Can I Lose my Health Insurance Coverage while out of work and receiving Workers’ Compensation benefits?

medical-cross-3-971653-mUnfortunately for injured workers in Massachusetts, the short answer to this question is “yes”.  Although Massachusetts General Laws Chapter 152, Section 75B(2) provides a legal remedy to injured workers who are fired in retaliation for filing a workers’ compensation claim, the law does not provide any protection for injured workers’ to protect their ongoing health insurance paid for by their employer.  The exception to this is that most union member’s are subject to collective bargaining agreement provisions (negotiated by their respective labor unions) that provide ongoing health insurance coverage for injured workers for a certain period of time during a period of disability from work.  However, most non-union employees have no protection at all.  Although the general answer to the question posed by this blog is “Yes”, there are some federal laws that may protect an injured workers’ ongoing entitlement to health insurance coverage.

Family Medical Leave Act (FMLA)

The FMLA protects the job status and health insurance for workers who are injured and unable to work for up to 12 weeks.  In order to receive this protection, the injured worker must have worked for their employer for at least 12 months, worked at least 1,250 hours for the employer during the 12-month period preceding the leave, and worked at a location where the employer has at least 50 employees with a 75-mile radius.  The injured worker must have a medical condition that makes the employee unable to perform the essential functions of his or her job.  For more detailed information on coverage provisions, eligibility requirement, and benefits provided by the FMLA, please visit the United States Department of Labor website at https://www.dol.gov/whd/regs/compliance/whdfs28.pdf.

COBRA Health Coverage Continuation

In situations where an injured worker remains disabled from work for a longer period of time than he or she is covered by the FMLA period, that employee may elect to continue health insurance coverage through their employer’s group health plan.  Employers are required to notify an injured worker about their COBRA rights along with instructions on how the employee can exercise those rights.  Likewise, the employee is required to notify his or her employer that they are exercising their rights to continue coverage on the employer’s health insurance plan.  Employees must pay the entire cost of the plan.  The employee may elect to exercise COBRA rights for up to 18 months after the onset date of their disability from work.  Obviously, the COBRA option does not provide ongoing health care benefits that were previously paid for by the employer, however this may be a cheaper alternative for an injured worker in Massachusetts rather than purchasing a new health insurance plan.

Massachusetts’ workers’ compensation benefits provide payment of all reasonable and necessary medical treatment that is causally related to a work injury (or sickness/disease caused by workplace conditions).  Although this is a benefit to the injured worker provided by our Massachusetts’ workers’ compensation laws, an injured worker who is not a member of a union and remains out of work past the FMLA period is faced with the dilemma of how to provide ongoing health insurance coverage for themselves (to pay for medical treatment made necessary by non-work related conditions) and their families.  If the disability last longer than 12 months, another option could be to apply for Social Security Disability Insurance (“SSDI”), which would make the SSDI recipient eligible for health coverage through Medicare after a 24-month waiting period.