Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Many seamen are provided health insurance through their Jones Act employer.  When these individuals suffer a work-related injury under the Jones Act, very often their employers will ask them (or even tell them) to use their private health insurance to pay for medical treatment related to their work injury.  There are several concerns about using your own medical insurance to pay for a work-related injury under the Jones Act.    First, many health insurance companies have a provision in their policies which states the insurance does not pay for work-related injuries.  If you choose to charge your medical treatment to your private health insurance, make sure you clearly state that the medical treatment relates to a work injury.  Also be sure to give a full history of how the injury occurred so that it is clear you are not trying to misrepresent the nature of your work injury.  Our office has seen many cases where an injured Jones Act employee is actually told by their employer to use their health insurance to pay for medical treatment and later the employer tries to claim that the injured Jones Act seaman misrepresented the nature of his injury since he claimed it on his own private health insurance.  Again, it is critical that you clearly state that your injury occurred at work if you are going to put any medical treatment on your own health insurance.    Another concern with using your own health insurance to pay for a work-related injury under the Jones Act relates to the lien or subrogation rights that your insurer will have for any medical expenses paid by your insurer.  Almost every private health insurance policy states that if a third-party claim is filed (or in this case your claim against your employer under the Jones Act) your health insurance company is legally allowed to recover from you all costs it has paid for medical treatment, up to the amount that you may recover through your suit.  In other words if your insurer pays $50,000.00 in medical costs, your insurer is then entitled to receive the full $50,000.00 payment out of any money that you may recover under your Jones Act case.  If your employer had properly paid for your medical expenses from the beginning of your Jones Act claim as required by law, you would then not need to pay any of your settlement money back to your own insurer.    Finally, a practical concern with placing your medical treatment for a Jones Act injury under your own insurance relates to the delay of your Jones Act claim.  Very often Jones Act employers will instruct employees to simply put their medical expenses on their own insurance in an effort to avoid recognizing the employee's Jones Act claim.  This can go on for months and months, and when the Jones Act seaman does eventually obtain counsel or try to resolve his Jones Act claim, very often it appears that the employee was trying to hide that the injury occurred at work.  If you have suffered an injury at work under the Jones Act, in almost all cases it is best to insist that your employer pay your medical benefits rather than claiming your medical expenses on your own private health insurance.  Using your own insurance should be a last resort if your employer refuses to pay under the Jones Act; and then, make sure you clearly state that the injury happened at work.  

Frequently Asked Questions

 


Q: Can I Use My Health Insurance To Pay For Medical Treatment For A Jones Act Maritime Injury?

A: Many seamen are provided health insurance through their Jones Act employer.  When these individuals suffer a work-related injury under the Jones Act, very often their employers will ask them (or even tell them) to use their private health insurance to pay for medical treatment related to their work injury.  There are several concerns about using your own medical insurance to pay for a work-related injury under the Jones Act. 

 
First, many health insurance companies have a provision in their policies which states the insurance does not pay for work-related injuries.  If you choose to charge your medical treatment to your private health insurance, make sure you clearly state that the medical treatment relates to a work injury.  Also be sure to give a full history of how the injury occurred so that it is clear you are not trying to misrepresent the nature of your work injury.  Our office has seen many cases where an injured Jones Act employee is actually told by their employer to use their health insurance to pay for medical treatment and later the employer tries to claim that the injured Jones Act seaman misrepresented the nature of his injury since he claimed it on his own private health insurance.  Again, it is critical that you clearly state that your injury occurred at work if you are going to put any medical treatment on your own health insurance. 

 
Another concern with using your own health insurance to pay for a work-related injury under the Jones Act relates to the lien or subrogation rights that your insurer will have for any medical expenses paid by your insurer.  Almost every private health insurance policy states that if a third-party claim is filed (or in this case your claim against your employer under the Jones Act) your health insurance company is legally allowed to recover from you all costs it has paid for medical treatment, up to the amount that you may recover through your suit.  In other words if your insurer pays $50,000.00 in medical costs, your insurer is then entitled to receive the full $50,000.00 payment out of any money that you may recover under your Jones Act case.  If your employer had properly paid for your medical expenses from the beginning of your Jones Act claim as required by law, you would then not need to pay any of your settlement money back to your own insurer. 

 
Finally, a practical concern with placing your medical treatment for a Jones Act injury under your own insurance relates to the delay of your Jones Act claim.  Very often Jones Act employers will instruct employees to simply put their medical expenses on their own insurance in an effort to avoid recognizing the employee's Jones Act claim.  This can go on for months and months, and when the Jones Act seaman does eventually obtain counsel or try to resolve his Jones Act claim, very often it appears that the employee was trying to hide that the injury occurred at work. 


If you have suffered an injury at work under the Jones Act, in almost all cases it is best to insist that your employer pay your medical benefits rather than claiming your medical expenses on your own private health insurance.  Using your own insurance should be a last resort if your employer refuses to pay under the Jones Act; and then, make sure you clearly state that the injury happened at work.

 



Contact the Louisiana Maritime Lawyers at The Young Firm if you have any questions at all regarding your rights!  We have been helping injured Louisiana Jones Act and maritime workers for years.  Your case is about more than your injury; your case is about your future.  
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