Who Covers Your Medical Bills After A Workplace Injury?

December 7, 2023

Getting injured or ill on the job can be many things – embarrassing, painful, and financially stressful, to name a few. It is important to always seek medical care immediately after an injury, even if you do not think it is that serious. Some injuries develop or change over time, so it is best to get a medical professional’s opinion. It is also important to document your injury because that can help you receive workers’ compensation benefits from your employer.

Worker’s Compensation: Basics And Coverage

Workers’ compensation is a type of insurance that provides benefits to injured employees. With a few exceptions, most employers in the United States are required to carry this insurance, guaranteeing that employees will have their medical bills covered after a workplace injury.

A workplace injury is any injury that occurs during working hours. Work injuries can stem from things like a workplace accident (falling off a ladder), repetitive motions (leading to carpal tunnel), or a motor vehicle accident if driving is part of the job. The injuries sustained in workplace accidents can range from concussions to broken bones to spinal cord injuries or even amputation. Workers’ compensation follows a no-fault system, meaning that no matter who is responsible for the injury, the employee will be covered.

There are a few types of situations that are not covered by workers’ compensation. If the injury happened off the clock, such as during lunch break, it will not be covered. If the injury occurred because the employee was engaging in reckless behavior or was intoxicated, it likely will not be covered either. And of course, if the employer does not carry workers’ compensation insurance, such as in Texas where it is not required by law, the employee will have to explore other legal avenues to get compensation.

If you do get injured at work, make sure to tell your boss as soon as possible and request the relevant forms that you will need to fill out in order to get benefits. It is your employer’s responsibility to submit the form, thereby filing a claim with their insurance. Check your local state laws to see what the deadline is for reporting the injury.

What If Someone Else Is At Fault?

There are some situations where a workplace accident was someone’s fault besides the employer or employee. If a third party was liable for the injury, a lawsuit can be filed against them. For example, if a construction worker gets injured by a machine due to a defect, the machine’s manufacturer could be held liable. In other cases, a negligent subcontractor could be liable for your injury. In these cases, you will be eligible for workers’ compensation but you can also choose to file a third-party claim. This will allow you to hold the responsible parties accountable and recover additional compensation to cover your medical bills and lost wages. It can be difficult to prove negligence in third-party liability cases, whereas applying for workers’ compensation benefits requires no proof.

Health Insurance

Understanding the role of health insurance in work injury cases is just as complicated as you might expect. Workers’ compensation tends to be the starting point for medical coverage, with health insurance filling in the gaps. Workers’ comp may not cover pre-existing conditions that get exacerbated, or there could be side effects of the injury that require health insurance coverage. In addition, if a workers’ compensation claim gets denied or disputed, you may need health insurance coverage instead, or until the dispute is resolved. A workers’ compensation attorney can help you navigate the complex legal and medical systems after a work injury.

Government Assistance Programs

When it comes to obtaining medical coverage after a work injury, several government assistance programs can be helpful. Medicaid and Medicare are two programs that offer financial support for medical expenses.

Medicaid, a joint federal and state program, provides medical coverage for low-income individuals. Eligibility criteria vary by state, but generally, individuals with limited income and specific work-related injuries may qualify for Medicaid. Medicare is a federal health insurance program primarily for individuals aged 65 and older. However, certain disabilities, including those resulting from work injuries, may make individuals eligible for Medicare benefits. 

Government assistance programs can either complement or serve as a substitute for other coverage options, such as workers’ compensation insurance. In cases where an employer’s insurance is insufficient or unavailable, Medicaid and Medicare can step in to cover medical expenses related to work injuries. It is essential to weigh the benefits and limitations of each option to make informed decisions regarding coverage.

No matter what avenue you pursue, just know that there are multiple systems in place to help you with medical bills after a work injury. In addition to workers’ compensation, there are other forms of insurance and assistance programs that help injured and out-of-work individuals. It can certainly get complicated navigating the eligibility requirements, forms, and documentation needed for coverage. By being informed about the options and consulting with a legal professional if necessary, injured employees can make sure they get the necessary care and compensation they need.

Related Posts Plugin for WordPress, Blogger...

Andi Perullo de Ledesma

I am Andi Perullo de Ledesma, a Chinese Medicine Doctor and Travel Photojournalist in Charlotte, NC. I am also wife to Lucas and mother to Joaquín. Follow us as we explore life and the world one beautiful adventure at a time.

More Posts - Website - Twitter - Facebook

Leave a Reply

Your email address will not be published. Required fields are marked *