Do I have to pay for my own health insurance while I’m off on workers comp?

When on medical leave, you shouldn't be worrying about whether you need to pay for your own health insurance while off on workers comp. Workers comp benefits apply to any worker who suffers a qualifying work injury. Many states have laws mandating that employers either pay for health insurance for workers comp employees or compensate for lost health insurance benefits along with lost wages. In many cases, the federal Employee Retirement Income Security Act of 1974 (ERISA) preempts these state laws to make sure that you are protected during extended medical leave. You will have to check your state laws to determine if ERISA applies to you. Learn more.

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 15, 2021

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Do I pay for my own health insurance when I’m on workers comp? Who pays for my health insurance while on workers comp in Florida? Can I lose my health insurance while on workers comp? Can an employer cancel health insurance while on disability? Can employers cancel health insurance while on workers compensation in Oregon? These are all important questions and ones which may need legal assistance to answer.

Whether or not your employer needs to provide you with workers compensation health insurance while you are off on workers comp is a very complicated question to answer, and one you are going to need a lawyer for.

While many states, including Alabama, Alaska, Colorado, Connecticut, Florida, Kansas, Maine, Rhode Island, and Washington DC have laws mandating that employers either pay for health insurance for workers comp employees or compensate for lost health insurance benefits along with lost wages, the Employee Retirement Income Security Act of 1974 (ERISA) preempts these state laws. Thus, you will need to determine if you and your employer are covered by ERISA.

To find workers compensation legal advice near you, enter your ZIP code in our search tool above.

Understanding Workers Comp and Health Insurance

Workers comp benefits apply to any worker who suffers a qualifying work injury. They guarantee that the worker’s health insurance (which includes medical bills, lost wages, and disability benefits) will be paid by his employer’s workers compensation insurance. However, the “medical bills” requirement applies only to medical bills relating to the injury, so you may still need your health insurance if you have a family who is covered under the policy or if you need routine care while on workers comp.

You will have to check both the rules of your state law, and also determine if ERISA applies to you, in order to determine whether your employer has to pay for the continuing health insurance coverage or not. If your employer isn’t obligated to pay, then you may also be able to take advantage of COBRA provisions that allow you to continue to keep your existing health insurance coverage, while on workers comp, if you pay the full premiums (i.e. you get the same coverage at the same discounted group rate as before, but now you’re picking up the whole bill for the premiums instead of your employer paying some).

Does the Family and Medical Leave Act offer health insurance during workers comp?

The Family and Medical Leave Act (FMLA) may be able to help while you are out on extended medical leave under certain circumstances. Factors such as company size, employee tenure, and annual hours worked will determine what, if any, benefits are available.

The FMLA offers coverage up to 12 weeks.

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Does COBRA offer continuing health insurance coverage?

If you are out past the 12-week FMLA cut-off, COBRA continuation coverage may be an option to extend your health insurance coverage. If you qualify, COBRA can extend health insurance coverage an additional 18 months.

Are there other health insurance options while on workers comp?

There may be other state or federal programs that can help with health insurance while on extended medical leave. Check with your company’s human resources department to see what may be available.

If necessary, you can also reach out to a legal professional for additional assistance.

Getting Help

To get help with determining which laws will apply to your workers comp case, consult with a lawyer as soon as possible. Find legal assistance near you by entering your ZIP code below.

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