Health Insurance and Workers' Comp After a Work Accident in New York: What You Need to Know

Accidents happen unexpectedly, especially in the workplace. If you find yourself injured on the job in New York, navigating the complexities of medical treatment and insurance coverage can be daunting to say the least.

One common question I see time and time again is whether your private health insurance can cover medical expenses from a work-related injury. Simply put the answer is ‘no’ with some caveats.

Understanding Workers’ Compensation in New York:

New York State law mandates that most employers provide workers’ compensation insurance coverage to their employees. This coverage serves to protect workers who suffer injuries or illnesses in the course of their employment.

Workers’ compensation benefits typically include medical treatment, wage replacement, disability payments, vocational rehabilitation, and death benefits to dependents in case of fatal accidents.

Can Private Health Insurance Cover Work-Related Injuries?

Simply put, this should not be done. When you go to a hospital or a medical provider and discuss why you are there, this is documented.

When the medical provider tries to bill your private health insurance, it will get rejected. This could happen months down the road, leaving you with thousands of dollars in medical bills because you didn’t set up a proper workers’ compensation case.

The private health insurance will find this out as you are there to treat for a work-related injury.

However, if you have a lawyer, they will make sure your medical bills get properly paid. These lawyers should not cost you anything out of pocket to pay for them.

It’s essential to understand that private health insurance may seek reimbursement from any settlement received from workers’ compensation for medical expenses they covered related to the work injury. This process, known as subrogation, allows private insurers to recoup the costs they paid for your medical treatment if you receive compensation from a third party, such as workers’ compensation. A lawyer will handle all of this for you.

Coordination of Benefits:

In situations where both workers’ compensation and private health insurance are involved, coordination of benefits is crucial. Coordination of benefits ensures that medical bills are paid appropriately and prevents overpayment or double dipping. Typically, workers’ compensation takes primary responsibility for covering medical expenses related to work injuries, while private health insurance may serve as secondary coverage.

It’s essential to inform all relevant parties, including healthcare providers, insurance companies, and your employer, about the circumstances surrounding your injury to ensure seamless coordination of benefits and avoid potential issues with coverage or reimbursement. However, always contact a workers’ compensation lawyer first.

Getting legal advice:

Dealing with the difficulties of workers’ compensation and health insurance coverage after a work-related injury can be challenging, especially when facing medical bills, lost wages, and potential disputes with insurance providers. In such situations, seeking guidance from a qualified lawyer experienced in workers’ compensation law can be invaluable and once again, this type of lawyer should not cost you any out of pocket money.

A lawyer will advocate on your behalf, help you understand your rights and entitlements under workers’ compensation law, negotiate with insurance companies, and ensure that you receive the appropriate medical treatment and compensation for your injuries.

Conclusion:

In the aftermath of a work-related injury in New York, understanding your options for medical treatment and insurance coverage is essential for ensuring that you receive the care and compensation you deserve. While workers’ compensation is typically the primary source of coverage for work injuries, private health insurance may also play a role in certain circumstances. Coordination of benefits and seeking legal guidance can help navigate the complexities of insurance coverage and ensure that your rights are protected throughout the process.