Risks Associated With Treating Through Private Health Insurance For Work Related Injuries

August 26, 2022 | Attorney, Matthew Dolman
Risks Associated With Treating Through Private Health Insurance For Work Related Injuries

With few exceptions, injuries or conditions that happen at work will result in your ability to file a worker's compensation claim. There are risks associated with treating through private health insurance for work related injuries by state law and you are entitled to these benefits. They cover injury, illness, or any medical condition caused directly by your job or employment.

Other Ways Other Than Workers' Comp

When people are injured at work, sometimes they or their employer have other ideas about how they will pay for the treatment. There are three common ways people treat work-related medical conditions or injuries, without using workers' compensation. They are:

  1. Employee decides not to file a workers' comp claim through their employer and instead attempts to treat their injuries using their private health insurance.
  2. Instead of filing a workers' comp claim, the employer does not tell the insurance company and instead offers to pay the medical costs for the employee out of their own pocket (or the business' money).
  3. The injured employee decides to pay the medical expenses themselves.
Anyone who is considering the above options should pay attention to the following advice. The repercussions that result from electing any of the above courses of action can be severe and irreversible.

Workers' Comp vs Private Health Insurance

Worker's compensation provides payment for lost wages and medical bills related to the treatment of injuries or illness that are caused at or because of your job. Because this system exists, your private health insurance is not obligated to pay for injuries you sustain on the job.

Not only is a private health insurance company not obligated, they will refuse payment for any treatment they determine to be related to a work accident.

When people elect to treat through their private health insurance for injuries sustained on the job, we often see their insurance company conduct an investigation into the injury. Specifically, they look to see if it was caused, or had a connection with, the persons' employment. The insurance companies deal with thousands of claim a day, so they know how to investigate such matters and when an injury seems suspicious like it might be work-related.

Such an investigation can occur as soon as your health care providers (doctors, hospital, chiropractor, etc.) begin submitting bills to your private health insurance company. Sometimes, the investigation may not begin for a number of months after your private health care providers submit bills. The amount of time depends on the health insurance company involved and the injuries you sustained. Just because they do not deny the claim right away, or pay the first couple of medical bills, does not mean that they have been duped or that they will continue to pay.

Regardless, all private health insurance companies review the bills and treatment note that the healthcare provider creates. This review includes examining the medical records of the kind of scenario that appears to be related to a work accident. Insurance companies can often tell what injuries caused on the job look like.

If your doctor finds out you were injured at work

If someone outright informs their doctor that the injury occurred at work, then most often the doctor will refuse to provide treatment. There's a simple reason for this because they know that the health insurance company is eventually going to deny the claim, and then they won't be paid.

Keep the following in mind: it's more a question of when your private health insurance company finds out, rather than if they find out.

When the discovery is made, your private health insurance company will terminate any existing payments and authorization for any future payments. Moreover, they are highly likely to seek reimbursement for any amounts paid in connection with your treatment. They will seek this reimbursement personally from you.

Denial of Lost Wage Benefits

In addition to the above risks, you will not receive any compensation for the time you take off work while treating your injuries if you elect to treat through your private health insurance carrier.

If you were using workers' compensation to pay for your medical treatment, and you are placed on a no-work status or restricted work status, you could be receiving your payments for lost wages. This money is extremely important to help offset the economic loss that would otherwise result from not working. No such protection exists when treating through a private insurance.

If you begin receiving income through a short- or long-term disability policy because of an injury you did not report to workers' comp, that income is also in jeopardy of being terminated. This is not always the case, since it depends highly on the language of the disability benefits, but it is a possibility.

Paying Co-Pays

If the foregoing reasons are not justification enough, keep in mind that private health insurance requires a co-pay. Of course, the amount of your co-pay depends on your coverage. However, with substantial work-related injuries, this amount can become sizeable. This is especially the case if you have to visit multiple doctors over-and-over again (requiring your to pay lots of small co-pays). Similarly, if surgical intervention is recommended, it carries a much larger co-pay than a normal doctor's visit.

