In many cases, employees who suffer work-related injuries choose to pay for resulting medical expenses using their employer-provided or private health insurance coverage rather than filing a workers’ comp claim. Even though it may seem easier to do this, it is never a good idea.

The reality is that if you are injured on the job and elect to pay for resulting medical expenses with your regular health insurance, you may miss out on a number of benefits to which you were are entitled. Moreover, if you decide down the road that you wish to seek the benefits of workers’ comp, you may be out of luck.

If you were injured on the job, it is important that you understand your rights. The workers’ comp legal team at Petro Cohen Petro Matarazzo has helped thousands of clients navigate New Jersey’s workers’ comp laws and obtain well-deserved benefits. Let us help you today!

Health Insurance v. Workers’ Comp Insurance: The Basics

Here is a brief look at the basic elements of these different types of insurance coverages.

Employer-Provided or Private Health Insurance Coverage

  • “Regular” health insurance coverage pays (or partially pays) for your medical expenses NOT incurred as the result of a work-related injury.
  • You as an individual are the policy holder.
  • As part of an employee benefit plan, your employer may pay a portion or all of the insurance premiums.
  • Depending on the policy, you may be subject to certain deductibles and co-pays.
  • The types of covered medical expenses may include just about anything – depending on the language of the policy.
  • Many health insurance policies exclude coverage for any medical expenses resulting from work-related injuries (including occupational illnesses).
  • The health insurance company is not required to continue paying benefits on your behalf if and when you stop paying premiums and/or if you become ineligible for coverage.

Workers’ Comp Insurance Coverage

  • With respect to workers’ comp insurance coverage, the named policyholder is your employer, rather than individual employees.
  • Your employer pays the premiums.
  • The State of New Jersey requires almost all employers to carry workers’ comp insurance coverage on behalf of their employees.
  • Workers’ comp pays ONLY for your work-related injuries or illnesses.
  • In New Jersey, an employer/insurance company has the right to choose your physicians and facilities that provide you with medical treatment for your injuries.
  • Also, the insurance company must authorize the nature and cost of medical treatment.
  • If you choose to see an unauthorized doctor and/or receive unauthorized medical treatment, the insurance company may deny payment; and you will be on the hook for resulting medical expenses.
  • In order to receive workers’ comp coverage for your work-related injuries, you must notify your employer within a very short period of time; you must seek medical treatment within a specified time period; and you must comply with all relevant filing deadlines.

In addition to paying for your medical treatment incurred as a result of your workplace injury, workers’ comp insurance also pays for some or all of the following benefits.

  • Certain disability benefits. These include the payment of a percentage of your wages for a period of time.
  • Permanent impairment compensation. This may be available to you if you suffered any type of permanent impairment from your work-related injury, including scars.
  • Vocational rehab services. These services may be available to you free of charge if your work-related injury forces you to seek new employment.
  • The right to appeal. If your employer/workers’ comp insurance company determines that you did not suffer a work-related injury, or if payment for medical expenses is denied, you can appeal the decisions within the workers’ comp system.
  • And more.

Contact Us Today

Don’t lose out on important benefits to which you may be entitled! If you were injured at work, let the team at Petro Cohen Petro Matarazzo help. Call or contact us for a free consultation. Talk to an experienced lawyer who can help you sort out your rights. We can be reached by phone at 888-675-7607, or you can complete our online form. We look forward to discussing your situation with you.