The Ohio Bureau of Workers’ Compensation (BWC) exists specifically to address the needs and challenges associated with job-related injuries and illnesses. These benefits relieve private health insurance companies of responsibility to individuals they insure when an incident happens at work. Yet, sometimes, complications involving workers’ comp claims make employees want to find other ways to address their medical issues.
However, after more than 30 years helping people secure the benefits they need, the short answer is that you might use health insurance in certain circumstances, but in most cases, you shouldn’t—and it may not even be allowed.
Here’s a closer look at using workers' comp vs. private insurance after a work injury, and why choosing the right path is essential for your recovery and financial stability.
Understanding the Ohio Workers’ Compensation System
The state program covers medical expenses and lost wages for employees injured while performing their job duties. Unlike private health insurance, workers’ comp isn’t fault-based—you don’t need to prove your employer did anything wrong to qualify. You simply need to prove that the injury or illness occurred as a result of your work.
When you’re injured, you or your employer should file a First Report of Injury with the BWC. Once your claim is allowed, you’ll receive coverage for approved medical treatment and potentially compensation for lost wages and disability. The state requires that injured workers receive treatment from BWC-certified medical providers, though emergency treatment is covered regardless of the provider.
3 Benefits of Using Workers’ Comp
If you’ve never dealt with the system before, you might feel hesitant about navigating a new process, especially as you’re trying to recover. However, it’s important to understand that workers’ compensation offers several benefits that your private health insurance can’t match.
1. Wage Replacement
If your injury forces you to take time off from your job, workers’ comp can provide temporary wage replacement benefits. These payments may be crucial in helping you stay financially stable while recovering.
2. Coverage for Permanent Disability
If your illness or injury leads to a permanent condition limiting your ability to work, the BWC provides benefits to compensate for your long-term loss of earning capacity. The level and duration of these benefits depend on the severity and type of impairment.
3. Full Coverage for Work-Related Treatment
Unlike private insurance, which may come with deductibles, copays, and limits on covered services, workers’ comp typically covers 100% of your necessary medical treatment—as long as it’s related to your approved workplace injury and provided by a BWC-certified provider.
3 Drawbacks of Relying on Private Health Insurance
Using insurance might seem like a faster or more familiar route, especially if you need to pay some medical expenses right away. But in most cases, here’s why it’s not a viable long-term solution for work-related injuries.
1. Companies Can Deny Work-Related Claims
Private health insurers aren’t obligated to cover injuries that occur on the job. In fact, many explicitly exclude them if your employer offers workers’ compensation. If you use your insurance and later it’s discovered the injury was work-related, your insurer may seek reimbursement through subrogation—which could leave you with unexpected bills.
2. Risk of Insurance Fraud
Some workers might feel tempted to downplay or misrepresent how an injury happened. However, lying about the cause of your condition is considered insurance fraud—a criminal offense that can result in serious legal consequences.
3. You May Still End Up in the Workers’ Comp System
Even if you begin treatment through your private insurance, once the work-related nature of the injury is established, you’ll likely need to transition into the workers’ compensation system anyway. This can cause confusion, delays, and complications with billing.
What If You Need Care Before Workers’ Comp Kicks In?
It’s common for there to be a short gap between the injury and the approval of a workers’ compensation claim. During this time, you might need immediate treatment—especially in emergency situations.
Here’s what to remember:
- Emergency care is always covered by workers’ comp, regardless of provider.
- If you use private insurance temporarily while waiting for your claim to process, your insurer may later seek repayment from the BWC once the claim is allowed.
- Many workers maintain their health insurance coverage even while receiving workers’ comp, especially if their employer continues to provide it as part of their company benefits. However, using it for a work injury is typically discouraged and unnecessary once BWC coverage begins.
How Our Ohio Workers’ Comp Legal Team Will Help You
It’s only natural for workers and their families to have concerns about paying bills after a job-related injury or illness. However, these worries shouldn’t keep you from seeking medical care—and as a dedicated employee in Ohio, you have a right to workers’ compensation benefits.
At Monast Law Office, our experienced legal team knows exactly how to help. We’ll partner with you to:
- Clearly detail your workers’ comp rights and options.
- Prepare and file a claim.
- Negotiate with the BWC.
- State your case at a hearing if your claim is denied or disputed.
Having legal support helps ensure you receive the benefits you’re entitled to and protects you from being pressured into using the wrong coverage.
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