and file a claim
  • Negotiate with the BWC
  • State your case at a hearing if necessary

Care and compensation in Ohio typically must be secured through the state’s workers’ compensation system, and while it can feel overwhelming, it is possible to succeed. At Monast Law Office, our experienced legal team has helped many injured workers obtain the benefits they deserved. Call our Upper Arlington office today or fill out the contact form on this page to speak with a member of our team and schedule a free, no-obligation consultation to learn more about how we may help.

 

James Monast
Fighting for Ohio’s Injured Workers and their Families