Workers’ Comp or Personal Health Insurance?


In the event of a work injury, workers’ compensation is intended to be the primary means of financial relief. However, it may be tempting to have your personal health insurance cover your medical expenses, particularly if your employer is showing some resistance to providing coverage.

It’s important to know how workers’ compensation differs from your personal health insurance, particularly when it comes to work injuries.

Injuries Covered by Workers’ Compensation

With very few exceptions, Illinois employers are required by state law to carry workers’ compensation coverage. As such, if you are injured in the course of fulfilling your employment duties, you are entitled to workers’ compensation coverage regardless of who was at fault.

Workers’ compensation is designed to cover the following expenses:

  • Medical expenses for up to two doctors of your choice plus chains of referrals from each.
  • Lost time from work.
  • Temporary and permanent disability.

In order to be covered by workers’ compensation, your injury has to have arisen from your job duties. In general, that means if you were on the clock, you are covered. On the other hand, if your employer can prove that your injury was not work-related, you’ll be denied benefits.

In addition, you need to make sure you report your injury within 45 days of the incident and file a claim within three years.

Injuries Covered by Health Insurance

Your employer might provide individual health insurance as well as workers’ compensation coverage. This coverage is intended for any medical treatment—including those resulting from injuries—you might need, so it’s not limited to only work injuries.

It’s worth noting that many health insurance policies don’t cover injuries that would otherwise be covered by workers’ compensation. The specifics of your policy may differ, so it may be worth reviewing if you’re ever in a situation where workers’ compensation benefits might be denied.

That said, if you have suffered a work injury, you’ll want to get benefits through your employer’s workers’ compensation insurance, even if that means navigating the process of filing a claim and negotiating with the insurance company.

Choosing the Right Coverage

When it comes to working injuries, you typically don’t have to shoulder the burden of choosing which type of coverage you’ll use. Workers’ compensation is intended to cover work injuries, so if you have been injured on the job, you shouldn’t have to use your personal insurance to cover the resulting costs. In many cases, it may not even be possible to cover a work injury with your health insurance, so workers’ compensation is the best option in this scenario.

That said, your employer may still try to dismiss your injury as unrelated to your job. If this happens, it might be possible to fall back on your personal insurance, but certainly not recommended. Your best course in this instance would be to contact a workers’ compensation attorney.

If you have already had a work injury covered by your insurance, the amount they paid for your treatment will likely come into play when negotiating workers’ comp with your employer and their insurance provider. Again, it’s best to have an attorney—such as us at Hart David Carson LLP—with you during these discussions.

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