New Jersey Workers’ Compensation Lawyers: What Happens to my Health Insurance Coverage While I’m Out on Workers’ Compensation?

If you have been injured in a workplace accident, your ability to receive employee health benefits can be impacted. Although New Jersey Workers’ Compensation law does not prevent your employer from discontinuing your benefits if you are no longer able to work, you may still be afforded some protections under the Federal Family Medical Leave Act (“FMLA”)—including continued healthcare coverage.

Generally, when an employee suffers a qualifying work-related injury and begins receiving workers’ compensation benefits, the workers’ compensation insurer will cover costs relating to that injury including medical bills, lost wages, and disability benefits. The covered medical bills, however, will only apply to costs associated with the qualifying workplace injury. The employee’s regular health insurance must still be used for other health related costs, such as routine medical care or coverage for a family member under the policy. And if you are no longer working due to your workplace injury, your coverage may be discontinued, leaving you on the hook for routine medical care expenses.

However, any workers’ compensation leave taken can be counted against an employee’s family or medical leave entitlement under the FMLA. And being on concurrent workers’ compensation leave and FMLA leave has benefits for some employees. Under federal FMLA, an employer must keep such an employee who is out on workers’ compensation covered under any company-provided health insurance plan, although private-sector employers are not federally required to continue coverage for an employee on workers’ compensation. Continuing medical coverage can last as long as the Federal FMLA permits. FMLA protections may also help ensure that a worker on leave gets his or her job back when the worker is ready to return.

In order for an absence to count as FMLA leave, the reason for the absence must meet the “serious health condition” criteria of FMLA, which is defined as an illness, injury, impairment, or physical or mental condition that involves continuing treatment by a health care provider or inpatient care at a hospital or similar facility. Generally, any injury that results in workers’ compensation leave would also be a qualifying serious illness or injury. Pursuant to the FMLA, an employer must also properly notify the employee in writing that the leave will be counted as family or medical leave. An employer cannot then charge the employee for paid sick leave or any other form of employee compensation for time off.

Employees who are not covered by FMLA leave may opt to take advantage of COBRA provisions that allow them to continue receiving the same coverage while on workers’ compensation. However, they must pay the full premium cost to obtain the same policy provisions, including any portion that was once paid for by the employer. The employee would still have access to any applicable discounted group rate.


New Jersey Workers’ Compensation Lawyers at Shebell & Shebell Advise Injured Workers About Continued Health Insurance Coverage

If you or someone you love has been injured at work, you may be entitled to compensation or other related benefits. The experienced Workers’ Compensation lawyers at Shebell & Shebell can help. We represent clients throughout New Jersey, including Monmouth County, Middlesex County, and Ocean County, including Howell, Freehold, Middletown, Shrewsbury, Wall, Union Beach and Neptune. For a free consultation, call us at 732-532-2011 or contact us online today.