When the claim is through workers' comp, there is almost always no co-payment obligation. Once you reach a point known as Maximum Medical Improvement, the workers' comp carrier may require that you pay a $10.00 co-pay for authorized doctor visits. However, this is often not implemented

Visit our Legal Glossary for a more precise definition of Maximum Medical Improvement.

To receive treatment through a worker's compensation carrier for the injuries you sustained on the job, you have to comply with certain rules and requirements. One of these requirements involves reporting the accident in a timely manner. This, and more information regarding Florida workers' compensation laws can be found, here. Failure to report an accident or illness in a timely manner can result in you being forever barred from receiving worker's compensation benefits for that injury.

You may have heard that receiving treatment through a worker's compensation carrier is difficult or confusing. It can indeed be somewhat trying. It is also not uncommon for a worker's compensation carrier to attempt to mislead an injured worker about the nature of the benefits they are entitled to. This is one of the main reasons why those injured on the job are encouraged to speak with a personal injury attorney about their work related accident.

These companies have legal experts and lawyers working for the around the clock. They also deal with thousands of cases a year, so they know the ends and outs. There is no risk in speaking with an attorney and no fees until they win you case, so you really have nothing to lose and everything to gain by at least consulting with one.

Contact Dolman Law Group To Learn About Your Workers' Comp Benefits

At Dolman Law Group Accident Injury Lawyers, PA, we work with clients on their workers' compensation claims on a daily basis.

If you have questions about your workers' comp benefits, or you have been injured at work and are yet to receive benefits, contact an experienced attorney at Dolman Law Group Accident Injury Lawyers, PA.

Even if you aren't sure you want to hire an attorney, you have absolutely nothing to lose by attending a free consultation. During the meeting, you'll be able to explain your circumstances to an attorney and hear their feedback. You're also free to ask questions about your rights and benefits.

If you have concerns about how attorneys' fees work for a workers' comp claim, check out this article.

We strive to provide experienced, personal representation to our clients. To ensure this is possible, Dolman Law Group Accident Injury Lawyers, PA only takes the amount of cases that we can handle properly. For us, it is about quality over quantity.

We also strive to provide you with personal service. To do this, we give every client their attorney's personal cell phone number and email address. We want all our clients to have access to the attorney they are paying for. It only makes sense.

Please contact our office anytime to schedule a free consultation. We can be reached at (727) 451-6900 or by emailing us on our Contact Page. Or, if you like, chat with a representative by visiting our website and clicking on the “Live Chat” box in the bottom right corner. We look forward to hearing from you.

Dolman Law Group Accident Injury Lawyers, PA
800 North Belcher Road
Clearwater, FL 33765

(727) 451-6900

References: [1] https://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/Sections/0440.185.html
*The above information was written and reviewed by either Attorney Matthew Dolman or another injury lawyer at the Dolman Law Group Accident Injury Lawyers, PA which has a combined 90 plus years of experience practicing Florida personal injury law. Matthew Dolman himself has been practicing personal injury law in Clearwater and St. Petersburg for the last fifteen (15) years. The information provided comes from extensive research and years of experience trying legal cases in courtrooms throughout Florida.


Matthew Dolman

Personal Injury Lawyer

This article was written and reviewed by Matthew Dolman. Matt has been a practicing civil trial, personal injury, products liability, and mass tort lawyer since 2004. He has successfully fought for more than 11,000 injured clients and acted as lead counsel in more than 1,000 lawsuits. Always on the cutting edge of personal injury law, Matt is actively engaged in complex legal matters, including Suboxone, AFFF, and Ozempic lawsuits.  Matt is a lifetime member of the Million Dollar Advocates Forum and Multi-Million Dollar Advocates Forum for resolving individual cases in excess of $1 million and $2 million, respectively. He has also been selected by his colleagues as a Florida Superlawyer and as a member of Florida’s Legal Elite on multiple occasions. Further, Matt has been quoted in the media numerous times and is a sought-after speaker on a variety of legal issues and topics.

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