Who Pays for My Health Insurance While on Workers Compensation?
Workers’ compensation insurance (also called workman’s or workers’ comp) is one way that small business employers can help protect the persons who work for them and their business from the costs associated with work-related accidents, injuries, and illnesses. Employers have a legal responsibility to offer a safe environment for their employees, but accidents happen. And some business environments have inherent health risks.
Employers can adopt a lot of safety measures to mitigate the risk of work-related injury or illness. But when such an incident occurs, employees’ compensation insurance provides some financial relief for the affected worker and the business. Workers’ comp insurance could protect your employees and your small business from financial bankruptcy in case of a catastrophic illness or injury.
Workers’ Compensation Insurance for Small Businesses
Workers’ compensation insurance is an insurance program that provides benefits to employees who suffer job-related injuries and illnesses.
It may be helpful to understand worker’s compensation in the context of two other common forms of insurance: small group health insurance and general liability insurance.
With some limits, an employee with a work-related illness or injury can get workers’ comp benefits irrespective of who was at fault—the employee, the employer, a coworker, a consumer, or some other party. Workers’ compensation insurance provides coverage when:
- The employee is eligible for benefits, and
- The injury or illness is work-related
In contrast, injuries or illnesses sustained by non-employees (like customers or vendors) visiting the business are usually covered by general liability insurance.
Injuries or illnesses that befall an employee outside of work are usually covered by individual or small group health insurance. Consult Health Insurance Plans Org to learn more about small group coverage. To demonstrate:
- Workers’ compensation health insurance would pay the medical bills suffered by a full-time employed waiter who slips on the wet floor in the restaurant kitchen.
- A restaurateur’s general liability insurance would pay the medical bills incurred by a vendor who slips on the wet floor in the restaurant kitchen while delivering produce.
- Health insurance will pay the medical bills suffered by the waiter if he slips on the wet kitchen floor at his home.
Injuries That Worker’s Health Insurance for Small Businesses Cover
Workers’ compensation for small businesses can cover injury sustained in the workplace or in the course of employment. A delivery driver injured in an auto accident while on the clock may be eligible for workers’ compensation.
An employee’s injury should be an accident—such as a fall from a ladder—to be covered by workers’ compensation. Nevertheless workers’ compensation insurance also covers illnesses linked to employment as defined by the state. A good example of this is a lung disease that is scientifically linked to exposure to chemicals utilized on the job or particles that permeate certain work environments. Rules differ among states and industries.
Additionally, many employees receive workers’ comp benefits for injuries resulting from overuse or misuse over a long time, like chronic back pain.
Does Workers’ Health Insurance Pay Costs Other Than Medical Bills?
Typically, a worker’s health insurance pays costs other than medical bills. While specific coverage details may differ some by state and insurance policy, generally workers’ compensation insurance pays:
- Hospital and medical costs necessary to diagnose and treat a work-related injury or illness
- Disability payments while a worker is unable to work (usually, about two-thirds of the employee’s regular salary)
- At least part of the cost for rehabilitation, retraining, and compensation for permanent injury
- Death benefits for the survivors of a worker killed while on work
Limitations and Restrictions That Apply to Workers’ Compensation Health Insurance
Workers’ comp benefits may not pay the full billed amount for qualified expenses. Depending upon the workers’ compensation plan, there may be limits in place for certain types of claims and cost-sharing arrangements, like deductibles.
Mostly, workers’ comp doesn’t cover injuries that happen because an employee is intoxicated or using illegal drugs. Coverage may also be denied if they are:
- Self-inflicted injuries (as well as injuries sustained by an employee who started a fight),
- Injuries suffered while an employee was committing a grave crime,
- Injuries that occurred due to an employee’s behavior that violated company policy,
- Injuries suffered while a worker was not on the job, and
Injuries suffered when an employee’s conduct violated work policy
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