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Will My Health Insurance Continue if I File for Workers’ Comp?

By Ali Overby

Many people wonder how filing a workers’ compensation claim might affect their employment status and their benefits – especially their health insurance.

It’s important to understand that your employment relationship with your employer should remain the same even though you have filed a workers’ compensation claim for an on-the-job injury. Although you are pursuing a claim, you are still an employee of this employer and you should continue to receive benefits just as you always have. You should pay the same health insurance premiums, if any, that you are normally required to. Your employer should continue to pay their portion of your health insurance as they have been doing.

What Happens if I Go Out of Work Receiving Workers’ Compensation Checks?

If your authorized treating provider writes you entirely out of work or your employer is unable to accommodate your work restrictions, you will be placed out of work. You will stop receiving your regular paycheck and you should begin receiving weekly workers’ compensation checks from the workers’ compensation insurance company that services your employer.

This is called temporary total disability or TTD. Your TTD payments are two-thirds of your average weekly wage for the 52 weeks prior to your work injury. While you are out on TTD it is important to talk to your employer about how to maintain your health insurance coverage.

If you usually contribute to your health insurance premium through payroll deduction, your employer may not automatically notify you that you need to continue making these contributions to maintain your health insurance.

Do not assume your regular health insurance contributions are coming out of your TTD check!

If your employer continues to make health insurance payments for you, but you are not making your usual contributions, your health insurance may end up being cancelled before you ever realize you owe anything. Talk to your employer, and find out if you need to send in a check each pay period to keep your health insurance coverage current.

What Happens to My Health Insurance if I’m Fired?

Unfortunately, you can still be fired by your employer even if you have an open workers’ compensation case. If you are terminated, you can expect your health insurance benefits to end the same way that they would for any terminated employee.

You have the option of temporarily continuing your health insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Your health plan administrator must give you a notice stating your right to choose to continue benefits provided by the plan. You then have 60 days to accept coverage or lose all rights to those benefits.

If you elect to continue coverage through COBRA you will have to pay the full cost of the coverage plus a 2% administrative charge. If your employer was paying the bulk of your health insurance expense before your termination you can expect that health insurance through COBRA will likely be much more expensive than you are used to.

COBRA generally applies to all group health plans maintained by private sector employers (with at least 20 full-time employees) or by state and local governments. If you work for an employer that has fewer than 20 full-time employees, North Carolina has a state continuation program similar to COBRA. Either way, you may want to shop around and consider other insurance companies to find your best options for obtaining private insurance.

Get a FREE Case Evaluation from NC Workers’ Comp Attorneys

If you are concerned that your employment status or your right to health insurance benefits may have been unduly affected by your workers’ compensation case, contact one of our workers’ compensation lawyers right away. There is a lot at stake, and if you are trying to negotiate on your own against a big powerful insurance company, you are likely at a huge disadvantage.

There is no charge to call us for an initial case evaluation. It is completely FREE to you.

Click here to contact us or call 1-866-900-7078 for a free case evaluation.

P.S. Think you can’t afford a James Scott Farrin workers’ comp attorney? Click here to see why you can.

Categories: Insurance Coverage

Susan “Ali” Overby joined the Law Offices of James Scott Farrin’s workers’ compensation department in 2015.

She received her J.D. from Campbell University School of Law, where she attended on a partial merit scholarship. Prior to her law degree, she completed the Paralegal Program at Meredith College and received a Bachelor of Arts from the University of Virginia, where she double majored in English and Psychology and was a dean’s list scholar.

Ms. Overby worked for over six years as a personal injury and workers’ compensation paralegal, and now she practices law focusing exclusively on workers’ compensation cases. She enjoys being a resource for injured workers

Contact Information

Raleigh Law Office

4325 Lake Boone Trail, Suite 100
Raleigh, NC 27607
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

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Fayetteville, NC 28303
Phone: 910-488-0611
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Charlotte, NC 28203
Phone: 704-599-1078
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New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

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300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

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214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
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514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
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709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
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Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
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Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
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Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
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Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078