Does Workers’ Comp Affect My Health Insurance?
If you’ve suffered a work injury, you may be asking, “Does workers’ comp affect my health insurance?”
This is a good question and an understandable one.
Workers’ compensation and health insurance are completely separate things.
Workers’ compensation insurance is paid for by the employer. In the state of Georgia, employers with 3 or more employees are required to have workers’ compensation insurance. Workers’ compensation insurance specifically provides coverage for work-related accidents and injuries, wage compensation, and funeral expenses.
Health insurance is not mandatory for employers unless they employ a large number of employees, but many employers offer health insurance as part of their benefits package. The employer may pay all or part of the premium for employees. Health insurance is only for health coverage. It does not provide wage compensation or funeral expenses.
Ideally, your employer should have workers’ compensation insurance and health insurance as part of a benefits package.
The problem is that, because of the health coverage overlap, there is confusion as to how one affects the other.
Hence the question, “Does workers’ comp affect my health insurance?” Let’s dive in.
Does Workers’ Comp Affect My Health Insurance? What Does Workers’ Comp in Georgia Cover?
Health insurance should cover non-work-related illnesses and injuries. Typically, you pay a premium for your health insurance, which usually includes paying co-pays for certain visits to medical offices.
With workers’ compensation, there are no co-pays on your end, and you are not paying a premium.
Workers’ compensation insurance is designed to offer compensation for medical treatment, rehabilitation, income benefits, and permanent disability should you be injured at work during working hours.
According to the Georgia State Board of Workers’ Compensation Notice of Payment or Suspension of Benefits:
In addition to paying your medical expenses for an injury at work, the employer will pay you for part of your lost wages if you are disabled from work for more than seven (7) calendar days because of your work-related injury.
TEMPORARY TOTAL
O.C.G.A. §34-9-261: IF YOU ARE NOT ABLE TO WORK AT ALL because of your injury, your employer/insurer must pay:
- 2/3 of your average weekly wage with a maximum of $725 per week if your date of accident was on or after July 1, 2022. A minimum of $50.00 per week, or your actual weekly wage if less than $50.00 per week.
- If your accident occurred on or after July 1, 1992, and if your injury is not catastrophic, you are not entitled to this type of benefit for more than 400 weeks. Furthermore, your benefits may be reduced to those allowed by O.C.G.A. 34-9-262 under certain circumstances after you have been released to return to work with limitations or restrictions.
TEMPORARY PARTIAL
O.C.G.A. §34-9-262: IF YOU MUST WORK FOR LOWER WAGES because of your injury at work, your employer/insurer will pay 2/3 of your wage loss (the difference between what you make after your injury and what you made before), with a maximum of $483 per week if your date of accident was on or after July 1, 2022 for a maximum of 350 weeks from the date of accident.
PERMANENT PARTIAL
O.C.G.A. §34-9-263: IF YOU LOST A PART OR MEMBER OF YOUR BODY or lose the use of a member (such as arm, finger, eye, etc.), you will first receive benefits described above during disability, and then upon return to work or otherwise becoming ineligible for TTD or TPD benefits, you will receive payment for permanent partial disability for a certain number of weeks, based on the percentage of your loss. Multiply the permanent partial disability (%) by the maximum number of weeks listed below to determine the number of weeks you will receive PPD benefits. For example, for a 15% permanent partial disability to an arm, multiply 15% times 225 weeks. The answer of 33.75 represents the number of weeks you will receive income benefits.
For More Info, Check Out This Video on Workers’ Comp Benefits in Georgia.
Does Workers’ Comp Affect My Health Insurance?
One of the main reasons you are likely asking, “Does workers’ comp affect my health insurance?” is because you are concerned about losing health insurance for other family members on your plan.
Again, this is completely understandable.
The long and short of it is that your employment relationship with your employer should stay the same even if you file a workers’ compensation claim.
The key word here is should.
You are still an employee of the same employer; therefore, you should continue to receive a benefits package. Your benefits package should not change.
If you’re injured on the job and your employer provides health insurance, your employer should continue paying for your health insurance premiums.
Just because they should, it doesn’t mean they will.
Can I Be Fired for Filing for Workers’ Compensation in Georgia?
Unfortunately, Georgia is an “at-will” state.
In “at-will” employment states, you can be fired at any time for any reason, except for being a member of a class protected from employment discrimination.
In other words, while you can’t be fired for making a workers’ compensation claim, you can be fired for being unable to work or not being able to perform the same quality/quantity of work as before the accident.
I mention this because, if you are fired in response to your workers’ compensation situation, your health insurance will end in the same way as a terminated employee.
[Related Read: I Filed for Workers’ Comp in Georgia and Got Fired. What Can I Do?]
What If My Employer Cuts My Health Insurance?
If your employer decides to quit paying your health insurance, then your employer must give you notice.
Unfortunately, one of the things that happens is, no one tells you that they’ve cut off your health insurance.
For example, if you are considered Temporary Total Disabled, you will be out of work. This means you will stop receiving your regular paychecks and will receive workers’ compensation instead. If your health care premiums were taken out of your paycheck directly, you will need to speak to payroll deductions to figure out how to continue paying premiums. If you don’t continue paying premiums, you will lose your health insurance.
But, if you are fired, or your employer cuts your health insurance, you do have some options.
One option is to continue paying the health insurance premium yourself under the Federal Continuation of Health Coverage (COBRA) program.
COBRA Continuation Coverage allows you to stay on your employee health insurance temporarily, but you pay the full premium yourself and a fee.
The COBRA premiums are generally significantly more expensive than what employees would have been paying through their benefits package.
COBRA coverage extends to the employee’s spouse and dependents.
Why Do I Need an Attorney?
In addition to having an attorney to help you navigate the complicated system, an experienced workers’ comp attorney will fight to ensure you the compensation you justly deserve.
They understand the ins and outs and know what to look for to ensure you don’t lose the health insurance your family needs.
What if health insurance typically comes out of your paycheck, but your paychecks cease coming?
Did your employer alert you or raise your workers’ compensation to cover the cost of your health insurance premiums?
One of the things reputable attorneys do is examine these issues to make sure you are getting every last dime you are entitled to so that you can pay those health insurance premiums if the employer cuts off your health insurance benefits.
Find Out the Top 5 Reasons to Hire a Work Comp Lawyer.
If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.
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