Who Pays Your Health Insurance While on Workers’ Compensation?

If you’ve been injured at work and are receiving workers’ compensation, you might be wondering, “What happens to my health insurance?” It’s a very important question, especially if you rely on your employer for your health coverage.

In this blog, we’ll explain everything you need to know in simple words. We’ll break down how health insurance works while you’re on workers’ comp, who pays for it, what your rights are, and what you should watch out for.

What Is Workers’ Compensation?

Workers’ compensation is a type of insurance that most employers are required to have. It provides medical care, lost wages, and other benefits to employees who are injured or become ill due to their job.

Workers’ comp usually covers:

• Medical bills related to the injury
• A portion of your lost wages
• Rehabilitation or therapy
• Disability benefits if needed

Important: Workers’ compensation only pays for treatment related to your work injury — not for any other health issues you might have.

Does Workers’ Compensation Cover Your Health Insurance?

No, workers’ compensation does not pay for your regular health insurance plan. It only pays for medical treatment related to your work injury.

But you may still need health insurance for:

• Doctor visits not related to your work injury
• Ongoing medications or treatments
• Family members on your plan
• Preventive care (like check-ups)

Who Pays for My Health Insurance While I’m on Workers’ Compensation?

The answer depends on a few things, such as:

• Your employer’s policy
• Your state’s laws
• Whether you’re still employed
• Whether you’re on leave or terminated

Let’s look at some common situations.

1. You’re Still Employed and on Workers’ Comp Leave

If your employer keeps you on as an employee, they may still offer your health insurance benefits.

In many cases, your employer will continue to:

• Offer your group health insurance
• Pay their portion of the premium

But there’s a catch — you may still have to pay your portion of the health insurance premium, just like you did when you were working.

Since you’re not receiving a regular paycheck (or are receiving reduced wages), this can be tricky. Usually, employers allow you to pay by check, bank transfer, or deduct it from your workers’ comp check if possible.

Tip: Stay in touch with your HR department to make sure you’re still covered and know how to pay your share.

2. You’re on Family and Medical Leave (FMLA)

If you qualify for FMLA (Family and Medical Leave Act), your employer must continue your health insurance for up to 12 weeks of leave — just like if you were working.

Here’s what to know:

• You’ll keep your health insurance
• Your employer will still pay their part
• You’ll have to pay your usual share

After 12 weeks, if you don’t return to work, the employer may stop providing coverage, or offer you COBRA (more on that later).

3. You’re No Longer Employed or Laid Off

If your employer terminates your job, they are usually not required to keep paying for your health insurance. However, in many cases, they must offer you a chance to keep your insurance under COBRA.

COBRA (Consolidated Omnibus Budget Reconciliation Act) allows you to keep your employer’s health plan — but you have to pay the full premium yourself, including the portion your employer used to pay. This can be expensive, but it keeps you insured.

COBRA can last for up to 18 months, and sometimes longer depending on your situation.

What If I Can’t Afford My Health Insurance While on Workers’ Comp?

It’s a common problem. Workers’ compensation benefits usually pay only two-thirds of your regular wages, and that may not be enough to cover your bills and health insurance premiums.

Here are a few options you might explore:

1. Medicaid or State Health Programs

If your income drops while on workers’ comp, you might qualify for Medicaid or other state health programs. These can offer free or low-cost health insurance.

2. Affordable Care Act (ACA) Marketplace

You can apply for insurance through the HealthCare.gov marketplace. You may qualify for subsidies or tax credits that make coverage more affordable.

3. Spouse’s Health Insurance

If your spouse has a job that offers health coverage, you might be able to join their plan — especially if you’ve lost your own.

4. COBRA (As mentioned above)

COBRA allows you to keep your existing insurance — though it may be costly.

What Happens If I Miss a Payment?

Missing a health insurance payment can be serious. Your coverage might be canceled — sometimes with no warning. That means you’ll have to pay out-of-pocket for non-work-related medical care.

To avoid this:

• Stay in regular contact with HR or your insurance provider
• Set reminders to pay on time
• Ask if there’s a grace period or payment plan

Can My Employer Cancel My Health Insurance While I’m on Workers’ Comp?

This depends on whether you’re still employed. If you are still considered an employee, your employer usually cannot cancel your health insurance just because you’re on workers’ compensation.

But they can cancel it if:

• You stop paying your share
• You’ve been terminated
• You’ve used up all your leave (like FMLA)

Always ask for your rights in writing and get help from a lawyer or workers’ comp advocate if needed.

Key Takeaways

Let’s sum it up in simple terms:

• Workers’ comp pays for your work-related injury treatment only
• It does not pay for your regular health insurance
• If you’re still employed, your employer may continue your health coverage — but you need to pay your share
• If you’re terminated or no longer eligible, you may be offered COBRA, or need to find coverage through Medicaid, ACA, or your spouse
• Don’t ignore health insurance payments, or you might lose your coverage

Final Thoughts

When you’re dealing with a work injury, the last thing you want to worry about is losing your health insurance. But knowing your rights and planning ahead can help you stay protected.

If you’re unsure what your employer offers, talk to your HR department or benefits coordinator. If things get complicated, consider speaking with a workers’ compensation attorney — many offer free consultations and can help you understand your legal options.

Staying informed is the first step in protecting your health and your future.

Frequently Asked Questions