Many seamen are provided health insurance through their 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.
First, many health insurance companies do not pay for injuries which are work-related. They’ll often have a provision in their policies which states the insurance does not pay for work-related injuries. Your health insurance policy should have a section called “Exclusions/Limitations” or something along those lines.
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. We always advise our clients and potential clients to be very honest and specific when providing their histories to their treating physicians.
You want to make sure that you explain fully to your doctors that your injury occurred on a vessel or oil rig while you were working, and you want to fill in such information on any doctor or hospital forms where you may receive treatment. You’ll want to give a full history of how the injury occurred so that it’s clear you are not trying to misrepresent the nature of your work injury.
Our office has seen many cases where a maritime employer told an injured worker to use their health insurance to pay for medical treatment, and later the employer claims that the worker 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.
It is generally not up to you to determine whether your health insurance will or will not cover work-related injuries. Rather, it is simply your job to be fully honest and clear that your injury did occur while you were at work on the vessel or oil rig and that it is a work-related injury. If your insurance company chooses to cover such, it is okay and will not harm your Jones Act claim since you have been fully honest. However, if you choose to use your private health insurance, you will likely be creating a debt that you eventually have to repay.
Another concern with using your own health insurance relates to the lien or subrogation rights that your insurer will have for any medical expenses they pay.
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 in medical costs, your insurer is then entitled to receive the full $50,000 payment out of any money that you may recover under your case. If your private health insurance company pays for medical expenses, in almost all circumstances you will be obligated to repay your medical expenses.
If your employer had properly paid for your medical expenses since the beginning of your injury as required by law, you would not need to pay any of your settlement money back to your health insurer.
Finally, a practical concern with using your own health insurance relates to delaying your claim. Very often employers will instruct injured workers to put their medical expenses on their own insurance. They do this in an effort to avoid recognizing the worker’s Jones Act claim. This can go on for months and months, and when the worker does eventually obtain counsel or try to resolve his 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, 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; and then, make sure you clearly state that the injury happened at work.
Another problem which may arise is that the company’s insurance company may never be notified of your maritime injury claim. Typically, vessel companies and oil rig companies have specific insurance which covers work-related injuries. The companies are aware that injuries happen in this line of work, so they purchase insurance to protect them should a work injury happen. It is their responsibility to notify their insurance company once an injury claim is filed. It is important, and usually best, for these insurance companies to become involved at the very beginning of a claim.
However, your employer will often try to hide an injury claim from their insurance company in order to prevent their premiums from increasing. This is a bad situation, and if you can, you want to always make sure that your company is properly reporting your injury and the need for your medical treatment to its insurance carrier.
Remember, it is always best to properly file your claim under your company’s insurance carrier policy. Although you do not control this issue, you can insist that your company properly report the claim, and you can refuse to use your own health insurance to pay for medical expenses to avoid the above issues.
Will your company drop your benefits after a maritime injury accident? A lot of times our clients are out of work for months at a time and they’re concerned that they’re going to lose their health insurance benefits or their family benefits. The answer is no.
Your company will not necessarily drop your health insurance just because you have a work-related accident and you’re off from work.
In order for a company to drop health insurance benefits for an employee, there has to be what’s called a triggering event. This type of event usually means that you’re being terminated by the company. Very often companies are scared or they’re worried to terminate an employee who has an injury.
What happens most of the time is the company simply carries on the payroll, they pay your workers’ compensation or maintenance benefits and they wait to see whether the doctor is ultimately going to release you to go back to work. So, most of the time your company is not going to stop your health insurance benefits for you or your family just because you have a maritime injury.
Call us if you have any questions about your rights or choices under maritime law.
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