How Do Workers’ Comp and Health Insurance Work Together After Work Injuries?

The vast majority of Ohioans have some type of health insurance. Having health insurance gives you financial peace of mind if you’re injured or diagnosed with an illness, as it can help you pay for many of the expensive doctor visits, treatments, or surgeries you might require to get better.

For many workers, having health insurance isn’t just for peace of mind in case they are injured in their daily lives—it’s also for peace of mind if they’re injured when they’re at work, especially in dangerous industries like construction, manufacturing, and transportation.

However, in addition to their health insurance, these workers are also often eligible for workers’ compensation benefits if they are hurt at work. That means when workers get injured on the job, they may have two types of benefits that can pay for their treatments instead of out of pocket.

Although health insurance and workers’ compensation are two entirely separate benefits, they can and do work together after on-the-job injuries.

The Differences Between Health Insurance and Workers’ Compensation

Before we explain how these two safety nets work, it’s important to define and contrast them. Health insurance and workers' compensation may seem similar because they both cover medical expenses, but they serve different purposes and have unique features:

Health Insurance

Individuals or their employers purchase health insurance to cover medical expenses for illnesses, injuries, and routine care. It applies whether you get sick or hurt at work or outside of work but is only valid if you opt-in to your employer’s plan or purchase your own plan.

With health insurance, you typically pay premiums, co-pays, and sometimes deductibles before and/or in addition to what the plan pays. Depending on the provider and plan, health insurance policies typically cover many different types of treatments and doctors.

Workers' Compensation

Ohio-based employers are legally required to purchase workers’ compensation insurance to cover employees who get injured or become ill due to their jobs and can’t work for at least seven days.

Unlike health insurance, employees are automatically covered by workers’ compensation and don’t have to opt-in. In addition, self-employed workers can purchase their own workers’ compensation insurance policies to protect themselves.

If you're injured or get sick at work, workers' compensation can pay for your medical and rehabilitation expenses and provide partial lost wages without requiring you to meet a deductible or pay any out-of-pocket costs. However, unlike health insurance, workers' compensation does not cover injuries or illnesses that happen outside of work.

Health Insurance Can Pay Your Bills Upfront

If you get hurt at work and need to be transported to the hospital in an ambulance, you will incur a fee for that. And when you arrive at the hospital, you’ll start racking up more bills within a matter of minutes or hours. The longer you stay at the hospital, the more bills you’ll see.

Many of those bills will be due shortly after your initial treatment, but getting approved for workers’ compensation often takes much longer. If you have health insurance, you can use it to pay your bills while your workers’ compensation claim is being processed.

Your Health Insurer May Seek Reimbursement if You Get Workers’ Comp

If you use your health insurance to pay for medical bills related to a work injury and are later approved to receive workers’ compensation benefits to cover future medical bills, your health insurance provider may seek reimbursement from your employer’s workers’ compensation insurer.

This is called subrogation. It also occurs when people are injured in non-job-related accidents and injuries and are awarded settlements through personal injury lawsuits, if their medical bills were initially paid by their health insurance policies.

Some Health Insurers Refuse to Pay for Work-Related Injuries

If you get hurt at work and your medical bills are for treatments that are solely due to that injury, your health insurer may refuse to cover them if you’re also covered by workers’ compensation.

It’s important to always be honest about what caused your injuries when you go to your doctor or the hospital, even if it could result in your health insurer denying coverage because workers’ compensation will pick up the tab. By making your healthcare provider aware that your injuries are work-related and covered by workers' compensation, they may agree to place a medical lien rather than charge you for treatment out-of-pocket.

If you misrepresent the cause of your injuries, you could find yourself being ineligible for coverage from both your health insurance plan and your employer’s workers’ compensation coverage.

Your Health Insurance Will Remain Active While You’re on Workers’ Comp

Around half of all insured Ohioans receive health insurance coverage through their jobs. If they quit or are fired, they lose their benefits. Many injured workers worry about maintaining their health insurance coverage if they’re out of work for a while, including if they have to go on workers’ compensation after an injury.

Injured workers who go on workers’ compensation are allowed to keep their job-related benefits, including their health insurance, while they undergo treatments and recover. However, if your premiums were deducted from your paychecks, it’s important to let your employer know about your workers’ compensation benefits status. You may need to make alternate arrangements to pay your premiums while you are receiving workers’ compensation wage benefits rather than employer-written paychecks.

Health Insurance Doesn’t Replace Wages, but Workers’ Comp Does

Getting compensation for your medical bills isn’t the only benefit of receiving workers’ compensation. You also may be eligible to receive a percentage of your usual paycheck while you’re unable to return to work due to your injuries.

Getting replacement wages is one of the most important reasons to file for workers’ compensation benefits, as many injured workers do not need much additional medical care after the initial treatment but may still be unable to work for weeks or months as their injuries slowly heal.

Let Us Help with Your Ohio Workers’ Compensation Claim

Workers’ compensation is supposed to be straightforward, but many things can throw a wrench into the application process—including knowing when and how to get health insurance involved. At Nurenberg, Paris, Heller & McCarthy, we understand the complexity of navigating workers’ compensation claims when injured workers also have health insurance claims to make.

Contact us right away for a free consultation after a work injury. We’ll put our years of experience to work helping you maximize your benefits and expedite your claim. You shouldn’t have to pay out of pocket for a work injury, and it’s our goal to ensure you and your family are taken care of by the Ohio Bureau of Workers’ Compensation.

Originally published October 3, 2022. Updated September 18, 2024.

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