Massachusetts Workers’ Compensation – Health Insurance Benefits
The Massachusetts Workers’ Compensation Act provides benefits for the payment of medical expenses incurred to treat a work related injury or condition. In order for an injured worker to receive coverage for such treatment, it must be proved that the treatment is reasonable, necessary and related to the claimed injury.
Workers’ compensation does not replace health insurance, but rather supplements it as it becomes the primary source of payment for treatment of the work related injury or condition. For all other medical care, the employee’s health insurer remains the source of payment as workers’ compensation pays only for the industrial injury or condition.
Employees must prepare for the prospect that their employers will terminate their health insurance when an injured worker is unable to work as there are only limited statutory provisions that require an employer to continue to provide health insurance benefits to an injured worker while receiving workers’ compensation benefits. If an employer exercises its right to terminate health insurance benefits an employee may have recourse, however.
State and federal law forbids discrimination based upon disability. If a disabled worker is treated differently than able-bodied employees, then a potential claim may exist. A second source of protection may be company policy. If a company has a policy of continuing to allow an absent worker to participate in the group health insurance plan, then it cannot discriminate against an employee injured on the job by terminating health insurance coverage. Thirdly, an injured worker can be protected by a written contract in the form of a union collective bargaining agreement or a written employment contract. Lastly, the Family Medical Leave Act also provides another source, albeit limited, of protection if an employer terminates coverage.
Employers, unless the policy or contract provides differently, are not required to make contributions or pay for health insurance while an injured employee is unable to work. It is crucial that an employee continues to make the premium co-payments in order to keep the policy effective.
Lastly, Federal COBRA statutes provide that an employer of 20 or more persons must allow a person whose employment has ceased for any reason, including a work related injury, to participate in any group health insurance plan in the injured worker was a participant before the injury forced him or her to stop work. This participation, however, requires such an employee to pay the entire premium.
There may be other options available to an injured worker through Mass Health, which may provide health benefits to the injured worker or his family. A second option may be enrollment in a plan available to a spouse through his or her employer.
Speak with a Massachusetts Workers’ Compensation Lawyer
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