What Workers Comp Covers (Health)
Workers compensation health insurance exists for the protection of workers, but unfortunately it is also an oft-abused product. Recent studies suggest that a small portion of workers comp claims are fraudulent, but perhaps even more are "exaggerated". As a result, of the need to balance workers protection with fraud reduction, states have instituted layers of regulations and the practice of workers comp in the legal profession thrives. We are not attorneys, nor are we state-level workers comp experts, so always seek the guidance of professionals for actual issues. Your employer or employers insurer can answer most specific questions about your particular workers comp coverage.
In general, however, here are some of the cases that may be covered by workers comp, and how the coverage may coordinate with other payers.
- If an injury occurred while performing work duties or an illness was caused directly by work, it is likely covered. This is really the classic case of what workers comp is for.
- Pre-existing injuries or illnesses that are made worse by performing job tasks may be covered by workers comp.
- Reasonable and necessary care is a condition of most workers comp plans. This means that the care you receive must be considered standard medical given the medical condition you have. It is important to coordinate your work-related medical care with your employer or workers comp insurer.
- For longer-term disability cases, health costs will likely shift away from workers comp to a disability plan, or ultimately Medicare. Medicare becomes the primary medical payer for disabled individuals after 29 months from the injury date, assuming all eligibility requirements have been met and approval by Medicare has been given.
Keep in mind, there is much more to workers comp than health insurance. Work with your employer, insurer, or another professional to fully understand how it applies to your specific situation.