Results 1 to 6 of 6
  1. #1
    Join Date
    Aug 2013
    Posts
    2

    Default Can Health Insurance Deny Benefits if I Choose Not to File Workman's Comp

    My workers compensation claim was made in the State of: Arkansas

    I was injured at work this past week. My employer is not disputing that the injury was work-related. In fact, Human Resources immediately filed what they call an initial report (without asking me, and I have not seen a copy of it, so I have no idea if their version of what happened is accurate). Now, two days later, Human Resources says it's up to me whether I want to pursue Workman's Comp benefits. I would prefer to use my health insurance, so as to retain my privacy and be able to choose my own doctors. I'm okay with paying more out of pocket than I would with Workman's Comp.

    My question is, can my employer-sponsored health insurance company decide to deny me benefits for this injury? My concern is that the health insurance will try to say that it is the employer's liability insurance -- in other words, Workman's Comp -- that is responsible for my medical costs. The last thing I want is to find out down the road that I'm not just paying copayments and deductibles but the entire cost of my medical care. The injury will cost in the thousands, even if it turns out that I don't require surgery. I have an appointment with a specialist next week to see if he thinks I need surgery or if the injury can heal on its own. I just can't pay for the costs of treating this injury without insurance coverage, especially if I turn out to need surgery. I feel like I have to make a decision soon, and I don't know the facts. The Human Resources lady said she did not know if the health insurance can deny responsibility, and she did not know what the deadline is for me to say if I want Workman's Comp.

  2. #2
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,749

    Default Re: Can Health Insurance Deny Benefits if I Choose Not to File Workman's Comp

    Why would you not want to take advantage of work comp benefits, if you are entitled to them? You really are not making much sense. Work comp insurance pays all the medical expenses, with no cost to you. You may have some input into the work comp doctor choice, so check with a local work comp lawyer.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney and Board Certified Specialist in NC Workers' Compensation Law

  3. #3
    Join Date
    Oct 2011
    Posts
    176

    Default Re: Can Health Insurance Deny Benefits if I Choose Not to File Workman's Comp

    In my opinion I would not use WC unless you absolutely have to. The end result is you will be treated poorly then fired! This is what most injured workers here will tell you they experienced. If you like your job and think you can still do it and wont need too much time to heal DO NOT go the WC route. Save your sanity and dignity because you will loose both if you choose WC. Take this from someone who knows all too well.

  4. #4
    Join Date
    Aug 2013
    Posts
    2

    Default Re: Can Health Insurance Deny Benefits if I Choose Not to File Workman's Comp

    Quote Quoting complwyr View Post
    Why would you not want to take advantage of work comp benefits, if you are entitled to them? You really are not making much sense. Work comp insurance pays all the medical expenses, with no cost to you. You may have some input into the work comp doctor choice, so check with a local work comp lawyer.
    complwyr, I gave my reasons why. In addition, it is not true that there is no cost to me. The time off is paid at only 2/3 of my salary under WC, as opposed to 100% if I use sick leave. I don't appreciate being negatively characterized, especially when you made no attempt to answer my actual question. Go verbally abuse someone else.

    - - - Updated - - -

    Quote Quoting jinga View Post
    In my opinion I would not use WC unless you absolutely have to. The end result is you will be treated poorly then fired! This is what most injured workers here will tell you they experienced. If you like your job and think you can still do it and wont need too much time to heal DO NOT go the WC route. Save your sanity and dignity because you will loose both if you choose WC. Take this from someone who knows all too well.
    Since my original post, I have found out that, yes, I absolutely have to. My employee-sponsored health insurance does not pay any expenses related to an injury that could potentially have been paid by WC, even if I never file WC and WC never considers the case. I can't afford the expenses associated with treating a fractured ankle, so I will be filing WC for better or worse.

  5. #5
    Join Date
    Jul 2008
    Location
    California
    Posts
    1,856

    Default Re: Can Health Insurance Deny Benefits if I Choose Not to File Workman's Comp

    Quote Quoting Ripley View Post
    complwyr, I gave my reasons why. In addition, it is not true that there is no cost to me. The time off is paid at only 2/3 of my salary under WC, as opposed to 100% if I use sick leave. I don't appreciate being negatively characterized, especially when you made no attempt to answer my actual question. Go verbally abuse someone else.

    - - - Updated - - -

    .
    I do not see any verbal abuse in "complwyrs" response. I agree with him as your post was a little confusing when you wrote "I'm okay with paying more out of pocket than I would with Workman's Comp." As complwyr replied you do not pay anything with work comp. The cost to you above with salary is a completely different scenario than what you originally posted, which was issues of "privacy and choosing your own doctors".

  6. #6
    Join Date
    May 2010
    Posts
    579

    Default Re: Can Health Insurance Deny Benefits if I Choose Not to File Workman's Comp

    Quote Quoting Ripley View Post
    The time off is paid at only 2/3 of my salary under WC, as opposed to 100% if I use sick leave.
    Just a heads up....That 2/3rds is Tax free... So your check depending on your dependents will be very close.....and TAX Free!

Similar Threads

  1. Replies: 2
    Last Post: 07-27-2011, 08:22 PM
  2. Benefits from Workman's Comp Insurance Co
    By sepi in forum Disability Benefits
    Replies: 11
    Last Post: 09-18-2010, 06:20 PM
  3. Replies: 2
    Last Post: 05-29-2010, 07:54 PM
  4. Replies: 1
    Last Post: 09-04-2007, 03:57 PM
  5. Employer Trying To Deny Health Insurance Coverage
    By unregistered in forum Connecticut
    Replies: 4
    Last Post: 05-11-2007, 07:25 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer