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Why those with health insurance file workers’ compensation claims

On Behalf of | May 13, 2025 | Workers' Compensation

Workers’ compensation coverage protects people in all different professions regardless of their seniority or their current wages. Professionals can file claims seeking disability pay to cover lost wages and medical coverage for treatment-related expenses. Their employers rely on workers’ compensation to indemnify the organization from direct liability for worker injuries.

Despite the availability of workers’ compensation benefits, not all professionals make use of the coverage available to them. Some employees might try to cover injury expenses using their own resources. For example, they might use their paid leave benefits while recovering from their injury or undergoing treatment. They might even intend to use their health insurance to pay for their care instead of workers’ compensation benefits. While doing so may seem simpler and even beneficial for the employer, it may ultimately be a financial mistake for the worker.

Health insurance forces patients to pay certain costs

Health insurance does not provide 100% coverage for treatment-related expenses. Every policy imposes certain patient responsibility costs. Many people have deductibles that they have to meet annually. Until they pay thousands of dollars of their own money for medical care, their insurance policy may not cover most types of treatment.

Co-pays are also common. People with health insurance have to pay a flat fee every time they attend an appointment or collect a prescription from the pharmacy. Many modern insurance policies also assess co-insurance obligations. The patient has to pay a percentage of their care costs even after they meet their deductible. The cost of paying for 30% of a surgery or for 20% of every physical therapy session can very quickly add up to an insurmountable financial challenge.

The medical coverage available through workers’ compensation is much more thorough. Health benefits can pay for 100% of the necessary treatment costs that a worker incurs. Especially in cases where workers have to take time away from their jobs because of their conditions, avoiding expenses during that time can be important for their long-term financial stability.

Many employees with medical conditions directly connected to and caused by their employment might be eligible for workers’ compensation benefits. Learning about the coverage available could help professionals understand the value of filing a workers’ compensation claim.