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What Is the Difference Between Health Insurance and New Jersey Workers’ Compensation for Medical Bills?

If you are injured playing basketball with friends and fracture your arm, you need health insurance to help cover the medical bills from hospital visit or expenses for other care. Depending on your health insurance plan, there are many in New Jersey, you may pay a certain portion of these expenses “out of pocket.”

If you are working as a bartender and fall on the wet floor, fracturing your arm, you are entitled to workers’ compensation to cover the medical expenses. Workers’ compensation is mandated by New Jersey law, but provided through your employer. In New Jersey, nearly all employers are required to have workers’ compensation insurance to cover these incidents. Therefore, a form of insurance also covers these expenses.

While these examples show the basic difference between health insurance and workers’ compensation insurance, the questions and interworking of these two insurance plans are much more in-depth.

If I am Injured at Work, Do I Need Health Insurance?

Currently, the majority of United States citizens are required to have health insurance under the Patient Protection and Affordable Care Act’s individual mandate. To remain compliant with federal law, you probably need health insurance, whether or not you are injured at work.

When it comes specifically to work-related injuries, workers’ compensation will cover these costs. That is why it is essential to document injuries and Of course, there are always contentious cases. An employer or insurance provider may argue that an injury wasn’t actually sustained at work or wasn’t in the course of work-related activities. As well, an insurance provider might illegally deny a claim or offer a minuscule settlement.

In these instances, personal health insurance might be used to pay medical bills that come due, or you would need to pay out of pocket. Sometimes, these bills are left unpaid until the workers’ compensation claim is settled. As the appropriate steps are based on the facts of your case, a workers’ compensation attorney would need to advise on your specific circumstances to know what is best.

What If I Pay Medical Bills from a Work Injury Through My Health Insurance?

When you are injured at work, report of the incident and a claim for workers’ compensation should be made immediately. In many instances, your employer’s workers’ compensation insurance will contact you within days of the incident, well before any bills become due and payable. However, this isn’t always the case.

Some employees do submit these medical bills to their health insurance company. Maybe you didn’t immediately report the injury to an employer or there is a delay in your claim. If your health insurance company covers all or part of the medical bills, then these costs will be repaid to your personal insurance provider out of your workers’ compensation settlement.

While Receiving Workers’ Compensation, Can My Employer Terminate Health Care?

This might seem like a simple question, but in New Jersey the answer is complicated and often unsatisfactory for employees. Unfortunately, there isn’t a law in New Jersey that directly addresses this issue. Nothing specifically prohibits your employer from terminating health care while you are receiving workers’ compensation. Other states, including Alabama, Colorado, Florida, and Rhode Island all require an employer to compensation for any lost health insurance benefits, in addition to disability from lost wages.

In New Jersey, there are laws that protect an employee from retaliatory practices by employers. For example, an employer cannot terminate an employee because of workers’ compensation claim. Yet, these retaliation laws may not extend to health care. Instead, New Jersey’s employees must rely a federal law for protection when it comes to personal health insurance.

The Family Medical Leave Act (FMLA) does provide certain protections to disabled and ill employees. In some situations, these statutes could apply to continuing health care coverage. For some employees, this law isn’t applicable. This careful determination of when the FMLA does and does not apply should be discussed with a lawyer.

Where Can You Ask Other Insurance Questions?

The Law Offices of Albert J. Talone has provided numerous clients guidance on issues involving personal health insurance, employer provided insurance programs, and how these plans intersect with workers’ compensation. At times, an employer makes the unfortunate decision to terminate health care coverage for these employees, and Albert J. Talone can help in these instances, as well. Call our New Jersey office for a free, initial consultation at (856)-234-4023.



The information in this blog post (“Post”) is provided for general informational purposes only. This information may not reflect the current law in your jurisdiction. No information contained in this Post should be construed as legal advice from The Law Office of Albert J. Talone or the individual author, nor is it intended to be a substitute for legal counsel on any subject matter.

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The Law Office Of Albert J. Talone is committed to providing for those with Workers Compensation cases throughout New Jersey.
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New Jersey
United States

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