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  1. #1
    Join Date
    Dec 2012
    Posts
    2

    Question Health Insurance Coverage While Under Workmans' Comp

    My husband was injured last Thursday (11/29/12) when he fell while at work. He is a plumber. He broke his right wrist and left ankle (not sure how the ankle got broken, but he landed his entire weight onto the wrist and shattered it). The WC doctor we were sent to tried to prescribe crutches for the broken ankle until I objected that he can't use crutches with a broken wrist. Then he prescribed a cane (hello??? the cane is to be used on the opposite side of injury, left ankle means right hand and he's got a broken right wrist). I requested a wheelchair for him to get him through these initial days where he couldn't put weight on the ankle (even in the boot) because of the pain. The doctor finally relented with the admonishment, "Don't get used to it!" I'm returning the wheelchair today -- 7 days later -- because he can get around ok on the ankle now. Then the doctor said he'd be fine to return to work in 1 1/2 weeks. Hello? He's a plumber and uses both hands, but his wrist is shattered. It's going to take 8-12 weeks to heal. Luckily the doctor said he'd defer to the surgeon's opinion if he had to have surgery.

    We saw the surgeon on Monday (12/3/12) and he needed surgery to put all the bones back together where they belong. Surgery was Tuesday (12/4/12). They put in a plate and seven screws. The surgeon has said that for these first two weeks, he's allowed a fork (if he can stand the pain) in that hand. It's going to be a minimum of 12 weeks before he'll be allowed to pick up a wrench, but he may be able to return to work (light duty) after 8 weeks. Because my husband is diabetic, healing may take longer.

    Because he was injured on the last day of the pay cycle, his paycheck tomorrow will be for a full 2 weeks pay. I understand that WC doesn't kick in until after 7 calendar days off work and will be retroactively paid once he's off work 14 calendar days. According to the claim representative for his case, he'll get 70% of his pay on a weekly basis, but I'm not sure WHEN the check will be mailed each week, so I have no clue when we're going to get more money after tomorrow (until my payday on January 1st). Also, will they pay the back pay on the 2nd check to us or the 3rd?

    However, my big question is: Who is responsible for paying his insurance premiums while he's out on WC? The employer pays part and the employee pays part in a normal situation.

    Thanks in advance for any help.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Health Insurance Coverage While Under Workmans' Comp

    insurance premiums are not part of worker compensation benefits.
    if the employment is covered under FMLA the employer should offer to continue his health insurance should continue under the same terms as before with the worker responsible for the same amount.
    your husband will have 12 weeks of job protection.
    more on FMLA
    http://www.dol.gov/whd/regs/complian...ers/fmlaen.pdf

  3. #3
    Join Date
    Dec 2012
    Posts
    2

    Default Re: Health Insurance Coverage While Under Workmans' Comp

    Well, it turns out that he's on "light duty" as of December 18, 2012. Of course, he still can't drive his car because his car requires squeezing with the right thumb to allow the gear shift to move into gear, but he's back on "light duty". Since he had 4 days vacation on a use-or-lose proposition, he chose to take the 4 days of vacation for December 18, 19, 20, and 21. Then we have paid holidays from December 22 - January 1. So he'll actually return to work on January 2, 2013. As a plumber, here are the restrictions:

    no standing/walking >2 hours per day
    no climbing stairs/ladders
    no use of right hand
    no lifting/carrying
    no pushing/pulling
    no pinching/grasping
    must wear splint 24/7

    Not sure what they're going to find that fulfills those restrictions at his work, but we'll see what his boss comes up with.

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